Patients with mechanical heart valves who present with intracranial haemorrhage are initially treated by reversing their coagulopathy. However, these patients will ultimately require that their oral anticoagulant be restarted. The time at which oral anticoagulants are restarted is critical since restarting too early may increase the risk of recurrent bleeding, while withholding anticoagulants increases the patient’s risk of thromboembolic events. The ideal time to restart patients on their oral anticoagulant medication is defined as the time at which all these risks are minimized. This thesis includes a systematic review and meta-analysis of the literature. The main outcomes were recurrent haematoma, valve thrombosis, stroke and peripheral emboli. Results were stratified by types of intracranial haemorrhage. We also conducted a survey to gain insight into current practices of neurosurgeons and thrombosis experts in Canada and USA when they are faced with deciding on anticoagulant restart times in patients with ICH. Results were stratified by type of intracranial bleed and participants’ characteristics and demographics. The systematic review identified that the ideal time for restarting anticoagulant therapy in patients following an ICH is unknown. Meta-analysis was limited by the heterogeneity of the studies. The survey results indicated that physicians had a wide range of practice and that their practice was dependent on the patient’s clinical features, but many physicians would restart oral anticoagulants between 4 and 14 days after the haemorrhage. For this reason we have proposed a multi centre cohort study to investigate the safety and efficacy of restarting patients on anticoagulation therapy between day 5 and 9 post haemorrhage. A full study protocol is presented in this thesis.

O Acidente Vascular Encefálico (AVE) Hemorrágico representa mais de 10% de todos os casos de AVE e possui altas taxas de morbidade e de mortalidade. Os pacientes que sobrevivem a este evento permanecem com alguma disfunção motora, que algumas vezes é incapacitante. O extravasamento de sangue em um AVE hemorrágico ocorre, geralmente, em regiões onde há bifurcação de pequenas arteríolas penetrantes, como na região dos núcleos da base. O estriado, importante componente dessa região, está relacionado a funções motoras superiores, como o planejamento e a execução do movimento. Alguns estudos demonstram que o pré-condicionamento (PC) isquêmico pode gerar a tolerância a outros eventos que acometem o sistema nervoso. O PC é definido como fenômeno decorrente da exposição de um tecido ou órgão a um insulto sub-letal capaz de resultar em adaptações determinantes para a tolerância tecidual. Isso ocorre mesmo quando esses dois estímulos são de origens diferentes; neste caso diz-se que o PC desenvolveu tolerância cruzada. Desta forma, o presente estudo dedicou-se ao estudo de efeitos celulares e funcionais do pré-condicionamento isquêmico, por oclusão bilateral das artérias carótidas durante 10 minutos, sobre o modelo de hemorragia intracerebral (HIC), por administração intraestriatal de colagenase do tipo IV-S em ratos. A hipótese de trabalho era de que o PC causaria tolerância cruzada para a HIC, e consequente neuroproteção avaliada por testes motores, volume de lesão, com envolvimento de astrocitose e de micróglia reativa Foram usados 67 ratos machos Wistar adultos, divididos em 4 grupos: Sham (controle cirúrgico), PC, HIC, PC+HIC. Assim, os animais dos grupos PC e PC+HIC foram submetidos ao pré-condicionamento e 24 horas depois os animais HIC e PC+HIC receberam a injeção de colagenase, enquanto os animais Sham e PC receberam uma injeção de salina. A avaliação motora dos animais foi realizada a partir dos testes do cilindro e do Staircase. Trinta e quatro dias após a HIC os animais foram perfundidos e o estriado ipsilateral à injeção foi dissecada para obtenção de amostras teciduais necessárias à avaliação da perda tecidual e quantificação de intensidade de fluorescência de GFAP (proteína glial fibrilar ácida) e OX-42, importantes marcadores de astrócitos e microglia, respectivamente. Os resultados demonstram que: a) a HIC causa deficits motores em ambos os testes realizados, e que o PC reverte este efeito; b) a HIC causa lesão estriatal que não é revertido pelo pré-condicionamento; c) a HIC causa aumento da intensidade de fluorescência para GFAP e para OX-42, e o PC reverte apenas a reatividade da micróglia. Em conjunto, sugere-se que o pré-condicionamento isquêmico causa tolerância cruzada com a hemorragia intracerebral experimental, resultando em proteção funcional, mas não morfológica, possivelmente associada a uma diminuição da reatividade da microglia após o evento hemorrágico. / Hemorrhagic Vascular Stroke (EVA) represents more