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PubMed2005

SUNCT: a new case with some unusual features.

A healthy 22-year-old man complained of primary stabbing headache (PSH) for about two months. The headache recurred after one year and after a month the pain took on the characteristics of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). This patient shows some unusual features: juvenile onset, miosis during attacks as part of autonomic phenomena and close temporal relationship with stressful events. The association between PSH and SUNCT may be interpreted as the coexistence of two different headaches or that the PSH is a forerunner to the SUNCT.

Adult↗
PubMed2003

GABAergic mechanisms involved in the vagally mediated heart rate response to muscle contraction as revealed by studies with benzodiazepines.

The aim of this study was to determine if central GABA mechanisms are involved in the cardiac vagal withdrawal at the beginning of exercise in man. We tested whether GABA-enhancing effects of a benzodiazepine could be observed in the HR change (R-R interval) immediately following the onset of a brief (10s) isometric contraction (60 % maximum) of the biceps muscle. The difference between the change in R-R interval occurring during the same phase of respiration was compared for placebo (Pla) and 10 mg oral diazepam (Dz) treatment in a double blind, crossover trial. ECG, blood pressure, respiration and biceps muscle tension were recorded. The subjects breathed to a metronome and R-R interval measurements were plotted for early and late inspiration and early and late expiration. The mean values of the first late expiration R-R interval immediately following the start of contraction in early expiration were compared to the same measurements without contraction. Contractions initiated following diazepam treatment resulted in a significantly greater reduction in R-R interval (P < 0.05) implying that GABAergic suppression of cardiac vagal outflow may be responsible for contraction-induced tachycardia in man.

Adolescent↗
PubMedDate not supplied

Transition from upbeat to downbeat nystagmus observed in a patient with Wernicke's encephalopathy.

BACKGROUND: We report an unusual case of Wernicke's encephalopathy presenting with transient upbeat nystagmus that changed to a persistent downbeat nystagmus. CASE: A 27-year-old man presented with upbeat nystagmus. Three months earlier, he had been diagnosed with Wernicke's encephalopathy after fasting for a month. OBSERVATIONS: This diagnosis was supported by his symptoms (ataxia, a confused state). Clinical recovery followed thiamine therapy. His upbeat nystagmus had linear slow phases with average amplitude and frequency (+/-SD) during fixation straight ahead of 2.8 +/- 0.7 degrees and 4.6 +/- 2.2 Hz, respectively. Two months later, the primary position upbeat nystagmus had diminished and downbeat nystagmus (0.9 +/- 0.5 degrees and 3.2 +/- 0.7 Hz on average) for a 20 degrees downward gaze had developed. Then, 8 months later, he showed only downbeat nystagmus, which obeyed Alexander's law. His primary position downbeat nystagmus was completely suppressed by clonazepam, a gamma-aminobutyric acid (GABA) agonist. CONCLUSIONS: Owing to an underlying central vestibular imbalance, even after the recovery of acute neurological symptoms, Wernicke's encephalopathy can be complicated by persistent downbeat nystagmus, which can be treated by a GABA agonist.

Adult↗
PubMed2004

Baseline plasma GABA: its relationship to the adverse effects of acute lorazepam administration on cognition in the elderly.

The GABA system is an active target for drugs to treat a variety of disorders and the availability of an indirect measure of central GABA activity would not only enhance psychiatric research, but also permit assessment of the pharmacodynamic effects of drugs designed to act on this system. The relationships between plasma baseline pre-drug GABA concentrations and cognitive impairments induced by an acute oral dose of lorazepam (0.5 and 1.0 mg) were investigated in 22 healthy elderly individuals. Partial correlations controlling for plasma lorazepam concentrations revealed no significant relationship between baseline plasma GABA levels and lorazepam-induced impairments on tests of cognitive functioning. Plasma GABA concentration does not appear to be a useful marker of susceptibility to benzodiazepine-induced cognitive toxicity in the elderly. Other approaches to estimating central GABA activity should be pursued.

Affect↗
PubMed2002

The current state of treatment of status epilepticus.

There have been many important developments in the diagnosis and treatment of status epilepticus in the recent past. Earlier treatment, including at home by caregivers and in the field by paramedics, has been shown to be safe and effective. Rapid-acting anesthetic agents, such as midazolam and propofol, are being used more often for refractory status epilepticus, though clinical trials are lacking. Nonconvulsive status epilepticus is being considered and recognized more often, including in ambulatory patients with a confusional state, after convulsive status epilepticus, and in critically ill patients. Modern technology and continuous digital electroencephalogram (EEG) recordings have taught us many things, but have raised at least as many questions. Much work needs to be done regarding the significance of certain EEG patterns (particularly periodic discharges) and when and how to treat them. This article reviews these issues, concentrating on recent advances and practical issues related to the clinical care of patients with status epilepticus.

