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Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Several aspects of thermoregulation play a role in epilepsy. Circuitries involved in thermoregulation are affected by seizures and epilepsy, hyperthermia may be both cause and result of seizures, and hypothermia may prevent or abort seizures. Autonomic manifestations of seizures including thermoregulatory disturbances are common in a variety of clinical epilepsy syndromes. Experimental hyperthermia has been studied extensively, predominantly to investigate febrile seizures of childhood. In particular prolonged or complex febrile seizures have been associated with the later development of epilepsy in adulthood and the pathophysiology of how febrile seizures cause epilepsy is of tremendous interest. Febrile seizures represent an opportunity to potentially intervene early in life in susceptible individuals and affect epileptogenesis. The pathophysiologic underpinnings of how hyperthermia induces seizures and how this in turn results in epilepsy are controversial, but likely involve multiple factors. Both glutamatergic and GABAergic neurotransmission is affected, and numerous mutations in genes encoding ion channels have been identified. Cytokines such as interleukin-1β have been implicated in febrile seizures as well as susceptibility to provoked seizures later in life. Hyperthermia is a common feature of generalized convulsive status epilepticus, but may also be seen with nonconvulsive seizures, indicating involvement of thermoregulatory centers., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: Subdural hematomas (SDH) are associated with seizures and epileptiform discharges, but little is known about the prevalence and impact of seizures, status epilepticus (SE), and epileptiform discharges on outcomes in patients with isolated acute SDH (aSDH)., Methods: Continuous EEG reports from 76 adult patients admitted to Rush University Medical Center with aSDH between January 2009 and March 2012 were reviewed. Clinical and radiographic findings, comorbidities, treatment, and outcome parameters, such as mortality, discharge destination, need for tracheostomy/percutaneous endoscopic gastrostomy placement, and length of stay (LOS), were assessed. Univariate and multivariate analyses were performed to assess the impact of clinical seizures, SE, and epileptiform EEG on outcomes., Results: Of 76 patients with aSDH who underwent EEG monitoring, 74 (97.4%) received antiseizure prophylaxis. Thirty-two (41.1%) patients had seizures, most of which were clinical seizures. Twenty-four (32%) patients had epileptiform EEG findings. Clinical or nonconvulsive SE was diagnosed in 12 (16%) patients. Clinical seizures were not associated with outcome parameters. Epileptiform EEG findings were independently associated with longer hospital LOS (13 vs. 8 days, P = 0.04) and intensive care unit LOS (10 vs. 4 days, P = 0.002). The SE also predicted longer intensive care unit LOS (10 vs. 4 days, P = 0.002). Neither epileptiform EEG nor SE was significantly related to mortality, discharge destination, or need for tracheostomy/percutaneous endoscopic gastrostomy placement., Conclusions: Seizures and epileptiform EEG findings are very common in patients with aSDH despite antiseizure prophylaxis. While clinical seizures did not affect outcomes, the presence of epileptiform EEG findings and SE was independently associated with longer intensive care unit LOS and hospital LOS.

Long-term memory (LTM) of fear stores activity dependent modifications that include changes in amygdala signaling. Previously, we identified an enhanced probability of release of glutamate mediated signaling to be important in rat fear potentiated startle (FPS), a well-established translational behavioral measure of fear. Here, we investigated short- and long-term synaptic plasticity in FPS involving metabotropic glutamate receptors (mGluRs) and associated downstream proteomic changes in the thalamic-lateral amygdala pathway (Th-LA). Aldolase A, an inhibitor of phospholipase D (PLD), expression was reduced, concurrent with significantly elevated PLD protein expression. Blocking the PLD-mGluR signaling significantly reduced PLD activity. While transmitter release probability increased in FPS, PLD-mGluR agonist and antagonist actions were occluded. In the unpaired group (UNP), blocking the PLD-mGluR increased while activating the receptor decreased transmitter release probability, consistent with decreased synaptic potentials during tetanic stimulation. FPS Post-tetanic potentiation (PTP) immediately following long-term potentiation (LTP) induction was significantly increased. Blocking PLD-mGluR signaling prevented PTP and reduced cumulative PTP probability but not LTP maintenance in both groups. These effects are similar to those mediated through mGluR7, which is co-immunoprecipitated with PLD in FPS. Lastly, blocking mGluR-PLD in the rat amygdala was sufficient to prevent behavioral expression of fear memory. Thus, our study in the Th-LA pathway provides the first evidence for PLD as an important target of mGluR signaling in amygdala fear-associated memory. Importantly, the PLD-mGluR provides a novel therapeutic target for treating maladaptive fear memories in posttraumatic stress and anxiety disorders., (Published by Elsevier Inc.)

