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How Can an Na + Channel Inhibitor Ameliorate Seizures in Lennox–Gastaut Syndrome?
Author(s) -
Lin YunChu,
Lai YiChen,
Chou Ping,
Hsueh ShuWei,
Lin TienHung,
Huang ChenSyuan,
Wang RenWei,
Yang YaChin,
Kuo ChungChin
Publication year - 2021
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.26068
Subject(s) - phenytoin , pentylenetetrazol , lennox–gastaut syndrome , spike and wave , pharmacology , epilepsy , neuroscience , chemistry , dravet syndrome , anticonvulsant , medicine , psychology
Objective Lennox–Gastaut syndrome (LGS) is an epileptic encephalopathy frequently associated with multiple types of seizures. The classical Na + channel inhibitors are in general ineffective against the seizures in LGS. Rufinamide is a new Na + channel inhibitor, but approved for the treatment of LGS. This is not consistent with a choice of antiseizure drugs (ASDs) according to simplistic categorical grouping. Methods The effect of rufinamide on the Na + channel, cellular discharges, and seizure behaviors was quantitatively characterized in native neurons and mammalian models of epilepsy, and compared with the other Na + channel inhibitors. Results With a much faster binding rate to the inactivated Na + channel than phenytoin, rufinamide is distinctively effective if the seizure discharges chiefly involve short bursts interspersed with hyperpolarized interburst intervals, exemplified by spike and wave discharges (SWDs) on electroencephalograms. Consistently, rufinamide, but not phenytoin, suppresses SWD‐associated seizures in pentylenetetrazol or AY‐9944 models, which recapitulate the major electrophysiological and behavioral manifestations in typical and atypical absence seizures, including LGS. Interpretation Na + channel inhibitors shall have sufficiently fast binding to exert an action during the short bursts and then suppress SWDs, in which cases rufinamide is superior. For the epileptiform discharges where the interburst intervals are not so hyperpolarized, phenytoin could be better because of the higher affinity. Na + channel inhibitors with different binding kinetics and affinity to the inactivated channels may have different antiseizure scope. A rational choice of ASDs according to in‐depth molecular pharmacology and the attributes of ictal discharges is advisable. ANN NEUROL 2021;89:1099–1113