INTRODUÇÃO: O processamento temporal pode ser definido como a percepção das características temporais do som, ou a percepção na mudança da duração dessas características, dentro de um intervalo de tempo restrito. Para que essas sutis mudanças possam ser percebidas, o sistema nervoso auditivo central necessita de um processamento preciso da estrutura de tempo do sinal acústico recebido. Nesse estudo, os objetivos foram: avaliar a resolução temporal, por meio de dois diferentes testes, o GIN (gap-in-noise), um teste comportamental, e o Potencial evocado auditivo de estado estável, um teste eletrofisiológico, em indivíduos normais, com lesão neurológica, e com transtorno de processamento auditivo (central); e verificar a sensibilidade e a especificidade, de ambos os testes. MÉTODOS: Foram avaliados 70 indivíduos voluntários, de ambos os gêneros, com idade entre 16 e 50 anos, divididos em três grupos: G1(grupo normal), G2 (grupo com lesão de lobo temporal, causada por Esclerose mesial temporal), e G3 ( indivíduos com transtorno do processamento auditivo (central)). Todos os indivíduos realizaram ambos os testes. No teste GIN foram utilizadas as listas um e dois. Os limiares de detecção de gap e a porcentagem de acertos foram calculados para todos os indivíduos. O potencial evocado auditivo de estado estável foi realizado com modulação de freqüência de 46 Hz, nas intensidades de 500 e 2000 Hz, em ambas as orelhas. Foram calculados os limiares eletrofisiológicos, os limiares estimados, e a diferença entre o limiar tonal comportamental e o eletrofisiológico, para todos os indivíduos. RESULTADOS: Os resultados do teste GIN mostraram que os indivíduos do G2 apresentam limiares de detecção de gap significantemente piores que os indivíduos do G1 e do G3. O mesmo ocorreu para a porcentagem de acertos, o G2 apresentou uma porcentagem de acertos pior que os grupos G1 e G3. Os indivíduos do G3 apresentaram limiares de detecção de gap aumentados em relação ao G1, porém, sem diferença estatisticamente significante. O teste GIN apresentou uma boa especificidade em todos os grupos, e uma sensibilidade melhor para lesão neurológica do que para transtorno do processamento auditivo (central). Os resultados do potencial evocado auditivo de estado estável mostraram que o G2 apresentou limiares eletrofisiológicos e estimados significantemente piores que os encontrados no G1 e G3. A diferença entre o limiar eletrofisiológico e o comportamental no G2 foi maior que a obtida no G1 e no G3. Os resultados da especificidade e da sensibilidade foram semelhantes aos encontrados no GIN. Além disso, foi encontrada uma boa especificidade, e sensibilidade melhor para lesão neurológica que para transtorno do processamento auditivo. CONCLUSÕES: Os indivíduos com lesão de sistema nervoso auditivo central mostraram um maior comprometimento da habilidade de resolução temporal, avaliada no teste GIN e no potencial evocado auditivo de estado estável, que os indivíduos com disfunção do sistema nervoso auditivo central, e os indivíduos normais. Os valores de especificidade foram melhores que os valores de sensibilidade em ambos os testes, nos três grupos avaliados. A sensibilidade para lesão neurológica foi melhor que a sensibilidade para transtorno do processamento auditivo (central) em ambos os testes / INTRODUCTION: Temporal processing can be defined as a perception of temporal characteristics of the sound, or as a perception of the change in the duration of these characteristics, in a restrict period of time. For these subtle changes to be noticed, the central nervous system needs an accurate processing of the structure of the acoustic stimulus received. The aims of this study were: to assess the temporal resolution using two different tests - the gaps-in-noise test (a behavioral test) and the Auditory steady-state response (an electrophysiological test) in three groups of subjects: normal group; neurological group and (central) auditory processing disorder group. It also aimed to verify the sensitivity and specificity of the two tests. METHODS: Seventy volunteers of both genders were evaluated. Subjects ranged in age from 16 to 50 years, and were divided in three groups: G1 (normal group); G2 (subjects with temporal lobe insult caused by temporal mesial sclerosis) and G3 (subjects with (central) auditory processing disorder). Both tests were conducted on all subjects. The lists 1 and 2 of the gap-in-noise test were applied in all subjects. Gap detection threshold and the percentage of correct responses were calculated for all participants. Auditory steady-state response with 46 Hz of frequency modulation was applied for the frequencies of 500 Hz and 2000 Hz in both ears. Electrophysiological and estimated thresholds were calculated, and the difference between estimated and behavioral tonal thresholds was also obtained for the subjects. RESULTS: results of the gaps-in-noise test showed that the G2 gap detection thresholds were significantly worse than the G1 and G3 thresholds. The same result was observed for the percentage of correct responses, G2 showed a worse percentage of correct responses than those verified for the G1 and the G3 groups. Individuals of the G3 showed increased gap detection threshold compared with the G1, although this difference was not statistically significant. Gaps-in-noise test showed a good specificity for all groups, and a better sensitivity for the neurological lesions group than for the central auditory processing disorder group. Auditory steady-state response results suggested that G2 had electrophysiological and estimated thresholds significantly worse than G1 and G3. The difference between electrophysiological and behavioral threshold for G2 was bigger than the difference obtained in G1 and G3. Specificity and sensitivity results were similar to what was observed for the gaps-in-noise test results. Moreover, a good specificity was detected and the sensitivity showed better results for neurological lesions than for (central) auditory processing disorder. CONCLUSIONS: Individuals with central auditory nervous system lesions showed larger commitment of temporal resolution ability, evaluated through the gaps-innoise test and through the auditory steady state test, than normal individuals. Specificity values for all groups in both tests were better than sensitivity values. The sensitivity for the neurological lesion group was better than for the central auditory processing disorder group, for the two tests.