Background: Although subdural hematoma (SDH) is common in neurocritical practice, little is known about SDH patients requiring prolonged mechanical ventilation (PMV). We aimed to determine predictors of PMV and its relationship with outcome in patients with SDH., Methods: SDH patients admitted to Rush University neurointensive care unit from January 2009 to March 2012 were reviewed. Duration of intubation, pulmonary complications, demographics, treatment, discharge disposition, and length of stay (LOS) were reviewed. PMV was defined as duration of intubation >4 days. Univariate and multivariate analyses were performed to identify predictors of PMV and association with outcome among survivors with SDH., Results: Of the 288 survivors with SDH, the mean age was 68, and of them 179 were male. A total of 137 required surgical SDH evacuation. Pneumonia occurred in 26 patients. Forty-eight patients (17%) required intubation, with duration of intubation being 1 to 20 days (median 3.0). Factors independently associated with PMV included alcohol abuse (OR, 4.31; 95% CI, 1.36-13.67), admission GCS<15 (OR, 11; 95% CI, 2.36-51.52), and surgical evacuation (OR, 9.27; 95% CI, 1.93-44.54). PMV predicted pneumonia (OR, 5.85; 95% CI, 1.52-22.57), tracheostomy (OR, 26.67; 95% CI, 2.93-242.67), increased LOS, and unfavorable discharge destination (OR, 73.1; 95% CI, 14.03-380.69)., Conclusions: PMV is associated with pulmonary complications, increased LOS, and unfavorable discharge destination in patients with SDH. Alcohol abuse, admission GCS, and surgical evacuation are associated with PMV among patients with SDH. Future studies should investigate the role of early tracheostomy in high-risk patients and impact on outcomes.

Objective: Cortical spreading depolarizations are a pathophysiological mechanism and candidate target for advanced monitoring in acute brain injury. Here we investigated manifestations of spreading depolarization in continuous electroencephalography (EEG) as a broadly applicable, noninvasive method for neuromonitoring., Methods: Eighteen patients requiring surgical treatment of traumatic brain injury were monitored by invasive electrocorticography (ECoG; subdural electrodes) and noninvasive scalp EEG during intensive care. Spreading depolarizations were first identified in subdural recordings, and EEG was then examined visually and quantitatively to identify correlates., Results: A total of 455 spreading depolarizations occurred during 65.9 days of simultaneous ECoG/EEG monitoring. For 179 of 455 events (39%), depolarizations caused temporally isolated, transient depressions of spontaneous EEG amplitudes to 57% (median) of baseline power. Depressions lasted 21 minutes (median) and occurred as suppressions of high-amplitude delta activity present as a baseline pattern in the injured hemisphere. For 62 of 179 (35%) events, isolated depressions showed a clear spread of depression between EEG channels with delays of 17 minutes (median), sometimes spanning the entire hemisphere. A further 188 of 455 (41%) depolarizations were associated with continuous EEG depression that lasted hours to days due to ongoing depolarizations. Depolarizations were also evidenced in EEG as shifts in direct current potentials., Interpretation: Leão's spreading depression can be observed in clinically standard, continuous scalp EEG, and underlying depolarizations can spread widely across the injured cerebral hemisphere. These results open the possibility of monitoring noninvasively a neuronal pathophysiological mechanism in a wide range of disorders including ischemic stroke, subarachnoid hemorrhage, and brain trauma, and suggest a novel application for continuous EEG., (© 2014 American Neurological Association.)

