The
interior of the normal brain cell carries a negative charge with
respect to the exterior. This charge (resting membrane potential)
is maintained by the sodium-potassium ATPase pump. When the brain
cell is excited, the membrane potential becomes more positive
until threshold is reached, the cell depolarises, and an action
potential is generated. Repolarisation occurs through activation
of the ATPase pump.
A
seizure occurs when brain cells spontaneously depolarise. There
are 2 basic pathophysiological processes that can result in the
development of seizures. These are:-
i)
excessive excitation of the cells increasing the likelihood of
depolarisation
or
ii)
loss of inhibition (disinhibition) of cell depolarisation.
For
example in hypoglycaemia the ATPase pump is deprived of energy
so that the cell resting potential is more positive and depolarisation
more likely. In some diseases eg hepatic encephalopathy, the
action of some inhibitory transmitters (eg GABA) at their specific
receptors is impaired. This lack of inhibition allows depolarisation
of cells to be triggered more easily.
Abnormal
electrical activity in the brain is usually confined to a small
area by surrounding inhibition. For a seizure to be propagated,
a cell or group of cells must depolarise. When depolarisation
is of a sufficient magnitude, the impulse will be conducted to
the entire brain producing a generalised seizure. A focal seizure
occurs when the electrical discharge does not spread across the
brain.
In
dogs seizures often occur in the middle of the night. During
low levels of awareness, drowsiness and dreamless sleep, decreased
activity in the reticular formation allows reverberating circuits
between the thalamus and the cortex to synchronize. Additionally,
some groups of neurons which are only mildly hyperactive when
the animal is awake, become more excitable during sleep.
Often
seizures arise from the same initial focus each time. Two phenomena
may affect seizure focus:
• |
Mirror
focus |
-
where a seizure focus creates similar activity in a corresponding
area of the contralateral hemisphere. |
|
|
|
• |
Kindling |
– where
occurrence of one seizure can increase the likelihood of
further seizures. With time both mirror foci and kindled
foci may form a new, independent seizure focus. |
Why
seizures terminate as rapidly as they begin is unknown. Metabolic
exhaustion of neurons is not an adequate explanation. There
may be specific areas of the brain ie within the cerebellum,
the caudate nucleus, parts of the thalamus and reticular formation
that inhibit impulse generation and have a role in termination
of seizure activity.
References
Lothman
EL (1990) The biochemical basis and pathophysiology
of status epilepticus. Neurology 40(suppl
2), 13-23. - PubMed -
March
PA (1998) Seizures: Classification, etiologies, and
pathophysiology. Clin Tech Small Anim Pract 13,
119-131.
- PubMed -
Platt
SR, McDonnell JJ (2000) Status epilepticus: Patient
management and pharmacologic therapy. Compendium on
Continuing Education for the Practicing Veterinarian 22(8),
722-729.
- Compendium -
|