Resumo ARAÚJO, D Contribuição das medidas volumétricas das estruturas temporais mesiais e neocorticais ao tratamento cirúrgico das epilepsias do lobo temporal. 2003. 120 p. Tese de doutorado. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. A epilepsia do lobo temporal é a forma mais comum de epilepsia focal sintomática e a esclerose mesial temporal a sua causa mais freqüente. A volumetria por ressonância magnética pode ser útil na investigação da epileptogênese na epilepsia temporal, bem como na lateralização das alterações hipocampais em pacientes candidatos à cirurgia, como já relatado em diversas séries. Realizamos a volumetria das estruturas do lobo temporal em 69 pacientes com suspeita clínica de epilepsia mesial temporal, avaliados consecutivamente no Centro de Cirurgia de Epilepsia do Hospital de Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. As estruturas medidas foram o pólo temporal, o lobo temporal, a amígdala, o hipocampo e o giro parahipocampal. Estas medidas foram comparadas às variáveis clínicas e neurofisiológicas dos pacientes, buscando fatores de bom prognóstico para o tratamento cirúrgico, bem como de variáveis clínicas que permitissem a correlação entre comprometimento estrutural e funcional. Nossos resultados mostraram uma importância central do hipocampo na epileptogênses temporal, embora não esteja elucidado se este papel é primário e independente ou secundário a alterações conjuntas com as outras estruturas. Todos os nossos casos apresentaram comprometimento hipocampal absoluto, relativo ou de assimetria. O pólo temporal foi a estrutura neocortical mais comprometida e houve uma correlação entre sua perda volumétrica e o tempo de epilepsia, sugerindo um dano progressivo. Seu comprometimento correlacionou-se ainda a déficits cognitivos, com menor quociente geral de inteligência. A amígdala e o giro parahipocampal estiveram relacionados à presença de crises parciais simples evoluindo para complexas, correlacionando dados clínicos e estruturais. Palavras chave: Epilepsia temporal; Volumetria; Tratamento cirúrgico. / Temporal lobe epilepsy is the most commom form of focal epilepsy. Mesial temporal sclerosis is the usual etiology. Magnetic resonance volumetry may be a useful research tool, and may be used to lateralize hippocampal changes in surgical candidates, according to several reports. We performed temporal lobe volumetry in 69 consecutive patients of the Epilepsy Surgery Center of the Hospital of Ribeirão Preto of the University of São Paulo. We measured temporal pole, posterior segment of the temporal lobe, amygdala, hippocampus, and parahippocampal gyrus. The volumes were compared to clinical and neurophysiologic variables, as an attempt to find variables that could predict surgical outcome. We also sought correlations between structural (volume), and functional (epileptogenesis and clinical features) changes. Our data suggest that the hippocampus has a very important role in temporal lobe epilepsy. The question as to wether this role is primary or secundary to changes in other structures remains to be solved. In all of our cases the hippocampal volume was altered, either as absolute or relative volumes, or as asymmetry index. The only variable that correlated with postsurgical outcome was the hippocampal asymmetry index, being greater in the group with best postsurgical evolution. The most involved neocortical structure was the temporal pole. There was a correlation between temporal pole and amygdala volume and duration of epilepsy. This suggests a progressive damabe, added to the initial precipitating injury (IPI). There was also significant difference between mesial structures contralateral to the surgery side and those of the controls. These data shows more widespread and bilateral damage, even in patients with unilateral epilepsy by EEG and clinical criteria.

