Refractory temporal lobe epilepsy (TLE) is associated with a dysfunction of inhibitory signaling mediated by GABAA receptors. In particular, the use-dependent decrease (run-down) of the currents (I GABA) evoked by the repetitive activation of GABAA recep-tors is markedly enhanced in hippocampal and cortical neurons of TLE patients. Understanding the role of I GABA run-down in the disease, and its mechanisms, may allow development of medical
alternatives to surgical resection, but such mechanistic insights are difﬁcult to pursue in surgical human tissue. Therefore, we have used an animal model (pilocarpine-treated rats) to identify when and where the increase in I GABA run-down occurs in the natural history of epilepsy. We found: (i ) that the increased run-down occurs in the hippocampus at the time of the ﬁrst spontaneous seizure (i.e., when the diagnosis of epilepsy is made), and then
extends to the neocortex and remains constant in the course of the disease; (ii ) that the phenomenon is strictly correlated with the occurrence of spontaneous seizures, because it is not observed in animals that do not become epileptic. Furthermore, initial exploration of the molecular mechanism disclosed a relative increase in α4-, relative to α1-containing GABAA receptors, occurring at the same time when the increased run-down appears, suggesting that alterations in the molecular composition of the GABA receptors may be responsible for the occurrence of the increased run-down. These observations disclose research opportunities in the ﬁeld of epileptogenesis that may lead to a better understanding of the mechanism whereby a previously normal tissue becomes epileptic.
Temporal lobe epilepsy accounts for 70-80% of epilepsy cases worldwide of which about 40% end up being refractory cases. The loss of hippocampal neurons due to the seizures are due to the imbalance of inhibition and excitation.
There was animated discussion about the procedure and results.