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doi:10.1016/j.pharmthera.2004.10.004    
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Copyright © 2004 Elsevier Inc. All rights reserved.

Cellular mechanisms underlying acquired epilepsy: The calcium hypothesis of the induction and maintainance of epilepsy

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Robert J. DeLorenzoa, b, c, Corresponding Author Contact Information, E-mail The Corresponding Author, David A. Suna, 1 and Laxmikant S. Deshpandea, b

aDepartment of Neurology, Virginia Commonwealth University, School of Medicine, Richmond, VA 23298-0599, United States

bDepartment of Pharmacology and Toxicology, Virginia Commonwealth University, School of Medicine, Richmond, VA 23298-0599, United States

cDepartment of Biochemistry and Molecular Biophysics, Virginia Commonwealth University, School of Medicine, Richmond, VA 23298-0599, United States


Available online 9 December 2004.


Referred to by:Erratum to “Cellular mechanisms underlying acquired epilepsy: The calcium hypothesis of the induction and maintenance of epilepsy” [Pharmacol. Ther. 105(3) (2005) 229–266]
Pharmacology & Therapeutics, Volume 111, Issue 1, July 2006, Page 287,
Robert J. DeLorenzo, David A. Sun, Laxmiant S. Deshpande
PDF (71 K)
Referred to by:Erratum to “Cellular mechanisms underlying acquired epilepsy: The calcium hypothesis of the induction and maintenance of epilepsy” [Pharmacol. Ther. 105(3) (2005) 229–266]
Pharmacology & Therapeutics, Volume 111, Issue 1, July 2006, Pages 288-325,
Robert J. DeLorenzo, David A. Sun, Laxmikant S. Deshpande
PDF (1436 K)

Abstract

Epilepsy is one of the most common neurological disorders. Although epilepsy can be idiopathic, it is estimated that up to 50% of all epilepsy cases are initiated by neurological insults and are called acquired epilepsy (AE). AE develops in 3 phases: (1) the injury (central nervous system [CNS] insult), (2) epileptogenesis (latency), and (3) the chronic epileptic (spontaneous recurrent seizure) phases. Status epilepticus (SE), stroke, and traumatic brain injury (TBI) are 3 major examples of common brain injuries that can lead to the development of AE. It is especially important to understand the molecular mechanisms that cause AE because it may lead to innovative strategies to prevent or cure this common condition. Recent studies have offered new insights into the cause of AE and indicate that injury-induced alterations in intracellular calcium concentration levels [Ca2+]i and calcium homeostatic mechanisms play a role in the development and maintenance of AE. The injuries that cause AE are different, but they share a common molecular mechanism for producing brain damage—an increase in extracellular glutamate concentration that causes increased intracellular neuronal calcium, leading to neuronal injury and/or death. Neurons that survive the injury induced by glutamate and are exposed to increased [Ca2+]i are the cellular substrates to develop epilepsy because dead cells do not seize. The neurons that survive injury sustain permanent long-term plasticity changes in [Ca2+]i and calcium homeostatic mechanisms that are permanent and are a prominent feature of the epileptic phenotype. In the last several years, evidence has accumulated indicating that the prolonged alteration in neuronal calcium dynamics plays an important role in the induction and maintenance of the prolonged neuroplasticity changes underlying the epileptic phenotype. Understanding the role of calcium as a second messenger in the induction and maintenance of epilepsy may provide novel insights into therapeutic advances that will prevent and even cure AE.

Keywords: AE; Epileptogenesis; Calcium; Glutamate; Brain injury; Status epilepticus; Stroke; Traumatic brain injury, TBI

Abbreviations: AE, acquired epilepsy; AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate; APV, 2-amino-5-phosphonovalerate; ATP, adenosine triphosphate; BAPTA, [1,2-bis(2)-aminophenoxy] ethane-N,N-N′,N′-tetraacetic acid; [Ca2+]i, intracellular calcium concentration levels; CNS, centralt nervous system; END, extended neuronal depolarization; EPSP, excitatory postsynaptic potential; ER, endoplasmic reticulum; GABA, γ-amino butyric acid; IP3R, inositol 1,4,5-tris-phosphate (IP3) receptor; IRRC, inability to restore resting [Ca2+]i; KA, kainate; MK801, (+)5-methyl-10,11-dihydro-5H-dibenzo(a,b)cyclohepten-5,10-imine maleate; NMDA, N-methyl-d-aspartic acid; PLC, phospholipase C; RNA, ribonucleic acid; RyR, ryanodine receptor; SE, status epilepticus; SOCs, store-operated Ca2+ channels; SREDs, spontaneous recurrent epileptiform discharges; STIB, stimulus train-induced bursting; TBI, traumatic brain injury; VGCC, voltage-gated Ca2+ channel