Orientadores: Fernando Cendes, Iscia Teresinha Lopes Cendes / Tese (Doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T19:28:39Z (GMT). No. of bitstreams: 1 Morita_MarciaElisabete_D.pdf: 30279244 bytes, checksum: 9795af46582295ee5e0f0f193429b5aa (MD5) Previous issue date: 2012 / Resumo: Introdução: A epilepsia de lobo temporal mesial (ELTM), a principal causa de epilepsia parcial no adulto, está freqüentemente associada à atrofia hipocampal (AH). O conhecimento sobre sua história natural e fisiopatologia é baseado predominantemente em séries cirúrgicas. A ELTM familiar (ELTMF) é caracterizada pela recorrência em uma mesma família de indivíduos com ELTM com diversos graus de gravidade. Este aspecto, associado ao fato de alguns membros assintomáticos apresentarem sinais de AH na RM, faz com que o estudo prospectivo da ELTMF seja o cenário ideal para o melhor entendimento da história natural e fisiopatologia da ELTM. Materiais e Métodos: Analisamos prospectivamente 103 indivíduos pertencentes a 17 famílias com ELTMF. O tempo de seguimento foi em média 7,6 anos (SD ± 1,8 anos). Os membros das famílias foram divididos em três grupos: ELTMF (n=53), não classificáveis (crises que não preenchiam critérios para ELTM; n=18) e assintomáticos na primeira avaliação (n=32). O grupo com ELTMF foi subdividido em subgrupos: remissão (n=19), benignos (n=17) e refratários (n=17). Posteriormente o grupo com ELTMF foi reclassificado de acordo com sua evolução clínica em favorável e desfavorável. As evoluções clínicas foram correlacionadas com os possíveis fatores prognósticos. Sinais de AH na MRI foram definidos por análise visual. Em um estudo paralelo, foi feita a volumetria manual do hipocampo nas duas imagens de RM quando disponíveis. Resultados: No grupo benigno os pacientes evoluíram ou para refratariedade (17,6%) ou para remissão (23,5%). No grupo inicialmente em remissão, a maioria dos pacientes permaneceu em remissão e 21% foram reclassificados como benignos. Todos os pacientes refratários permaneceram refratários, exceto quando submetidos à cirurgia. Dos assintomáticos 12,5% desenvolveram ELTMF benigna e do grupo não classificáveis 22% evoluíram para o diagnóstico de ELTMF benigna. Foram considerados fatores preditivos relacionados à evolução clínica desfavorável a presença de AH (p=0,0192) e atividade epileptiforme no EEG (p=0,0174). A correlação entre incidentes precipitantes iniciais e evolução clínica não foi significativa, porém, uma clara tendência (p=0,0549) foi observada. Em relação à volumetria observamos progressão da atrofia quando comparamos o volume da RM inicial com a última RM. Discussão: Os resultados observados confirmam o caráter geralmente benigno da ELTMF. Este achado ressalta a existência de pacientes que mesmo na presença de sinais de AH apresentam uma evolução favorável, colocando em questão o conceito tradicional de que a ELTM com AH seria necessariamente refratária. Além disso, a demonstração da existência de fatores preditivos de má evolução clínica corrobora a hipótese de que outros fatores, além da influência genética, também estariam envolvidos na fisiopatologia desta doença. Em relação à progressão da ELTMF, dados de volumetria reforçam a teoria de que a ELTM seria uma doença progressiva, cuja velocidade de seu curso poderia ser influenciada por fatores externos. Este estudo longitudinal trouxe dados adicionais sobre a história natural da ELTMF que reforçam e clareiam algumas das hipóteses previamente formuladas. O melhor entendimento dos mecanismos subjacentes a ELTMF é importante para determinar estratégias terapêuticas visando melhor controle de crises e talvez, assim, prevenindo epileptogênese e progressão de dano neuronal / Abstract: Introduction: Mesial temporal lobe epilepsy (MTLE), the main cause of partial epilepsy in adulthood, is frequently associated with hippocampal atrophy (HA). The knowledge regarding its natural history and pathophysiology is based mainly on surgical series. Familial mesial temporal lobe epilepsy (FMTLE) is characterized by the recurrence of MTLE in the same family with different degrees of severity. This aspect, together with the fact that some asymptomatic members have MRI signs of HA, makes the prospective study of FMTLE the perfect scenario for the better understanding of the natural history and pathophysiology of MTLE. Material and Methods: We analyzed prospectively 103 individuals belonging to 17 families with FMTL. The mean duration of follow up was 7.6 years (SD, ± 1.8 years) Family members were divided into 3 groups: FMTLE (n=53), unclassified (seizures that did not fulfill criteria for MTLE, n=18) and asymptomatic at first evaluation (n=32). The FMTLE group was divided into 3 subgroups named: remission (n=19), benign (n=17) and refractory (n=17) and