Animals↗
PubMed1995

Benzodiazepines as antidepressants: does GABA play a role in depression?

Benzodiazepines, the most widely prescribed psychotropic drugs, are often used in patients with depressive disorders, either alone or in combination with standard antidepressants. This review evaluates the efficacy of benzodiazepines (alprazolam, diazepam, chlordiazepoxide) as established in acute-phase, randomized controlled trials (RCTs) in major depressive disorder. Metaanalyses using intent-to-treat, as well as adequate treatment exposure samples, revealed an overall efficacy of 47-63% and a drug-placebo difference of 0-27% for all benzodiazepines. Alprazolam, the best studied of the benzodiazepines, had a 27.1% (sd = 6.1%) greater response than placebo, which is comparable to standard antidepressants. Alprazolam, in particular, may be a useful treatment option for patients in whom standard antidepressant medications are contraindicated, poorly tolerated, or possibly ineffective. Alprazolam may have a more rapid onset of action for some patients. Benzodiazepines do not primarily affect biogenic amine uptake or metabolism, although they do augment gamma-amino butyric acid (GABA) activity. The antidepressant efficacy of benzodiazepines, which are GABAA receptor agonists, is consistent with the GABA theory of depression.

Alprazolam↗
PubMed1995

Cerebrospinal fluid gamma-aminobutyric acid in patients with panic disorder.

Cerebrospinal fluid (CSF) gamma-aminobutyric acid (GABA) levels were measured in 11 patients with panic disorder (PD) prior to and following 7 months of treatment with alprazolam or imipramine and in six neurological control patients. Although a clear treatment response was observed in patients with PD, neither alprazolam nor imipramine significantly changed CSF GABA during the treatment period. A negative correlation was demonstrated between baseline CSF GABA and posttreatment overt psychopathology. Low pretreatment level of CSF GABA correlated significantly with poor therapeutic outcome, judged by the amount of anxiety and depression as well as by the frequency of panic attacks at the end of follow-up.

Adult↗
PubMed1996

A study of the potential confounding effects of diet, caffeine, nicotine and lorazepam on the stability of plasma and urinary homovanillic acid levels in patients with schizophrenia.

Ten men inpatients who met DSM-III-R criteria for schizophrenia participated. On five occasions at least one week apart, each subject had an intravenous line placed at 0730 after an overnight fast. On each occasion blood samples were drawn at 0800 and hourly thereafter through 1200 noon for measurement of plasma homovanillic acid (HVA). Total four-hour urine collections were obtained for measurement of urinary HVA. Subjects received five experimental conditions, in randomized sequence: no intervention, smoking one cigarette per hour, drinking one caffeinated cola per hour, lorazepam 2 mg IV push, or a high monoamine meal. Baseline (0800) plasma HVA measures showed only minor intrinsic variability. The average standard deviation in baseline plasma HVA over five occasions of measurement was low relative to the changes in HVA produced during treatment with antipsychotic medications. The high monoamine meal significantly elevated plasma HVA, with a similar trend for urinary HVA. Neither caffeine, nicotine, nor lorazepam significantly affected plasma or urinary HVA.

Adult↗
PubMed1984

Actions of ATP on the soma of bullfrog primary afferent neurons and its modulating action on the GABA-induced response.

Adenosine 5'-triphosphate (ATP) produced a long-lasting depolarization in bullfrog spinal ganglion cells. Since the ATP-induced slow depolarization was associated with an increase in membrane resistance and a reverse in polarity (about--90 mV) which was most likely brought about by an inactivation of membrane potassium conductance. In some cells, a rapid and transient depolarization followed by the long-lasting depolarization was produced by ATP and it was markedly reduced in sodium-free solution. ATP reversibly augmented the GABA-induced depolarization which was caused by ionophoresis of GABA. These observations were confirmed using a voltage clamp method. Dose-response analysis of the action of ATP on the GABA-induced response suggests that the facilitatory action of ATP on the GABA response is effected on the GABA receptor channel complexes without changing the GABA affinity.

Adenosine Triphosphate↗
PubMed1985

Binding of [3H]Ro 5-4864 in primary cultures of astrocytes.

Intact primary cultures of astrocytes display benzodiazepine receptors, which can be labeled with [3H]Ro 5-4864. Binding of [3H]Ro 5-4864 is specific, saturable and temperature dependent, being maximal at 0 degrees C. Scatchard analyses show a single population of high affinity binding sites with a Kd value of 6.7 nM and a Bmax value of congruent to 12,000 fmol/mg protein. The binding reaches equilibrium at congruent to 100 min, with k+1 of 0.0078 nM-1 X min-1 and is rapidly reversible with k-1 of 0.057 min-1. [3H]Ro 5-4864 binding is not modulated by GABA. Certain benzodiazepines (flunitrazepam, diazepam, Ro 7-3351) and dipyridamole displace this binding with IC50 values in the nanomolar range, whereas other benzodiazepines (alprazolam, clonazepam, chlordiazepoxide) as well as carbamazepine, phenytoin and phenobarbital have IC50 values in the micromolar range. These characteristics resemble those of Ro 5-4864 binding to brain membrane preparations reported by other authors and thus indicate that the cultured astrocytes are good models of their in vivo counterparts.