Article Outline

1. Introduction
1.1. Epilepsy
1.2. Idiopathic and acquired epilepsy
1.3. The role of Ca2+ in the induction and maintenance of acquired epilepsy
2. Acquired epilepsy and epileptogenesis—central nervous system insults lead to acquired epilepsy
2.1. Central nervous system injuries that produce acquired epilepsy
2.2. Three phases in the development of acquired epilepsy
2.3. The role of Ca2+ in the development of acquired epilepsy
3. Pathophysiology of epileptogenic central nervous system insults
3.1. Status epilepticus: Causes neuronal injury and increased glutamate and Ca2+
3.2. Stroke: Causes neuronal injury and increased glutamate and Ca2+
3.3. Traumatic brain injury: Causes neuronal injury and increased glutamate and Ca2+
4. Glutamate excitotoxicity: a common mechanism underlying epileptogenic central nervous system insults that cause elevated Ca2+
4.1. Mechanisms of glutamate excitotoxicity
4.2. Glutamate
4.3. Glutamate receptors
4.3.1. Ionotropic glutamate receptors
4.3.2. α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionate receptors
4.3.3. Kainate receptors
4.3.4. N-methyl-d-aspartic acid receptors
4.3.5. Metabotropic glutamate receptors
4.4. N-methyl-d-aspartic acid receptor-mediated excitotoxicity
5. Calcium as a common denominator in the injury phase of acquired epilepsy
5.1. Neuronal calcium homeostasis
5.1.1. Influx of extracellular Ca2+ across the plasma membrane
5.1.2. Calcium extrusion across the plasma membrane
5.1.3. Calcium buffering, sequestration, and storage
5.1.4. Intracellular Ca2+ release
5.2. Nuclear Ca2+ signaling
5.3. Extended neuronal depolarization
5.4. Inability to restore resting free intracellular Ca2+ concentration
5.5. Calcium-dependent mechanisms of neuronal death
6. Dead cells do not seize: Surviving neurons are the substrate for epileptogenesis
7. Experimental models of injury-induced spontaneous recurrent seizures
7.1. Status epilepticus-induced spontaneous recurrent seizures
7.1.1. In vivo models
7.1.2. In vitro models
7.1.3. Kindling models: prolonged kindling model
7.1.4. Direct electrical stimulation models
7.2. Stroke-induced spontaneous recurrent seizures
7.2.1. In vivo models
7.2.2. In vitro models
7.3. Traumatic brain injury-induced spontaneous recurrent seizures
7.3.1. In vivo models
7.3.2. In vitro studies
8. A calcium continuum from epileptogenesis to excitotoxicity
9. Calcium and the induction of epileptogenesis
9.1. Evidence that the development of acquired epilepsy is dependent on N-methyl-d-aspartic acid receptor activation during the injury phase
9.2. Evidence that the development of acquired epilepsy is dependent on elevated [Ca2+]i during the injury phase of acquired epilepsy
9.3. Elevated levels of free [Ca2+]i in the acute and epileptogenesis phases of acquired epilepsy
9.4. Increased [Ca2+]i during the injury phase of acquired epilepsy in other brain regions and hippocampal neurons
10. Calcium and the maintenance of acquired epilepsy
10.1. Permanent elevations of hippocampal neuronal [Ca2+]i are associated with the chronic phase of acquired epilepsy
10.2. Altered calcium homeostatic mechanisms in the chronic phase of acquired epilepsy
10.3. Inhibition of SERCA associated with the chronic phase of acquired epilepsy
10.4. Increased IP3 CICR activity associated with the chronic phase of acquired epilepsy
11. Effects of elevated [Ca2+]i and altered calcium homeostatic mechanisms in the chronic phase of acquired epilepsy on calcium-dependent signaling cascades
11.1. Effects of altered [Ca2+]i on Ca2+-regulated enzyme systems
11.2. Calcium-dependent gene regulation in the development and maintenance of epilepsy
11.3. Calcium-dependent changes in neuronal inhibitory function
11.4. Calcium and γ-amino butyric acidA receptor recycling in acquired epilepsy
12. Implications for the development of novel anticonvulsant drugs, antiepileptogenic agents and potential therapies to possibly reverse acquired epilepsy
12.1. Calcium systems as a target for anticonvulsant agents
12.2. Calcium systems as a target for antiepileptogenic agents and the prevention of acquired epilepsy
12.3. Calcium systems as a target for a possible cure of acquired epilepsy
Acknowledgements
References