than 10% of all stroke cases with high rates of morbidity and mortality. Patients who survive this event, remain with some motor dysfunction, which is sometimes disabling. The extravasation of blood in a hemorrhagic stroke occurs, generally, in regions where there is bifurcation of small vessels, as in the region of striatum. The striatum is related to the higher motor functions, such as the planning and execution of the movement. Some studies have shown that preconditioning (PC) can generate a tolerance to other events that accompany the nervous system. The PC is presented as the source of the exposure of a sub-lethal, resulting in an adaptation of determinants to a tissue tolerance. Thus, the present study aimed shows the ischemic preconditioning effects, by bilateral occlusion of the carotid arteries for 10 minutes, on the intracerebral hemorrhage (ICH) model, by intra- striatum administration of type IV S collagenase in rats. The working hypothesis was tolerance to HIC, and consequent neuroprotection by motor function, lesion volume, astrocytosis and reactive microglia. A total of 84 male Wistar adult rats were divided into 4 groups: Sham (surgical control), PC, HIC, PC + HIC Thus, the animals of the PC and PC + HIC groups were introduced to the preconditioning and 24 hours later, the HIC and PC + HIC animals received a collagenase injection, while the Sham and PC animals received a saline injection. The evaluation of the animal function was performed from cylinder and Staircase tests. Thirty-four days after the surgery, the striatum was dissected and prepared to lesion volume analysis and fluorescence intensity of GFAP quantification (acid glial fibrillary protein) and OX-42, important astrocyte and microglia markers respectively. The results demonstrate that: a) an HIC causes motor deficits in both tests performed, and that the PC reverses this effect; b) an ICH causes a striatal lesion that is not reversed by preconditioning; c) an HIC promoted high fluorescence intensity for GFAP and OX-42, and PC reverses the microglia reactivity. Taken together, we suggest that ischemic preconditioning combined with experimental intracerebral hemorrhage, promotes functional but not morphological protection, being associated with the microglial reactivity decrease after the hemorrhagic event.

O Acidente Vascular Encefálico (AVE) Hemorrágico representa mais de 10% de todos os casos de AVE e possui altas taxas de morbidade e de mortalidade. Os pacientes que sobrevivem a este evento permanecem com alguma disfunção motora, que algumas vezes é incapacitante. O extravasamento de sangue em um AVE hemorrágico ocorre, geralmente, em regiões onde há bifurcação de pequenas arteríolas penetrantes, como na região dos núcleos da base. O estriado, importante componente dessa região, está relacionado a funções motoras superiores, como o planejamento e a execução do movimento. Alguns estudos demonstram que o pré-condicionamento (PC) isquêmico pode gerar a tolerância a outros eventos que acometem o sistema nervoso. O PC é definido como fenômeno decorrente da exposição de um tecido ou órgão a um insulto sub-letal capaz de resultar em adaptações determinantes para a tolerância tecidual. Isso ocorre mesmo quando esses dois estímulos são de origens diferentes; neste caso diz-se que o PC desenvolveu tolerância cruzada. Desta forma, o presente estudo dedicou-se ao estudo de efeitos celulares e funcionais do pré-condicionamento isquêmico, por oclusão bilateral das artérias carótidas durante 10 minutos, sobre o modelo de hemorragia intracerebral (HIC), por administração intraestriatal de colagenase do tipo IV-S em ratos. A hipótese de trabalho era de que o PC causaria tolerância cruzada para a HIC, e consequente neuroproteção avaliada por testes motores, volume de lesão, com envolvimento de astrocitose e de micróglia reativa Foram usados 67 ratos machos Wistar adultos, divididos em 4 grupos: Sham (controle cirúrgico), PC, HIC, PC+HIC. Assim, os animais dos grupos PC e PC+HIC foram submetidos ao pré-condicionamento e 24 horas depois os animais HIC e PC+HIC receberam a injeção de colagenase, enquanto os animais Sham e PC receberam uma injeção de salina. A avaliação motora dos animais foi realizada a partir dos testes do cilindro e do Staircase. Trinta e quatro dias após a HIC os animais foram perfundidos e o estriado ipsilateral à injeção foi dissecada para obtenção de amostras teciduais necessárias à avaliação da perda tecidual e quantificação de intensidade de fluorescência de GFAP (proteína glial fibrilar ácida) e OX-42, importantes marcadores de astrócitos e microglia, respectivamente. Os resultados demonstram que: a) a HIC causa deficits motores em ambos os testes realizados, e que o PC reverte este efeito; b) a HIC causa lesão