Animals↗
PubMed1987

Localization of benzodiazepine-like molecules in the rat brain. A light and electron microscopy immunocytochemistry study with an anti-benzodiazepine monoclonal antibody.

The anti-benzodiazepine (BZD) monoclonal antibody 21-7F9 was used with light and electron microscopy immunocytochemistry techniques for studying the distribution of BZD-like molecules in the rat brain. With light microscopy, BZD-like immunoreactivity was found throughout the brain, mainly in neurons and occasionally in some glial cells (in periventricular areas, as well as in some perivascular astrocytes). Despite the fact that in the cerebellum the GABAergic neurons exhibit BZD-like immunoreactivity, co-localization of these two molecules is not exact, since there are also BZD-like positive neurons that are non-GABAergic (e.g., cerebellar granule cells, some neocortical and hippocampal pyramidal cells). Ultrastructural study of the cerebellar cortex disclosed that all neuronal categories were immunoreactive, as were some astrocytes within the granular layer. The reaction product was concentrated in neuronal perikarya and dendritic processes. Axons and axon terminals remained mostly unlabeled. The absence of immunoprecipitate within cytoplasmic organelles (Golgi apparatus, mitochondria, lumen of endoplasmic reticulum) and its presence at the cytoplasmic face of the cell membranes strongly suggests that endogenous BZD-like molecules are present in both the soluble cytoplasm (hyatoplasm), and also in association with both external and internal cell membranes. The results suggest that the brain BZD-like molecules might be functionally involved in either the modulation of GABA neurotransmission and/or the biotransformation, accumulation and elimination of benzodiazepines and benzodiazepine-like molecules in the brain.

Animals↗
PubMed1987

Microinjections of the gamma-aminobutyrate antagonist, bicuculline methiodide, into the caudate-putamen prevent amygdala-kindled seizures in rats.

We used amygdala-kindled seizures in rats to study the function of striatal gamma-aminobutyrate (GABA) in the regulation of the seizure threshold of the limbic forebrain. Microinjections of the GABAA antagonist, bicuculline methiodide, 1 pmol, into the caudate-putamen protected rats against amygdala-kindled seizures. This result shows that striatal GABA differentially modulates the threshold for limbic seizures.

Amygdala↗
PubMed1989

Co-administration of Ro 15-1788 prevents diazepam-induced retardation of recovery of function.

Following unilateral lesions of the anteromedial cortex, recovery from somatosensory asymmetry reliably occurs within about 10 days. Chronic exposure to diazepam significantly delays this recovery. In the present study, co-administration of Ro 15-1788, a benzodiazepine antagonist (i.e. it blocks the negative and positive allosteric modulation of GABA), prevented diazepam-induced retardation of recovery from somatosensory asymmetry. Nocturnal ambulatory (motor) activity was not different between rats receiving diazepam-alone and those receiving Ro 15-1788 in combination with diazepam. These data suggest that the benzodiazepine receptor is importantly involved in the detrimental effects of diazepam on recovery, and that non-specific behavior sedation plays little or no role.

Animals↗
PubMed1992

Regulation of the prefrontal cortical dopamine system by the neuroactive steroid 3a,21-dihydroxy-5a-pregnane-20-one.

The dopamine innervation of the prefrontal cortex can be differentiated from other telencephalic dopamine projection fields by its sensitivity to stress. The stress-induced activation of the mesoprefrontal cortical dopamine system can be blocked by pretreatment with benzodiazepines. A group of neuroactive steroids that modulate GABA-induced chloride flux through means distinct from that of the benzodiazepines has recently been identified. Intraventricular administration of the neuroactive steroid 3 alpha,21-dihydroxy-5 alpha-pregnane-20-one resulted in a dose-dependent decrease in dopamine metabolites in the prefrontal cortex, but not in mesolimbic or striatal sites; sedative effects were not observed. Moreover, the neuroactive steroid selectively attenuated the stress-induced activation of the mesoprefrontal cortical dopamine system. These data suggest that neuroactive steroids may function as endogenous anxiolytic agents.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1993

Norepinephrine turnover in the goldfish brain is modulated by sex steroids and GABA.