were further reclassified according to their outcome in favorable outcome and poor outcome. Outcome groups were correlated with possible predictor factors. MRI signs of atrophy were defined by visual analysis. In a related study, we performed manual volumetry in both MRI images when they were available. Results: In the benign group patients evolved to either refractoriness (17.6%) or remission (23.5%). In the remission group, most patients remained seizure free and only 21% were further reclassified as benign. All refractory patients remained refractory or underwent surgery. From the asymptomatic group 12.5% developed benign FMTLE and from the unclassified seizure group 22% evolved to a diagnosis of benign FMTLE. Predictive factors related to poor outcome were presence of HA (p=0.0192) and interictal epileptiform discharges on EEGs (p=0.0174). The correlation between initial precipitating injuries and clinical outcome was not significant although a clear tendency was observed (p=0.0549). Regarding volumetric analysis, when comparing hippocampal volumes from initial and last MRIs, we observed progression of HA. Discussion: Our results confirm the benign aspect of FMTLE. This finding emphasizes the existence of patients with good outcome even in the presence of signs of HA, challenging the notion that MTLE with HA is always refractory. Furthermore, the demonstration of predictive factors of poor clinical outcome supports the hypothesis that, in addition to the genetic influence, there should be other factors involved in the pathophysiology of this condition. Volumetric data reinforces the theory that MTLE might be a progressive disorder, and that the rate of progression would be influenced by external factors. This longitudinal study brought additional data regarding the natural history of FMTLE that strengthens and clarifies some of the previously formulated hypotheses. The better understanding of the underlying mechanisms of FMTLE is important to determine therapeutic strategies aiming better seizure control and perhaps thereby preventing epileptogenesis and progression of neuronal damage / Doutorado / Neurociencias / Doutor em Fisiopatologia Medica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Epilepsy is a disease that affects about 1-2% of the general population. Considering the high number of patients with epilepsy who are refractory to currently available drugs, it is important to search for new anticonvulsant drugs. For this it is important that reproduces model epilepsy, such as the pilocarpine model, a muscarinic agonist causing limbic seizures and status epilepticus, which after a latency period is characterized by a temporal lobe epilepsy. A potential drug target in the treatment of epilepsy is the Na+,K+-ATPase, which is characterized by being a plasma membrane protein having important role in the maintenance of cellular ionic homeostasis, changes in the Na+,K+-ATPase activity directly affect cell signaling via neurotransmitters and neuronal activity. In this context, a impair the functioning of the Na+,K+-ATPase leads to an increased or decreased neuronal excitability, depending on the degree of inhibition induced neuronal and type affected. Therefore, the present study searched for the role of Na+,K+-ATPase and the specific antibody that enhances the activity of Na+,K+-ATPase (DRRSAb) in the pilocarpine model in C57BL/6 mice challenged with pentylenetetrazol (PTZ). It was seen that the activity of Na+,K+-ATPase was decreased in hippocampus of epileptic mice, 60 days after status epilepticus (SE). Furthermore, the Michelis-Menten constant for different ATP concentrations increased in the SE. Reduced activity of Na+,K+-ATPase appears to involve the nitration of α subunit, but no changes in the expression or its phosphorylation state at Ser943 was found. Interestingly, activation of Na+,K+-ATPase intrahippocampal injection with a specific antibody (DRRSAb) produced against a regulatory site of the α subunit, decreases susceptibility to myoclonic seizures induced by PTZ in epileptic animals. On the other hand, the administration of DRRSAb in the hippocampus of naive animals facilitated the onset of seizures induced by PTZ. Quantitative analysis of hippocampal EEG recordings revealed that DRRSAb increased the percentage of total power contributed by delta frequency band (0-3 Hz) to large irregular amplitude pattern of hippocampal EEG. On the other hand, no DRRSAb-induced changes were found regarding the theta functional state. Therefore, activation of Na+,K+-ATPase activity as a novel approach in seizure disorders, may become a potential target for epilepsy. / A epilepsia é uma doença que atinge cerca de 1 % da população em geral. Embora vários tratamentos farmacológicos sejam utilizados, um elevado