estriatal que não é revertido pelo pré-condicionamento; c) a HIC causa aumento da intensidade de fluorescência para GFAP e para OX-42, e o PC reverte apenas a reatividade da micróglia. Em conjunto, sugere-se que o pré-condicionamento isquêmico causa tolerância cruzada com a hemorragia intracerebral experimental, resultando em proteção funcional, mas não morfológica, possivelmente associada a uma diminuição da reatividade da microglia após o evento hemorrágico. / Hemorrhagic Vascular Stroke (EVA) represents more than 10% of all stroke cases with high rates of morbidity and mortality. Patients who survive this event, remain with some motor dysfunction, which is sometimes disabling. The extravasation of blood in a hemorrhagic stroke occurs, generally, in regions where there is bifurcation of small vessels, as in the region of striatum. The striatum is related to the higher motor functions, such as the planning and execution of the movement. Some studies have shown that preconditioning (PC) can generate a tolerance to other events that accompany the nervous system. The PC is presented as the source of the exposure of a sub-lethal, resulting in an adaptation of determinants to a tissue tolerance. Thus, the present study aimed shows the ischemic preconditioning effects, by bilateral occlusion of the carotid arteries for 10 minutes, on the intracerebral hemorrhage (ICH) model, by intra- striatum administration of type IV S collagenase in rats. The working hypothesis was tolerance to HIC, and consequent neuroprotection by motor function, lesion volume, astrocytosis and reactive microglia. A total of 84 male Wistar adult rats were divided into 4 groups: Sham (surgical control), PC, HIC, PC + HIC Thus, the animals of the PC and PC + HIC groups were introduced to the preconditioning and 24 hours later, the HIC and PC + HIC animals received a collagenase injection, while the Sham and PC animals received a saline injection. The evaluation of the animal function was performed from cylinder and Staircase tests. Thirty-four days after the surgery, the striatum was dissected and prepared to lesion volume analysis and fluorescence intensity of GFAP quantification (acid glial fibrillary protein) and OX-42, important astrocyte and microglia markers respectively. The results demonstrate that: a) an HIC causes motor deficits in both tests performed, and that the PC reverses this effect; b) an ICH causes a striatal lesion that is not reversed by preconditioning; c) an HIC promoted high fluorescence intensity for GFAP and OX-42, and PC reverses the microglia reactivity. Taken together, we suggest that ischemic preconditioning combined with experimental intracerebral hemorrhage, promotes functional but not morphological protection, being associated with the microglial reactivity decrease after the hemorrhagic event.

Background Many risk factors for stroke are well characterized and might, at least to some extent, be similar for first-ever stroke and for recurrent stroke events. However, previous studies have shown heterogeneous results on predictors and rates of stroke recurrence. Patients who survive spontaneous intracerebral hemorrhage (ICH) often have compelling indications for antithrombotic (AT) treatment (antiplatelet (AP) and/or anticoagulant (AC) treatment), but due to controversy of the decision to treat, a large proportion of these patients are untreated. In the absence of evidence from randomized controlled trials (RCTs), there is need for more high- quality observational data on the clinical impact of, and optimal timing of AT in ICH survivors. The aims of this thesis were to assess time trends in stroke recurrence, to determine the factors associated with an increased risk of stroke recurrence – including socioeconomic factors – and to determine to what extent ICH survivors with and without atrial fibrillation (AF) receive AT treatment and to determine the optimal timing (if any) of such treatment.  Methods The population-based Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) stroke incidence register was used to assess the epidemiology and predictors of stroke recurrence after ischemic stroke (IS) and ICH from 1995 to 2008 in northern Sweden. Riksstroke, the Swedish stroke register, linked with the National Patient Register and the Swedish Dispensed Drug Register, made it possible to identify survivors of first-ever ICH from 2005 to 2012 with and without concomitant AF to investigate to what extent these patients were prescribed AP and AC therapy. The optimal timing of initiating treatment following ICH in patients with AF 2005–2012 was described through separate cumulative incidence functions for severe thrombotic and hemorrhagic events and for the combined endpoint “vascular death or non-fatal stroke”. Riksstroke data on first-ever stroke patients from 2001 to 2012 was linked to the Longitudinal Integration Database for Health Insurance and Labour market studies to add information on education and income to investigate the relationship between socioeconomic status and risk of recurrence. Results Comparison between the cohorts of 1995–1998 and 2004–2008 showed declining risk of stroke recurrence (hazard ratio: 0.64, 95% confidence interval (CI): 0.52-0.78) in northern Sweden. Significant factors associated with an increased risk of stroke recurrence were age and diabetes. Following ICH, a majority (62%) of recurrent stroke events were ischemic.  