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Neurosteroids and epilepsy

Biagini, Giuseppea; Panuccio, Gabriellab; Avoli, Massimob,c

doi: 10.1097/WCO.0b013e32833735cf
Seizure disorders: Edited by Michael Sperling

Purpose of review: Neurosteroids are a family of compounds synthesized directly in the brain by transforming cholesterol into pregnenolone, which is then converted to compounds such as allopregnanolone and allotetrahydrodeoxycorticosterone. In view of their ability to modulate neurotransmission, neurosteroids may influence the clinical course of epileptic disorders. In this review, we highlight two emerging properties of neurosteroids, that is, their anticonvulsant and antiepileptogenic activities.

Recent findings: It has been shown that fluctuations in neurosteroid synthesis, such as those seen in response to stress or during the ovarian cycle, determine an increase in seizure threshold. Moreover, increased neurosteroid synthesis, presumably occurring in glial cells during epileptogenesis, delays the appearance of recurrent spontaneous seizures in an animal model of temporal lobe epilepsy; such an effect may be due to augmented tonic γ-aminobutyric acid type A receptor-mediated inhibition. Finally, clinical trials with ganaxolone, an allopregnanolone analogue, have demonstrated beneficial effects in pharmacoresistant epileptic patients, whereas finasteride – which interferes with neurosteroid synthesis – facilitates seizures in catamenial epilepsy.

Summary: The overall evidence suggests that neurosteroids may represent a novel therapeutic strategy in epileptic disorders and a future perspective to control epileptogenicity.

aDipartimento di Scienze Biomediche, Università di Modena and Reggio Emilia, Modena, Italy

bMontreal Neurological Institute and Departments of Neurology and Neurosurgery and of Physiology, McGill University, Montréal, Québec, Canada

cDipartimento di Medicina Sperimentale, Prima Facoltà di Medicina e Chirurgia, Sapienza Università di Roma, Rome, Italy

Correspondence to Massimo Avoli, MD, PhD, McGill University, Montreal Neurological Institute, 3801 University, room 794, Montreal, QC H3A 2B4, Canada Tel: +1 514 998 6790; e-mail: massimo.avoli@mcgill.ca

© 2010 Lippincott Williams & Wilkins, Inc.