número de pacientes com epilepsia são refratários às drogas disponíveis atualmente o que torna importante à busca por novas drogas anticonvulsivantes. Para isso, é necessário um modelo que reproduza a epilepsia, como é o caso do modelo da pilocarpina, um agonista muscarínico que causa convulsões límbicas e status epilepticus (SE), que após crises recorrentes se caracteriza por uma epilepsia do lobo temporal. Um possível alvo farmacológico na terapia da epilepsia é a enzima Na+, K+-ATPase, que se caracteriza por ser uma proteína de membrana plasmática que tem um papel importante na manutenção da homeostase iônica celular cuja mudança na atividade da Na+, K+-ATPase afeta diretamente a sinalização celular via neurotransmissores e a atividade neuronal. Neste contexto, um prejuízo ao funcionamento da Na+, K+-ATPase ocasiona aumento ou diminuição da excitabilidade neuronal, dependendo do grau de inibição induzido e do tipo neuronal afetado. Portanto, o presente estudo, procurou o papel da Na+, K+-ATPase e de um anticorpo específico que aumenta a atividade da Na+, K+-ATPase (DRRSAb), no modelo da pilocarpina em camundongos C57BL/6 e sobre a susceptibilidade ao pentilenotetrazol (PTZ). Foi constatado que a atividade da Na+, K+-ATPase está diminuída no hipocampo de camundongos 60 dias após o SE. Além disso, a constante de Michelis-Menten para as diferentes concentrações de ATP aumentou no grupo pós-SE. A redução da atividade da Na+,K+-ATPase parece envolver a nitração da subunidade α, mas nenhuma alteração na expressão ou no estado de fosforilação na Ser943 foi encontrada. Interessantemente, a ativação da Na+, K+-ATPase, com uma injeção intrahipocampal do anticorpo DRRSAb produzido contra um local regulador da subunidade α, diminui a susceptibilidade para crises mioclônicas induzida por PTZ nos animais epilépticos. Por outro lado, a administração de DRRSAb no hipocampo de animais normais facilitou o aparecimento de convulsões induzidas por PTZ. A análise quantitativa do registro eletroencefalográfico (EEG) no hipocampo, revelou que o DRRSAb aumentou a porcentagem de poder total na frequência da banda delta (0-3 Hz), quando analisado padrão de atividade irregular de grande amplitude (LIA). Por outro lado, não houve alterações induzidas pelo DRRSAb sobre o estado funcional do ritmo teta. Portanto, a ativação Na+, K+-ATPase, como uma nova abordagem em distúrbios convulsivos, pode tornar-se um alvo farmacológico em potencial na epilepsia.

Le carisbamate est la 1ère molécule à avoir un effet modificateur de l’épileptogenèse, dont environ 50% des animaux traités développent des crises d’absence, au lieu des crises limbiques normalement observées dans le modèle de la pilocarpine. Le principal objectif de cette thèse a été celui d’étudier les altérations qui se produisent par le traitement par le carisbamate. Pour cela nous avons effectué une cartographie de l’activité cérébrale, avec un immunomarquage de la protéine c-Fos, et nous avons vérifié les concentrations des monoamines et acides aminés dans l’hippocampe, le thalamus et dans le cortex piriforme par HPLC, 4h après le début du status epilepticus (SE). Enfin, nous avons vérifié le profil d’expression protéique dans l’hippocampe, 2 mois après le SE par électrophorèse bidimensionnelle.Les résultats indiquent que le carisbamate augmente l’activité des noyaux MD et LD du thalamus. Les résultats suggèrent aussi que la dopamine, la noradrenaline, le GABA et la sérotonine peuvent participer à la significative neuroprotection et à l’effet modificateur de l’épileptogenèse du carisbamate. L’étude de protéomique suggère également une réduction globale du métabolisme énergétique cellulaire chez les rats traité par le carisbamate qui développent des crises d’absence. / The carisbamate is the 1st molecule showing an epileptogenesis modifying effect, that about 50% of treated animals develops absence instead limbic seizures, commonly seen in the pilocarpine model. The aim of this thesis was to study the changes that follows carisbamate treatment. Therefore, we made a brain activity cartography, by labelling c-Fos protein, and we quantified the concentrations of amino acids and monoamines in hippocampus, thalamus and piriform cortex, 4h after the status epilepticus (SE). Moreover, we studied the protein expression profile in the hippocampus, 2 month after SE, by two-dimensional electrophoresis.The results points towards an increased activity of MD and LD thalamic nuclei in carisbamate treated rats. Furthermore, dopamine, noradrenaline, GABA and serotonin appears to play a role in neuroprotection and in the epileptogenesis modifying effect of carisbamate. The proteomic study revealed a global reduction of cellular energetic metabolism of carisbamate treated rats that develops absence seizures.

