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Excessive release of neurotransmitter is a characteristic of epileptogenic cells. A number of lines of evidence implicate defects in the synaptic vesicle cycle as a cause of this excessive release. Synaptic vesicles are retrieved by more than one route in central nerve terminals. During mild stimulation the dominant synaptic vesicle retrieval pathway is classical clathrin mediated endocytosis. During elevated neuronal activity retrieval of synaptic vesicle membrane by bulk endocytosis is the predominant retrieval method. As it is triggered by strong stimulation, bulk endocytosis may be of importance in retrieval during epilepsy, however little is currently known about this pathway. In order to investigate the role of bulk endocytosis, we sought to establish a cell culture model of epilepsy, to develop an assay to distinguish retrieval by bulk endocytosis, and to use these tools to look at the molecular players controlling this form of endocytosis. Characterisation of bulk endocytosis through the development of tailored assay systems has revealed that bulk endocytosis is a fast event that is triggered during strong stimulation. Bulk endocytosis provides the nerve terminal with an appropriate mechanism to meet the demands of synaptic vesicle retrieval during periods of intense synaptic vesicle exocytosis. Inhibition of a dephosphorylation specific dynamin I-syndapin I interaction by competitive peptides inhibits activity dependent bulk endocytosis, implicating this interaction in a role in this method of synaptic vesicle retrieval. Having characterised the strength of stimulation needed to activate bulk endocytosis, and the speed at which it occurs, we also investigated the effects of known anti-epileptogenic drugs on bulk endocytosis in our central nerve terminal model system.

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Voltage-gated sodium ion channels play a vital role in neuron function, which becomes evident when variants in these genes disrupt their function. Mutations in SCN8A have only recently been linked to an epilepsy phenotype characterized by early-onset of seizures, delayed development, and intellectual disability. Using patient data from published papers (n = 75) as well as an online support group (n = 61), we were able to identify several patterns in the pathogenic mutations and compare them to a group of healthy individuals from the Exome Aggregation Consortium (ExAC) (n = 960). Most of the variants are missense, with one reported nonsense mutation in an individual with ataxia instead of epilepsy. The average age of onset from 85 individuals combined from the published papers and the online support group was 4.45 months. Notably, the ages of onset have a bimodal distribution instead of normal, with one peak within the first month of life and a second peak at 4 months of age. Pathogenic mutations are more likely to appear in the transmembrane regions of the protein encoded by SCN8A (Nav1.6) (Proportion Test: p-value = 9.1 x 10⁻⁵) while non-pathogenic variants were more likely to appear in the connecting loops of the protein (Proportion Test: p-value<2.2 x 10⁻¹⁶). This is most likely due to the transmembrane regions having a greater functional role than the loops. When we further separate the mutations into functional parts of the protein, we generally see that areas with more pathogenic mutations have fewer non-pathogenic variants, and vice versa. For example, the inactivation gate of the protein has more pathogenic variants (Exact Binomial Test: p-value = 3.52 x 10⁻⁶) while the N-terminus has more non-pathogenic variants (Exact Binomial Test: p-value = 0.0128). This suggests that areas with more pathogenic variants are less tolerable to variation while those with more non-pathogenic variants are more tolerable. Interestingly, there are some areas of the protein with very few pathogenic and non-pathogenic variants, such as the pore regions of the protein. This is likely due to the vital functional nature of the pore, and any variants in that region lead to lethality. Further analyses are needed to determine if there are correlations between categories of pathogenic mutations and the phenotypes of the patients.

Thesis advisor: Judith Vessey / The objective of this study was to describe the parental perspective of caring for a child with intractable epilepsy. The purpose of this study was twofold: (1) to describe the caregiver transitions from caring for a healthy child to caring for a child with intractable epilepsy, and (2) to study families that provide caregiving, to identify the challenges, and learn how they address the intricacies and nuances of caring for a child with intractable epilepsy. The specific research questions that guide this study were: (1) What do parents of children with epilepsy find helpful or challenging during transitions from caring for a healthy child to a child with intractable epilepsy? (3) What factors enable parents to transition from caring for a healthy child to a child with intractable epilepsy? The research design used qualitative descriptive design and was based on naturalistic inquiry. This methodology was used to describe parental experiences using their own words and not interpret these experiences. Research participants were recruited from a Level 4 National Association of Epilepsy Center at a Children's Hospital in the Northeast. A purposive sample of twelve parental caregivers participated. Themes that emerged from the interviews included (1) Journey to Diagnosis, Connecting the Dots, (2) Drunken Sailor, Medication Management, (3)Negotiating and Advocacy for Education (4) Provider Challenges, Communication and Parenting and (5) It Takes a Village: Sibling, Family Members and Friends. Nurses play a significant role in education, advocating, and guiding families through the initial diagnosis to dealing with activities of daily living and future planning. This research study serves as a foundation for future intervention studies regarding how best to support parents of children with intractable epilepsy. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis (M.S.)--Boston University