Peri-ictal water drinking and other ictal vegetative symptoms: Localizing and lateralizing the epileptogenic zone in temporal lobe epilepsy? Two case reports and review of the literature.

Peri-ictal behavior disorders can be helpful in localizing and lateralizing seizure onset in partial epilepsies, especially those originating in the temporal lobe. In this paper, we present the case of two right-handed women aged 36 and 42 years who presented with partial seizures of mesial temporal type. Both of the patients had drug resistant epilepsy and undergone presurgical evaluation tests including brain magnetic resonance imaging, video-EEG monitoring and neuropsychological testing. The two patients had hippocampal sclerosis in the right temporal lobe and exhibited PIWD behavior concomitant with right temporal lobe discharges documented during video-EEG recordings. Anterior temporal lobectomy was performed in one case with an excellent outcome after surgery. The patient was free of seizures at 3 years follow-up. We reviewed other publications of peri-ictal autonomic symptoms considered to have a lateralizing significance, such as peri-ictal vomiting, urinary urge, ictal pilo-erection. Clinicians should search for these symptoms, even if not spontaneously reported by the patient, because they are often under-estimated, both by the patients themselves and by physicians. Additionally, patients with lateralizing auras during seizures have a significantly better outcome after epilepsy surgery than those without lateralizing features.

The expression of GABA(A) receptor alpha2 subunit is upregulated by testosterone in rat cerebral cortex.

The GABAergic system is sexually dimorphic in certain brain regions and can be regulated by testosterone (T). However, the contribution of T to sex-specific developmental processes in the brain is less clear. We have examined whether T regulates expression of GABA(A) receptor alpha2 subunit in the cerebral cortex of embryonic and postnatal female rats using in situ hybridization and Western blotting. We found that both alpha2 mRNA and protein levels are significantly increased by T treatment at embryonic day 20 (E20) and birth (P0). The observed modulation of the expression of GABA(A) receptor alpha2 subunit by T may be translated into changes in the levels or composition of GABA(A) receptor, either of which would be expected to alter neuronal functional response to GABA activation. As the effects of T are developmental-stage-specific, they may have an organizational impact on brain development.

Initially expressed early rat embryonic GABA(A) receptor Cl- ion channels exhibit heterogeneous channel properties.

We have studied the earliest expression of GABA-induced CI- channels in the rat embryonic dorsal spinal cord (DSC) using in situ hybridization, immunocytochemistry, flow cytometry and electrophysiology. At embryonic day 13 (E13) cells in the dorsal region are still proliferating. In situ hybridization consistently showed transcripts encoding only three GABAA receptor subunits (alpha4, beta1 and gammal); immunocytochemistry both in tissue sections and in acutely isolated cells in suspension demonstrated the expression of the corresponding proteins and also revealed staining for other subunits (alpha2, alpha3, beta3, gamma2). In patch-recordings performed in cells acutely isolated from the dorsal cord, responses to GABA were detected in 356 out of 889 cells. GABA-evoked responses, which often displayed the opening of a few channels, were mediated by CI- ions, were inhibited by bicuculline and picrotoxin, and potentiated by benzodiazepines. Taken together, these observations indicate that CI- channels likely involve GABAA type receptors. Fluctuation analysis revealed channel kinetics consisting of three exponential components (Ts: approximately 1,9 and 90 ms) and a wide variety of inferred unitary conductance values, ranging between 4 and 40 pS. A comparison of these results with observations in other, later embryonic cell types and recombinant receptors suggests that most of the earliest E13 DSC GABAA receptors may include alpha3 subunit. These GABAA receptor Cl- channels may be activated physiologically as both GABA synthesizing enzymes and GABA are present in the E13 dorsal cord.

Electron microscopic serial analysis of GABA presynaptic terminals on the axon hillock and initial segment of labeled abducens motoneurons in the rat.

The aim of the present study was to provide a quantitative analysis of the synapses made onto the axon hillock and initial segment of rat abducens motoneurons retrogradely or intracellularly stained with HRP. GABA-immunoreactive terminals contacting these axons were visualized using a postembedding procedure. The presynaptic terminals contained either spherical or pleomorphic vesicles. gamma-Aminobutyric acid (GABA)-immunoreactive axon terminals, which belonged to this last category, were distributed both onto axon hillocks and the proximal part of initial segments. The percentage of axonal membrane covered by synapses ranged from 44.1 to 68.2%. A quantitative analysis performed on a series of ultrathin sectioned terminals contacting the axon of an intracellularly labeled motoneuron revealed a significant correlation between the length of membrane apposition of the terminals and their perimeter or surface area, and also between the area of membrane apposition and terminal volume. GABA-immunoreactive terminals had a mean perimeter and volume that were larger than those of unlabeled axon terminals. The number of active zones was correlated with the area of apposition. Some hypotheses concerning the functional role of the GABAergic innervation of this particular part of the neuron are discussed.

Evidence for colocalization of GABA and glycine in afferents to retrogradely labelled rat abducens motoneurones.

The coexistence of gamma-aminobutyric acid (GABA) and glycine in axon terminals impinging on rat abducens motoneurones was investigated using a double staining procedure combining retrograde labelling of the motoneurones with HRP and post-embedding immunocytochemical staining of axon terminals. Adjacent ultrathin sections of cell bodies of identified motoneurones were individually treated with GABA or glycine antibodies. The terminals single labelled for GABA represented 11.4% of the terminals analyzed, while 8% of them were glycine immunoreactive and 9% were both GABA and glycine immunoreactive. All the labelled terminals contained pleomorphic vesicles. The mean length of apposition of the double labelled terminals was statistically larger (2.20 +/- 0.97 microns) than the GABA (1.65 +/- 0.57 microns) or glycine immunoreactive ones (1.37 +/- 0.35 microns).

GABAergic innervation of rat abducens motoneurons retrogradely labelled with HRP: quantitative ultrastuctural analysis of cell bodies and proximal dendrites.

In this quantitative electron microscopic study we investigated the distribution of GABA axon terminals on rat abducens motoneurons by combining retrograde labelling of montoneurons with post-embedding immunodetection of GABA. We analysed the synapses on 13 cell bodies and 60 proximal dendritic profiles distributed along the entire rostro-caudal extent of the nucleus. For each of these two compartments, we analysed 1754 and 1176 axon terminals in contact with 6042 and 3299 microns of postsynaptic membrane. The axon terminals were classified as Sv-type (containing spherical vesicles) or Pv-type (containing pleomorphic vesicles). The GABAergic terminals contained pleomorphic vesicles and established mainly symmetrical synaptic contacts. Their apposition lengths were greater than those of unlabelled terminals. On cell bodies, the percentage of GABAergic synaptic covering varied from 2.5% to 14.1% and the synaptic frequency of GABAergic axon terminals varied from 0.6% to 8.9%. These two parameters were significantly correlated with the diameter of the motoneurons. The percentage of synaptic covering and synaptic frequency were smaller on dendrites of small motoneurons than on those of large ones. The proximal dendrites of small motoneurons had a lesser GABAergic innervation than large ones. The total synaptic covering and frequency were smaller on somata than on dendrites. However, the percentage of synaptic covering by GABA terminals was higher on cell bodies than on proximal dendrites.