Cette thèse a pour objectif spécifique d’explorer les événements précoces pouvant être à l’origine du bourgeonnement aberrant des fibres moussues (FM) du gyrus denté, une réorganisation majeure dans l’Epilepsie du Lobe Tempora (ELT). Nous avons utilisé le modèle pilocarpine d’ELT chez le rat afin de montrer que la transmission GABAergique jouait un rôle prépondérant dans la formation des FM aberrantes au cours de l’épileptogenèse. Ceci étant due à une altération de l’homéostasie chlore, suite à une augmentation de l’expression du co-transporteur NKCC1 et une diminution du co-transporteur KCC2. Nos résultats ont démontré que le récepteur aux neurotrophines p75NTR était un médiateur de l’action trophique de la réponse GABAergique dépolarisante sur le bourgeonnement aberrant des FM. Le blocage de l’action dépolarisante de la transmission GABAergique via l’utilisation de la bumétanide, a permis de réduire le bourgeonnement aberrant des MF en réduisant l’expression de p75NTR. Enfin, l’application transitoire de la bumétanide au cours de l’épileptogenèse a abouti à la réduction du nombre de crises récurrentes et spontanées au cours de la phase chronique d’ELT chez le rat. Ce travail a permis de dévoiler les mécanismes moléculaires sous-jacents de la réorganisation du réseau neuronal glutamatergique consécutif à une crise inaugurale dans un modèle d’ELT. Dans l'ensemble, cette thèse apporte un éclairage nouveau sur l’importance de l’interaction de la signalisation GABAergique avec les neurotrophines afin d’orchestrer la plasticité réactive au sein de l’hippocampe dans TLE. / The present dissertation undertakes to investigate the early triggering events of the mossy fiber sprouting (MFS) in the dentate gyrus, a hallmark of hippocampal reactive plasticity in Temporal Lobe Epilepsy (TLE). We used the rat pilocarpine model of TLE to show that altered GABAA receptor-mediated transmission play a key role in the formation of early ectopic MFS during epileptogenesis. This is likely due to a compromised chloride homeostasis, as a result of increased expression of chloride loader NKCC1 and downregulation of the neuronal chloride extruder KCC2. We next addressed the mechanistic action of depolarizing GABAAR responses with regard to neurotrophin signaling. Our findings uncovered that the pan neurotrophin receptor p75 (p75NTR) mediated the sculpting action of depolarizing GABAAR responses on the ectopic MFS. Blockade of depolarizing GABAAR responses using the loop diuretic bumetanide reduced abnormal p75NTR subsequently decreased the ectopic MFS. Finally, transitory application of bumetanide during epileptogenesis resulted in reduction of spontaneous and recurrent seizures during the chronic phase of TLE. The rationale of this work is that unveiling the molecular mechanisms underlying the hippocampal post-seizure glutamatergic network rewiring will help to drive future novel therapeutic avenues involving chloride homeostasis and neurotrophin interplay. Overall, this dissertation shed a new light on how GABAergic transmission and neurotrophin signaling crosstalk can orchestrate reactive hippocampal plasticity in TLE.

En plus des crises, les patients atteints d'épilepsie du lobe temporale (ELT) souffrent de déficits cognitifs tels que des troubles de l'apprentissage et de la mémoire épisodique. La formation de la mémoire épisodique nécessite des interactions entre le cortex et l'hippocampe pendant le sommeil. Ces interactions sont orchestrées par l'oscillation lente qui est générée dans le réseau thalamocortical. L'oscillation lente se propage dans d'autres structures sous corticales mais l'hippocampe semble être moins influencé. Cela pourrait être du à la fonction de filtre du gyrus denté. Dans l'ELT, le gyrus denté subit une réorganisation structurelle et fonctionnelle qui pourrait altérer sa fonction de filtre et aussi modifier la propagation d'activités épileptiformes du cortex vers l'hippocampe. Cependant, la propagation de rythmes physiologiques du cortex vers le réseau hippocampique pendant l'épileptogenèse a été peu étudié. Ce travail de thèse a eu pour but d'étudier l'influence des oscillations lentes corticales sur le potentiel de membrane et la décharge des cellules granulaires du gyrus denté dans un modèle d'ELT sous anesthésie. Nos résultats montrent une augmentation de la modulation du potentiel de membrane et ainsi que de la décharge des cellules granulaires du gyrus par l'oscillation lente corticale pendant l'épileptogenèse. Les changements qui s'opèrent dans le gyrus denté pendant l'épileptogenèse le rendraient plus permissif aux informations en provenance du cortex facilitant ainsi la propagation des oscillations lentes du cortex vers l'hippocampe. / In addition to seizures, patients with temporal Lobe Epilepsy (TLE) suffer from cognitive deficits such as learning and episodic memory impairment. The functional interactions between the cortex and the hippocampus notably during sleep are thought to be important for episodic memory formation. These interactions are orchestrated by the slow oscillation which is generated in thalamo-cortical networks. The slow oscillation is not confined to thalamo-neocortical networks but propagates to other subcortical structures but the hippocampus seems however less strongly influenced by the widespread propagation of the slow oscillation. This could result from the gate function of the dentate gyrus. In TLE, the dentate gyrus is associated with profound structural and functional network alterations which can alter the propagation of pathological activities such as epileptiform discharges from the cortex to the hippocampus. However, whether and how epilepsy modifies the impact of physiological activities on hippocampal networks remains to be investigated. This work was designed to study the influence of slow cortical oscillations on the membrane potential and discharge of granule cells in the dentate gyrus in an animal model of TLE. Our results show an increase in the modulation of membrane potential and as well as the discharge of granule cells in the dentate gyrus by the cortical slow oscillation during epileptogenesis. The changes that occur in the dentate gyrus during epileptogenesis would make it more permissive facilitating the spread of slow oscillations from the cortex to the hippocampus.