The nationwide Riksstroke study confirmed the declining incidence, and it further concluded that low income, primary school as highest attained level of education, and living alone were associated with a higher risk of recurrence beyond the acute phase. The inverse effects of socioeconomic status on risk of recurrence did not differ between men and women and persisted over the study period. Of Swedish ICH-survivors with AF, 8.5% were prescribed AC and 36.6% AP treatment, within 6 months of ICH. In patients with AF, predictors of AC treatment were less severe ICH, younger age, previous anticoagulation, valvular disease and previous IS. High CHA2DS2-VASc scores did not seem to correlate with AC treatment. We observed both an increasing proportion of AC treatment at time of the initial ICH (8.1% in 2006 compared with 14.6% in 2012) and a secular trend of increasing AC use one year after discharge (8.3% in 2006 versus 17.2% in 2011) (p<0.001 assuming linear trends). In patients with high cardiovascular event risk, AC treatment was associated with a reduced risk of vascular death and non-fatal stroke with no significantly increased risk of severe hemorrhage. The benefit appeared to be greatest when treatment was started 7–8 weeks after ICH. For high-risk women, the total risk of vascular death or stroke recurrence within three years was 17.0% when AC treatment was initiated eight weeks after ICH and 28.6% without any antithrombotic treatment (95% CI for difference: 1.4% to 21.8%). For high-risk men, the corresponding risks were 14.3% vs. 23.6% (95% CI for difference: 0.4% to 18.2%). Conclusion Stroke recurrence is declining in Sweden, but it is still common among stroke survivors and has a severe impact on patient morbidity and mortality. Age, diabetes and low socioeconomic status are predictors of stroke recurrence. Regarding ICH survivors with concomitant AF, physicians face the clinical dilemma of balancing the risks of thrombosis and bleeding. In awaiting evidence from RCTs, our results show that AC treatment in ICH survivors with AF was initiated more frequently over the study period, which seems beneficial, particularly in high-risk patients. The optimal timing of anticoagulation following ICH in AF patients seems to be around 7–8 weeks following the hemorrhage.

Patients with mechanical heart valves who present with intracranial haemorrhage are initially treated by reversing their coagulopathy. However, these patients will ultimately require that their oral anticoagulant be restarted. The time at which oral anticoagulants are restarted is critical since restarting too early may increase the risk of recurrent bleeding, while withholding anticoagulants increases the patient’s risk of thromboembolic events. The ideal time to restart patients on their oral anticoagulant medication is defined as the time at which all these risks are minimized. This thesis includes a systematic review and meta-analysis of the literature. The main outcomes were recurrent haematoma, valve thrombosis, stroke and peripheral emboli. Results were stratified by types of intracranial haemorrhage. We also conducted a survey to gain insight into current practices of neurosurgeons and thrombosis experts in Canada and USA when they are faced with deciding on anticoagulant restart times in patients with ICH. Results were stratified by type of intracranial bleed and participants’ characteristics and demographics. The systematic review identified that the ideal time for restarting anticoagulant therapy in patients following an ICH is unknown. Meta-analysis was limited by the heterogeneity of the studies. The survey results indicated that physicians had a wide range of practice and that their practice was dependent on the patient’s clinical features, but many physicians would restart oral anticoagulants between 4 and 14 days after the haemorrhage. For this reason we have proposed a multi centre cohort study to investigate the safety and efficacy of restarting patients on anticoagulation therapy between day 5 and 9 post haemorrhage. A full study protocol is presented in this thesis.

No description available.

