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Article
Neuroactive Steroids for the Treatment of Status Epilepticus
Epilepsia (2013)
  • Michael A. Rogawski, University of California - Davis
  • Carlos M. Loya
  • Kiran Reddy
  • Dorota Zolkowski, University of California - Davis
  • Christoph Lossin, University of California - Davis
Abstract
Benzodiazepines are the current first-line standard-of-care treatment for status epilepticus but fail to terminate seizures in about one third of cases. Synaptic GABA-A receptors, which mediate phasic inhibition in central circuits, are the molecular target of benzodiazepines. As status epilepticus progresses, these receptors are internalized and become functionally inactivated, conferring benzodiazepine resistance, which is believed to be a major cause of treatment failure. GABA-A receptor positive allosteric modulator neuroactive steroids, such as allopregnanolone, also potentiate synaptic GABA-A receptors, but in addition they enhance extrasynaptic GABA-A receptors that mediate tonic inhibition. Extrasynaptic GABA-A receptors are not internalized, and desensitization of these receptors does not occur during continuous seizures in status epilepticus models. Here we review the broad-spectrum antiseizure activity of allopregnanolone in animal seizure models and the evidence for its activity in models of status epilepticus. We also demonstrate that allopregnanolone inhibits ongoing behavioral and electrographic seizures in a model of status epilepticus, even when there is benzodiazepine resistance. Parenteral allopregnanolone may provide an improved treatment for refractory status epilepticus.
Keywords
  • refractory status epilepticus,
  • seizure,
  • allopregnanolone,
  • neurosteroid,
  • allosteric modulator,
  • extrasynaptic GABA-A receptor
Publication Date
2013
Publisher Statement
Available at: http://dx.doi.org/10.1111/epi.12289
Citation Information
Michael A. Rogawski, Carlos M. Loya, Kiran Reddy, Dorota Zolkowski, et al.. "Neuroactive Steroids for the Treatment of Status Epilepticus" Epilepsia Vol. 54 Iss. Suppl. 6 (2013)
Available at: http://works.bepress.com/michael_rogawski/58/