It is known that norepinephrine (NE) is important in the neuroendocrine control of pituitary gonadotropin II (GTH-II) and growth hormone (GH) release but very little is known about the factors regulating NE neurons in the goldfish brain. Female gonad-intact goldfish were implanted intraperitoneally (100 micrograms/g) with testosterone (T) or estradiol (E2) to elevate serum steroid levels. High-performance liquid chromatography measurements showed that steroid implantation had no effect on NE content in the telencephalon, including preoptic area (TEL-POA), or the hypothalamus (HYP). The turnover rate of NE was estimated from the rate of depletion of NE content from tissues following inhibition of tyrosine hydroxylase by alpha-methyl-p-tyrosine (240 micrograms/g). The present study demonstrates that E2 can decrease NE turnover rates in TEL-POA and HYP of sexually regressed goldfish (August). The results in recrudescent fish (November), however, indicate a more complex interaction of E2 with NE neurons since E2 increased NE turnover in TEL-POA and HYP in these animals. Testosterone (T) has less prominent effects on NE turnover rates in TEL-POA and HYP; the only significant effect of T-implantation was a small reduction of NE turnover in the TEL-POA of sexually recrudescent fish. Elevation of endogenous brain GABA concentrations by injection of the GABA transaminase inhibitor, gamma-vinyl-GABA (300 micrograms/g), significantly reduced NE turnover in TEL-POA. These data demonstrate that goldfish NE neurons in the TEL-POA are sensitive to regulation by changes in circulating sex steroids and by increases in brain GABA.

4-Aminobutyrate Transaminase↗
PubMed1996

The neuroanatomical specificity of the anxiolytic effects of intra-septal infusions of midazolam.

Microinfusions of the benzodiazepine anxiolytic midazolam into the lateral but not the medial septum suppressed fear reactions in two test of rat 'anxiety'. Midazolam infusions into the lateral septal nuclei increased open-arm exploration in the elevated plus-maze test, and blocked burying behavior in the shock-probe test, whereas midazolam infusions into the medial septum produced neither of these anxiolytic effects. The anxiolytic effects of midazolam in the lateral septum were partially blocked by pre-infusion of the benzodiazepine receptor antagonist Ro15-1788, which had no intrinsic effects by itself. These results suggest that the anxiolytic effects of intra-septal midazolam occur, at least in part, at GABAA-benzodiazepine receptor sites located in the lateral septal nuclei.

Animals↗
PubMed1996

Effect of a pharmacological stressor on glutamate efflux in the prefrontal cortex.

The anxiogenic beta-carboline, FG 7142 (20 mg/kg) significantly increased glutamate efflux in the prefrontal cortex of conscious rats as assessed by microdialysis. Pretreatment with the benzodiazepine receptor agonist, diazepam (5 mg/kg), abolished this effect. These findings indicate that anxiogenic compounds produce an effect similar to physical stressors on the outflow of glutamate, and implicate the GABA/benzodiazepine receptor complex in the stress-induced activation of glutamate systems in the prefrontal cortex.

Animals↗
PubMed1995

Pharmacodynamic modeling of the electroencephalographic effects of flumazenil in healthy volunteers sedated with midazolam.

The purpose of this study was to model pharmacodynamically the reversal of midazolam sedation with flumazenil. Ten human volunteers underwent four different sessions. In session 1, individual midazolam pharmacokinetics and electroencephalographic pharmacodynamics were determined. In sessions 2 and 3, a computer-controlled infusion of midazolam with individual volunteer pharmacokinetic data was administered, targeting a plasma concentration corresponding to a light or deep level of sedation (20% or 80% of the maximal midazolam electroencephalographic effect) for a period of 210 minutes. After obtaining a stable electroencephalographic effect and constant midazolam plasma concentrations, a zero-order infusion of flumazenil was started until complete reversal of midazolam electroencephalographic effect was obtained. The flumazenil infusion was then stopped and the volunteer was allowed to resedate because of the constant midazolam drug effect. The electroencephalographic response was measured during a 180-minute period and analyzed by aperiodic analysis and fast-Fourier transforms. In session 4, a midazolam plasma concentration corresponding to a deep level of sedation was targeted for 210 minutes to examine for the possible development of acute tolerance. No flumazenil was given in session 4. For a light sedation level, with a mean midazolam plasma concentration of 160 +/- 64 ng/ml, the mean half-life of the equilibration rate constant of flumazenil reversal is 5.0 +/- 2.5 minutes, and the mean effect site concentration causing 50% of Emax is 13.7 +/- 5.8 ng/ml. For a deep level of sedation, with a mean midazolam plasma concentration of 551 +/- 196 ng/ml, the mean half-life of the equilibration rate constant is 3.9 +/- 1.5 minutes, and the mean effect site concentration causing 50% of Emax is 20.6 +/- 6.8 ng/ml. This study provides an estimate of the magnitude of the blood/central nervous system equilibration delay for flumazenil antagonism of midazolam sedation and further defines the usefulness of the electroencephalogram as a measure of midazolam pharmacodynamic effect.

Adult↗