La douleur sociale est une forme de douleur non physique dérivant de la perception de l'exclusion sociale. L'importance de la compréhension de ses modulations comportementales et neuronales est fondamentale, car ses conséquences sur le long terme peuvent être très néfastes. Dans ce travail de thèse, j'ai exploré ces aspects à travers une étude comportementale à l‟aide d‟enregistrements par SCR (Skin Conductance Recording), et trois études en iEEG (électro-encéphalographie intracrânienne) chez des patients épileptiques. La première étude comportementale a exploré la direction dans laquelle l'exclusion sociale est influencée par une récompense et ses réactions sur le long terme. Ainsi, la récompense monétaire altère l'équilibre social et augmente l‟activité électrodermale. La personne ayant été exclue met alors en oeuvre des mécanismes de vengeance en défavorisant la personne qui l‟a exclue précédemment. Les études en iEEG ont été une fenêtre unique d'exploration du cerveau lors de différentes types de modulation de l'exclusion. Dans la première étude en iEEG, nous avons observé que la douleur sociale produit une activation des oscillations thêta (3-7 Hz), lors de d'exclusion, dans l'insula, l'ACC, le cortex préfrontal et le gyrus fusiforme. La deuxième étude iEEG s'est intéressée aux modulations produites par la douleur sociale dans BA 19 et BA 17 présentant des P1 d'amplitude majeure lors de l'observation des photos du joueur qui exclut. La troisième étude en iEEG a exploré la réponse neuronale de l'influence d'une variable monétaire lors de l'exclusion. Nos résultats démontrent que l'insula postérieure présente une activation thêta indépendante du fait que l'exclusion soit positive (exclusion et gain d'argent) ou encore négative (exclusion et perte d'argent), à la différence de l'insula antérieure, active seulement lors d'une exclusion négative / Pain is a form of social non-physical pain arising from the perception of social exclusion. The importance of understanding its behavioral and neuronal modulations has a critical value, since its long lasting consequences can be extremely harmful. In this thesis I firstly explored these issues through a behavioral SCR study (Skin Conductance Recording), and successively through three iEEG studies in patients with epilepsy (intracranial EEG). The SCR study explored the direction in which social exclusion is influenced by a reward and its long lasting reactions. Money affects social equilibrium and increases the SCR pics. The excluded individual implements revenge attitudes toward the person who excluded in a previuous interaction. The iEEG studies were a unique window for exploring the brain during different types of social pain modulations. In the first iEEG study, we found that social pain produced activation of theta oscillations (3-7 Hz) during exclusion in the insula, in the ACC, in the prefrontal cortex and in the fusiform face area. The second iEEG study wanted to explore deeply the primitive modulations produced by social pain in visual area. We found in BA 19 and BA 17 greater P1 peak amplitude during excluder pictures presentation. The third iEEG study investigated the neuronal modulations produced by a monetary reward during social pain. These results demonstrated that the posterior insula has a theta activation independent of whether the exclusion is positive (excluded but gaining money) or more negative (excluded but losing money), whereas the anterior insula, has a theta activation only during a negative exclusion

La localisation de source d'EEG devient un outil important pour traiter les patients atteints d'épilepsie en localisant les zones épileptogènes avant d'effectuer une chirurgie de résection. Compte tenu d'un modèle de tête direct, la localisation de la source EEG est réalisée en résolvant le problème inverse. Le modèle de tête direct est un modèle biophysique de tête plus ou moins complexe qui décrit la distribution électrique. En considérant la propagation électrique expliquant la distribution de potentiels, outre la numérisation, le modèle nécessite le réglage deux paramètres lesquels sont la géométrie du modèle de tête et la valeur des conductivités de chaque compartiment du modèle de tête. En raison des progrès computationnel et des techniques d'imagerie (comme l'IRM et la CT), il est possible de générer des modèles de tête humaine qui représentent avec une grande précision la géométrie de la tête réelle. Cependant, il existe une incertitude sur les valeurs de conductivité de chaque compartiment et la méthode avec laquelle ils devraient être estimés. Dans la littérature, les valeurs communes pour les conductivités proviennent principalement des expériences in-vitro. Dans ce travail, nous effectuons une estimation de la conductivité in-vivo à partir de données EEG/SEEG/Stimulation électrique de trois patients épileptiques. Ces données sont constituées des images IRM et des CT SCAN pour la construction d'un modèle de tête FEM à cinq compartiments pour chaque patient, ainsi que les enregistrements SEEG et EEG qui ont été acquis en même temps que la stimulation électrique intracérébrale (IES). L'originalité de ce travail réside dans l'évaluation de la performance de l'estimation des conductivités in-vivo par des mesures EEG et / ou SEEG en fonction de différents paramètres spatiaux et de la localisation des IES. Le travail se compose de trois parties