Temporal lobe epilepsy is the most common form of epilepsy and hippocampal sclerosis represents the main underlying structural abnormity. Approximately 20% of TLE cases are non- lesional due to absence of any obvious epileptogenic lesion and tetanus toxin model is traditionally considered as a model of non-lesional temporal lobe epilepsy. The main aim of this study was to evaluate the presence of the cell damage and to determine its spatiotemporal profile. Tetanus toxin was stereotaxically injected into CA3 subregion of dorsal hippocampus in adult male Wistar rats. Brain tissue was extracted 4, 8 and 16 days following the surgery. Postfixed brains were sectioned to 50 µm slices and labeled using Nissl's and FluoroJade B staining (FJB). Hippocampal sclerosis was present only in animals from D16 group, however, it was localized mainly in contralateral CA1 area. Additional finding was decreased Nissl's staining in contralateral hippocampus which corresponded with the presence of FJB positive neurons. In animals from group D8, we have identified presence of FJB positive neurons predominantly in ipsilateral hippocampus. In D4 animals, cellular degeneration was absent. To examine the non- lesional nature of tetanus toxin model, we have performed blind study, when Nissl's staining were reviewed...

Ce travail de thèse explore la mémoire de stimuli émotionnels au cours de quatre études en adoptant une approche pluridisciplinaire chez l’enfant sain et consécutivement à une chirurgie de l’épilepsie du lobe temporal (ELT). Nos objectifs étaient (1) de comparer l’influence des émotions sur la mémoire verbale et non verbale au cours du développement sain et en cas d’ELT, (2) de décrire les bases cérébrales des processus de la mémoire de visages exprimant la peur au cours du développement au moyen de l’IRMf, (3) de s’intéresser à l'impact de l’ELT droit sur ce réseau (4) d’illustrer l’impact d’une chirurgie de l’ELT droite sur la mémoire émotionnelle et les caractéristiques cognitivo-émotionnelles en phase pré- puis post-opératoire. Nos résultats montrent que La reconnaissance mnésique de stimuli émotionnels est perturbée chez les jeunes patients présentant un dysfonctionnement du LTM, sauf pour les visages exprimant la peur. Chez les sujets sains, l’activation de l’amygdale basolatérale qui se met en place au moment de l’adolescence, serait notamment la signature cérébrale du phénomène de modulation émotionnelle des souvenirs associée à la recollection, et la maturation fonctionnelle des structures de la mémoire au sein du lobe temporal médian (LTM) suivrait un gradient caudo-rostral. Des capacités de réorganisation controlatérale sont néanmoins observées chez les patients avec ELT droite, au niveau de l’amygdale et des structures mnésiques du LTM, avec une sur-compensation au niveau du cortex parahippocampique. Ces adaptations permettraient de soutenir la mémoire de visage exprimant la peur sur la base d’un sentiment de familiarité, notamment après le contrôle des crises. Ce travail de thèse a permis de mettre en évidence des résultats novateurs à propos de l’implication du LTM du développement du lien entre mémoire et émotion. / In this multidisciplinary work, four studies were conducted to examine the memory for emotional stimuli in healthy children and post-surgery for temporal lobe epilepsy (TLE). The aims were (1) to compare emotional influences on memory for faces and words in healthy and TLE children, (2) to explore age-related neural networks of fear faces memory with fMRI, (3) to elicit the effect of childhood right-TLE on these developing networks and (4) to illustrate the impact of right-TLE surgery on emotional memory and cognitive-emotional features in a pre- vs. post-surgery case study. Our results show that patients suffering from a MTL dysfunction are impaired in emotional memory, except for fear faces. In heathly participants, emotional modulation of recollected memories is associated with an activation of basolateral amygdala in adolescents and that functional maturation through the mesial temporal lobe (MTL) is characterized by a caudo-rostral gradient. In right-TLE patients, controlateral recovery abilities are nonetheless observed, in amygdala and memory structures in MTL, with an over-activation in parahippocampal cortex. This reorganization would allow sustaining memory for fear faces supported with familiarity process. This thesis highlights new results about MTL involvement in memory-emotions interactions during development.

