Here, we show that an increase in the body temperature of rat pups leads to
a pronounced increase in the rate of respiration, which is followed by an increase
in brain pH that triggers ictal activity. That the ictogenesis in the present model
of febrile seizures
5,6 is causally connected to the respiratory alkalosis is
supported by several lines of evidence. First, there is an extensive amount of work
showing that alkalosis of brain tissue leads to enhanced neuronal excitability and
to epileptiform activity
20–30. We found that in the P8–P11
pups (i) seizure activity induced by hyperthermia had a well-defined pH threshold of
about 0.25 units; (ii) seizures were provoked by brain alkalosis of a similar
magnitude after injection of bicarbonate; (iii) an increase in the ambient
CO
2 to 5% blocked the hyperthermia-associated brain alkalosis
as well as the experimental febrile seizures, without affecting body temperature;
and (iv) the bicarbonate-induced pH changes and seizures were also blocked by
5% ambient CO
2. Finally, although hyperthermia led to a
moderate increase in respiratory frequency, there was no respiratory alkalosis and,
consistent with this, no seizures in rats at P22–P23. The dependence on
age of experimental febrile seizures has been well characterized
5,6 but, so far, no
clear explanation has been provided for the high propensity of rats for
hyperthermia-induced seizures at around P10. This topic will be discussed in detail
below.
Prevention of brain alkalosis and the consequent experimental febrile
seizures by 5% CO
2 blocked two types of hyperthermia-induced
changes at the level of neuronal communication and long-term plasticity: the
increase in the I
h current in hippocampal pyramidal neurons
10 and the increase in the expression of the CB1 cannabinoid receptor
12. Our data indicate that the upregulation of
both I
h and CB1 are caused by seizure activity and not by hyperthermia as such.
Moreover, we found that with regard to the long-term modulation of I
h and CB1, the effects of the hyperthermia-induced seizures were closely
mimicked by those caused by bicarbonate injection. This provides additional support
for the key role of brain alkalosis. We also show for the first time that robust,
hyperthermia-induced electrographic seizure activity can be recorded not only in the
hippocampus
6 but also in the temporal
cortex. A major conclusion that can be drawn from the present work, however, is that
the basic mechanisms underlying experimental febrile seizures cannot be elucidated
by focusing solely on hippocampal and cortical functions. It is obvious that the
temperature-sensitive mechanisms controlling respiratory activity and acid-base
homeostasis have a key role in the generation of experimental febrile seizures.
Despite the abundance of data on the age dependence of experimental febrile
seizures
5, previous work has shed little
light on the question of why the immature rat brain has a particularly high
susceptibility for the generation of hyperthermia-induced seizures at the end of the
second week of life. It should be noted that the experimental febrile seizures are
evoked in normal, healthy rat pups that do not have any specific pathological
susceptibility for hyperthermia-induced seizures. Our observations provide a new
view into this problem.
In mammals, the neuronal mechanisms that control respiration have the dual
task of playing an important role in thermoregulation and maintaining the partial
pressures of blood gases (both oxygen and CO
2) constant
18,36,37. But the immature neuronal mechanisms that
control respiration in the neonatal rat
19,38 are apparently not able to
cope with the above dual homeostatic functions when challenged by an abnormally high
increase in ambient temperature. The overall result is a thermal tachypnea that
strives to cool the body, but obviously does so at the expense of a net loss in
CO
2 homeostasis, which thereby becomes manifest as a substantial
respiratory alkalosis in brain tissue. It is of interest to note that the
CO
2 chemosensitivity of rat pups reaches a minimum at around P10 (ref.
39). Our observation that hyperthermia
leads to respiratory alkalosis in P8–P11 but not in P22–P23
rats are in agreement with the fact that the ‘nadir’ in
CO
2 chemosensitivity
39
coincides with the developmental time window in which the hyperthermia-induced
seizures have their lowest threshold
5,6.
It is widely assumed that experimental febrile seizures as studied in the
present rat pup model have, at least to a certain degree, a mechanistic basis
similar to simple and complex febrile seizures in children. The fact that
hyperthermia induces respiratory alkalosis in the immature brain leads to a number
of consequences that are likely to be relevant for the understanding of the basic
mechanisms underlying febrile seizures and related disorders, such as febrile
seizures plus (FS+) and generalized epilepsy with febrile seizures plus
(GEFS+)
40,41. In addition to abnormalities in hippocampal and
cortical functions, the disease mechanisms underlying FS, FS+ and
GEFS+ may involve neuronal mechanisms that control respiration and
acid-base homeostasis. Obviously, homeostatic malfunctions of these types are not
mutually exclusive, and various kinds of susceptibility factors may coexist in an
individual. There is notably little information available on the effects of fever on
respiratory functions in children
14. Hence,
data from blood gas analyses (especially of CO
2) during fever-related
epileptic episodes will be important in order to further examine the relevance of
the present observations for the human condition.
In future studies, it will be interesting to study whether some of the ion
channel gene mutations underlying febrile seizures, FS+ and
GEFS+ have an influence on the pH sensitivity of the corresponding
mutated channels
31,32,42.
Furthermore, in view of the polygenic heterogeneity underlying epilepsy
32, genes coding for proteins involved in the
control of respiration
36,37 provide a novel, functionally attractive class of
candidate modifier or susceptibility genes for epilepsy. This, of course, does not
exclude genuinely temperature-sensitive mechanisms in FS+,
GEFS+ and other kinds of fever-related epileptic syndromes
43.
The blocking effect of ambient 5% CO
2 on the
experimental febrile seizures in the rat pups was markedly fast and potent, with a
delay of only ~ 20 s to a complete suppression of electrographic ictal activity. The
prompt action of CO
2 raises the possibility that, also in children,
ongoing ictal activity associated with fever could be quickly suppressed by a rise
in ambient CO
2. Notably, CO
2 also prevented the conspicuous
effects on long-term neuronal plasticity that are known to take place after
hyperthermia-induced seizures
9–12. In conclusion,
our work indicates a mechanism for triggering hyperthermia-induced seizures and
suggests new strategies in the research and therapy of fever-related epileptic
syndromes.