principales: la première partie vise à déterminer la méthode d’optimisation sous contraintes la plus robuste parmi les algorithmes courants pour optimiser les paramètres du modèle direct de tête. L'objectif de la deuxième partie est d'analyser la sensibilité des valeurs de conductivité à différentes conditions sur la position de stimulation, le conditionnement du problème avec les positions de mesure et leur nombre et le nombre de compartiments. Alors que dans la partie finale, les conductivités d'un modèle de tête FEM isotrope et homogène à cinq compartiments ont été estimées avec des paramètres précédemment déterminés pour les trois patients. Enfin, l'effet de la fréquence de stimulation sur les conductivités estimées est analysé / EEG source localization is becoming an important tool for treating epileptic patients by localizing the epileptogenic zones before performing a resection surgery. Given a forward head model, EEG source localization is performed by solving the inverse problem. The forward head model is a biophysical model which describes the electrical distribution in the human head. When considering the propagation as the only way for the current distribution to move in the head, the focus is directed primarily on two parameters for having an accurate forward head model. These parameters are: the geometry of the head model and the conductivity value of each compartment of the head model. Due to the recent advances in computers and imaging techniques (like MRI and CT), it is possible to generate human head models that represent with a high accuracy the geometry of the real head. However, there is still an argument about the conductivity values and the method by which it should be estimated. In literature, the common values for conductivities come mostly from in-vitro experiments. In this work we are performing in-vivo conductivity estimation by considering the data of three epileptic patients. This data consists of MR images and CT scans for building a five-compartment FEM head model for each patient along with SEEG and EEG recordings that were acquired in simultaneous with intracerebral electrical stimulation (IES). The originality of this work lies in evaluating the performance of in-vivo conductivity estimation by EEG and/or SEEG measurements in function of different spatial parameters and locations of the IES. The following work consists of three major parts: the first part aims to determine the most robust optimization algorithm among common algorithms for optimizing the forward head model. The objective of the second part is to analyze the sensitivity of the conductivity values given different conditions on stimulation position, measurement positions and number of compartments. While in the final part, the conductivities of an isotropic and homogeneous five-compartment FEM head model were estimated with previously selected parameters for three drug-resistant epileptic patients. Finally the effect of changing the stimulation frequency on the estimated conductivities was determined

Les inhibiteurs sélectifs de recapture de la sérotonine (5-HT) (ISRS) bloquent directement le transporteur de la 5-HT (SERT) et stimulent indirectement de multiples auto- et hétérorécepteurs5-HT par l’augmentation de la concentration extracellulaire de 5-HT dans la fente synaptique. Cependant, le rôle des différents récepteurs ainsi que leur interaction dans les effets thérapeutiques des ISRS restent mal connus. Nous avons tenté de les identifier à l'aide de tests neurochimiques (microdialyse intracérébrale in vivo) et électrophysiologiques en utilisant une approche pharmacologique (utilisation de escitalopram, de ligands des récepteurs 5-HT1A/2A) et génétique (utilisation de souris knock-out [KO] SERT, 5-HT1A ou 5-HT2A). Les études neurochimiques et électrophysiologiques révèlent que les auto-(1A) et hétéro-(2A) récepteursagissent de concert pour maintenir une influence inhibitrice sur le système sérotoninergique, en particulier, en réponse au escitalopram : l'absence d'un récepteur est compensée par une régulation de l'autre. Enfin, les souris KO SERT constituent un nouveau modèle pour tester le mécanisme du escitalopram dans l’augmentation des concentrations de noradrénaline (NA). / Selective serotonin (5-HT) reuptake inhibitors (SSRIs) directly block the 5-HT transporter(SERT) and indirectly stimulate multiple 5-HT (auto- and hetero-) receptors by enhancing itsextracellular levels in the synaptic cleft, although the role of particular receptors as well asinteraction(s) among different receptors in the therapeutic effects of SSRIs is not fullyunderstood. We tried to highlight it using neurochemical (in vivo intracerebral microdialysis) andelectrophysiological tests with a pharmacological (using escitalopram, 5-HT1A/2A receptorsagonists and antagonists) and genetic (using SERT, 5-HT1A ou 5-HT2A receptor knock-out [KO]mice) approaches. Neurochemical and electrophysiological experiments indicated that 5-HT1Aauto- and 5-HT2A hetero-receptors act in concert to maintain an inhibitory influence on theserotonergic system, particularly in response of escitalopram to increased levels of endogenous 5-HT: the absence of one receptor being compensated by an up-regulation of the other. Finally,SERT knockout mice might be a new model to test the mechanism of escitalopram for anincrease of norephedrine (NE) level.

No description available.