Les épilepsies mésiales du lobe temporal (ELTM) sont parmi les formes les plus fréquentes d’épilepsies partielles pharmaco-résistantes de l’adulte et l’enfant. Dans ces épilepsies les études électrocliniques et expérimentales indiquent que la zone épileptogène, qui désigne un ensemble de neurones nécessaire et suffisant à l’organisation d’une décharge anormale, ne peut être réduite à la seule formation hippocampique (FH) et impliquerait une réorganisation mettant en jeu plusieurs structures au sein du système limbique. Dans ce travail de thèse, nous nous sommes intéressés à la connectivité structurale entre le noyau supramammillaire (SuM) et la FH chez le rat dans le but de déterminer l’identité neurochimique de la voie de projection supramammillaro-hippocampique qui n’avait pas été clairement identifiée et, vérifier l’hypothèse d’une éventuelle réorganisation de cette voie de projection dans le modèle d’ELTM induit par l’injection intrapéritonéale de pilocarpine chez le rat. Chez les rats naïfs, nous mettons en évidence deux voies de projection distinctes. La première a pour origine les neurones localisés dans la partie latérale du SUM (SuML) qui innervent le champ CA2-CA3a et principalement la couche supragranulaire du gyrus dentelé dorsal. Cette voie est essentiellement ipsi-latérale et a la caractéristique de présenter un profil neurochimique unique, à la fois GABAergique et glutamatergique. La seconde voie de projection a pour origine les neurones localisés dans la partie plus postérieure et médiane du SuM (SuMM) qui innervent la région CA2-CA3a et la région ventrale du gyrus dentelé exclusivement ; cette voie est purement glutamatergique. Chez les rats traités à la pilocarpine, nos résultats montrent une réorganisation structurale des afférences des noyaux SuML et SuMM qui innervent le gyrus dentelé. Cette réorganisation est caractérisée par une distribution aberrante et une augmentation du nombre de fibres et terminaisons axonales en provenance des noyaux SuML et SuMM dans la couche moléculaire interne du gyrus dentelé. Cette réorganisation commence à la fin de la période de latence, et évolue pendant l’épilepsie induite par la pilocarpine. Avec ce travail, nous montrons pour la première fois : 1) l’hétérogénéité à la fois anatomique et neurochimique des voies de projection supramammillaro-hippocampiques ; 2) dans le gyrus dentelé des animaux traités à la pilocarpine, une réorganisation structurale d’origine extra-hippocampique, en provenance des noyaux SuML et SuMM. Cette connectivité aberrante pourrait contribuer avec la réorganisation des circuits intrinsèques de l’hippocampe à l’émergence des premières crises spontanées et à l’installation de l’épilepsie. / Mesial temporal lobe epilepsies (MTLE) are among the most common forms of pharmacoresistant partial epilepsies in adults and children. In these epilepsies, spontaneous seizures likely originate from a multi-structural epileptogenic zone including several structures of the limbic system connected to the hippocampal formation (HF). In this thesis, we investigate the structural connectivity between the supramammillary nucleus (SuM) and the HF in rat, in order to determine the not yet known neurochemical identity of the supramammillaro-hippocampal pathway and, to test the hypothesis of a potential reorganization of this pathway in the rat pilocarpine model of MTLE. In naïve rats, our results highlight two distinct pathways. The first pathway originates in the lateral part of the SuM (SuML) and innervates the supragranular layer of the dorsal dentate gyrus mainly, and the CA2-CA3a pyramidal cell layer of the hippocampus. This pathway is mainly ipsilateral and displays a unique dual phenotype for GABAergic and glutamatergic neurotransmission. The second pathway originates in the most posterior and medial part of the SuM (SuMM) and innervates exclusively the inner molecular layer of the ventral dentate gyrus and the CA2-CA3a subfield and is glutamatergic only.In pilocarpine-treated animals, our findings demonstrate a structural reorganization of dentate gyrus afferents originating from the SuM nuclei. Such reorganization is characterized by an aberrant distribution and an increased number of fibers and axon terminals from neurons of the both lateral and medial regions of the SuM, invading the entire inner molecular layer of the dentate gyrus. It starts at the end of the latent period and evolves during the epilepsy induced by pilocarpine. Our findings demonstrate for the first time: 1) the anatomical and neurochemical heterogeneity of the supramammillaro-hippocampal pathways; 2) in pilocarpine-treated animals, a marked reorganization of dentate gyrus afferents originating from the SuM nuclei. This aberrant connectivity could contribute along with the reorganization of hippocampal intrinsic circuitry to the emergence of the first spontaneous seizures and epilepsy installation.