Faculty Bibliography

Climate change is with us. As professionals who place value on evidence-based practice, climate change is something we cannot ignore. The current pandemic of the novel coronavirus, SARS-CoV-2, has demonstrated how global crises can arise suddenly and have a significant impact on public health. Global warming, a chronic process punctuated by acute episodes of extreme weather events, is an insidious global health crisis needing at least as much attention. Many neurological diseases are complex chronic conditions influenced at many levels by changes in the environment. This review aimed to collate and evaluate reports from clinical and basic science about the relationship between climate change and epilepsy. The keywords climate change, seasonal variation, temperature, humidity, thermoregulation, biorhythm, gene, circadian rhythm, heat, and weather were used to search the published evidence. A number of climatic variables are associated with increased seizure frequency in people with epilepsy. Climate change-induced increase in seizure precipitants such as fevers, stress, and sleep deprivation (e.g. as a result of more frequent extreme weather events) or vector-borne infections may trigger or exacerbate seizures, lead to deterioration of seizure control, and affect neurological, cerebrovascular, or cardiovascular comorbidities and risk of sudden unexpected death in epilepsy. Risks are likely to be modified by many factors, ranging from individual genetic variation and temperature-dependent channel function, to housing quality and global supply chains. According to the results of the limited number of experimental studies with animal models of seizures or epilepsy, different seizure types appear to have distinct susceptibility to seasonal influences. Increased body temperature, whether in the context of fever or not, has a critical role in seizure threshold and seizure-related brain damage. Links between climate change and epilepsy are likely to be multifactorial, complex, and often indirect, which makes predictions difficult. We need more data on possible climate-driven altered risks for seizures, epilepsy, and epileptogenesis, to identify underlying mechanisms at systems, cellular, and molecular levels for better understanding of the impact of climate change on epilepsy. Further focussed data would help us to develop evidence for mitigation methods to do more to protect people with epilepsy from the effects of climate change.

Post-traumatic epilepsy (PTE) is diagnosed in 20% of individuals with acquired epilepsy, and can impact significantly the quality of life due to the seizures and other functional or cognitive and behavioral outcomes of the traumatic brain injury (TBI) and PTE. There is no available antiepileptogenic or disease modifying treatment for PTE. Animal models of TBI and PTE have been developed, offering useful insights on the value of inflammatory, neurodegenerative pathways, hemorrhages and iron accumulation, calcium channels and other target pathways that could be used for treatment development. Most of the existing preclinical studies test efficacy towards pathologies of functional recovery after TBI, while a few studies are emerging testing the effects towards induced or spontaneous seizures. Here we review the existing preclinical trials testing new candidate treatments for TBI sequelae and PTE, and discuss future directions for efforts aiming at developing antiepileptogenic and disease-modifying treatments.

We have earlier demonstrated that a Status Epilepticus (SE) during CNS development has long-lasting effects on cholinergic neurotransmission, detectable in vitro and in vivo. In this work, we aimed to localize changes in temporal (T) vs septal (S) hippocampus and to correlate adult CA3 interictal epileptiform discharge (IED) frequency changes to those of Ripples (R) and Fast Ripples (FR) of the High-Frequency Oscillations (HFOs). Spontaneous IEDs were induced by bathing slices in Mg²⁺-free ACSF or in 4-Aminopyridine (4-AP, 50 µM) and data were analyzed separately for each model. IED frequencies were similar in same origin normal (N) slices across models, but differed in SE slices, being lower in Mg²⁺-free ACSF than in 4-AP, suggesting a post-SE long-term increase in a K⁺ conductance. Rs and FRs detected within IEDs had generally higher power in 4-AP than in Mg²⁺-free ACSF; FR/R ratio was the highest in T-SE slices in 4-AP and similar in all other slice groups. Carbachol or eserine increased IED rates universally, but had region- and conditioning-specific effects on HFOs, suggesting that IED frequency and HFOs represent possibly independent indices of excitability. The muscarinic antagonist atropine depressed IED rates with increasing effectiveness in S slices post-SE in both models. In conclusion, the long-term effects of an immature SE are region-specific within the hippocampus, affect differently synchronizing components like the IED frequency and HFOs and may shape neurotransmitter effects (ACh) on neuronal networks, thus affecting seizure threshold and information processing, especially in behavioral conditions of rising extracellular ACh levels.