Glutamatergic pre-ictal discharges emerge at the transition to seizure in human epilepsy.
Résumé
Mechanisms involved in the transition to an epileptic seizure remain unclear. We studied this question in tissue slices from human subjects with mesial temporal lobe epilepsies. Ictal-like discharges were induced in the subiculum by increasing excitability together with an alkalinization or low Mg2+. During the transition, distinct pre-ictal discharges emerged concurrently with interictal events. Intracranial recordings from the mesial temporal cortex of epileptic subjects revealed similar discharges before seizures were restricted to seizure onset sites. In vitro, pre-ictal events spread faster, have a larger amplitude and a distinct initiation site than interictal discharges. They depend on glutamatergic mechanisms and are preceded by pyramidal cell firing, while interneuron firing precedes interictal events which depend on both glutamatergic and depolarizing GABAergic transmission. Once established, recurrence of these pre-ictal discharges triggers seizures. Thus the subiculum supports seizure generation and the transition to seizure involves a novel, emergent glutamatergic population activity.
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