Cocaine relapse can occur when cocaine-associated environmental cues induce craving. Conditioned place preference (CPP) is a behavioral paradigm modeling the association between cocaine exposure and environmental cues. The amygdala is involved in cocaine cue associations with the basolateral amygdala (BLA) and central amygdala (CeA) acting differentially in cue-induced relapse. Activation of metabotropic glutamate receptors induces synaptic plasticity, the mechanism of which is thought to underlie learning, memory and drug-cue associations. The goal of this study was to examine the neural alterations in responses to group I metabotropic glutamate receptor (mGluR) agonists in the BLA to lateral capsula of CeA (BLA-CeLc) pathway in slices from rats exposed to cocaine-CPP conditioning and withdrawn for 14 days. mGluR1, but not mGluR5, agonist-induced long-term potentiation (mGluR1-LTP) in the BLA-CeLc pathway was reduced in rats withdrawal from cocaine for 2 and 14 days, and exhibited an altered concentration response to picrotoxin. Cocaine withdrawal also reduced γ-aminobutyric acid (GABA)ergic synaptic inhibition in CeLc neurons. Blocking cannabinoid receptor 1 (CB(1) ) reduced mGluR1-LTP in the saline-treated but not cocaine-withdrawn group. Response to CB(1) but not CB(2) agonist was altered after cocaine. Additionally, increasing endocannabinoid (eCB) levels abolished mGluR1-LTP in the saline but not cocaine-withdrawn group. However, CB(1) and CB(2) protein levels were increased in the amygdala of cocaine-withdrawn rats while mGluR1 and mGluR5 remained unchanged. These data suggested that the mechanisms underlying the diminished mGluR1-LTP in cocaine-withdrawn rats involve an altered GABAergic synaptic inhibition mediated by modulation of downstream eCB signaling. These changes may ultimately result in potentiated responses to environmental cues that would bias behavior toward drug-seeking., (© 2011 The Authors. European Journal of Neuroscience © 2011 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.)

Corticotropin-releasing factor (CRF) in the amygdala is involved in stress responses. Moreover, dopaminergic neurotransmission in the brain reward system including the amygdala plays a significant role in the pathology of cocaine addiction. The present study analysed CRF-induced synaptic plasticity, its pharmacological sensitivity and interactions with the dopamine (DA) system in the basolateral to lateral capsula central amygdala (lcCeA) pathway after a 2-week withdrawal from repeated cocaine administration. A physiologically relevant CRF concentration (25 nm) induced long-term potentiation (LTP) that was enhanced after cocaine withdrawal. In saline-treated rats, CRF-induced LTP was mediated through N-methyl-d-aspartate (NMDA) receptors, L-type voltage-gated calcium channels (L-VGCCs) and CRF(1) receptors. However, in cocaine-withdrawn animals, activation of CRF(1) and CRF(2) receptors was found to enhance LTP. This enhanced CRF-induced LTP after cocaine withdrawal was mediated through endogenous activation of both D1- and D2-like receptors. Furthermore, expression of the D1 receptor (D1R) but not the D2R, D3R, D4R or D5R was significantly increased after cocaine withdrawal. CRF(1) but not CRF(2) protein expression was increased, suggesting that elevated levels of these proteins contributed to the enhancement of CRF-induced LTP during cocaine withdrawal. CRF interactions with the DA system in the amygdala may represent a fundamental neurochemical and cellular mechanism linking stress to cocaine-induced neuronal plasticity.

The amygdala is part of the brain reward circuitry that plays a role in cocaine-seeking and abstinence in animals and cocaine craving and relapse in humans. Cocaine-seeking is elicited by cocaine-associated cues, and the basolateral amygdala (BLA) and CeA are essential in forming and communicating drug-related associations that are thought to be critical in long-lasting relapse risk associated with drug addiction. Here we simulated a cue stimulus with high-frequency stimulation (HFS) of the BLA-CeA pathway to examine mechanisms that may contribute to drug-related associations. We found enhanced long-term potentiation (LTP) after 14-day but not 1-day withdrawal from 7-day cocaine treatment mediated through N-methyl-d-aspartate (NMDA) receptors (NRs), L-type voltage-gated calcium channels (L-VGCCs), and corticotropin-releasing factor (CRF)(1) receptors; this was accompanied by increased phosphorylated NR1 and CRF(1) protein not associated with changes in NMDA/AMPA ratios in amygdalae from cocaine-treated animals. We suggest that these signaling mechanisms may provide therapeutic targets for the treatment of cocaine cravings.

Cocaine addiction is an enduring, relapsing, behavioural disorder in which stressors reinstate cocaine-seeking even after prolonged abstinence. Evidence suggests that the 'anxiety-like' behaviour and stress associated with protracted withdrawal may be mediated by increased corticotropin-releasing factor (CRF) in the central nucleus of the amygdala (CeA), a part of the limbic circuitry engaged in the coding and transmission of stimulus-reward associations. In the present study we describe a long-lasting potentiation of glutamatergic transmission induced at lateral amygdala (LA)-to-CeA synapses by rat/human CRF. After 2 weeks of withdrawal from repeated intermittent exposure to cocaine, CRF-induced long-term potentiation (LTP) was greatly enhanced compared to the respective saline control group while, after short-term withdrawal (24 h), there was no significant difference between the two treatment groups, indicating alterations in CRF systems during protracted withdrawal from chronic cocaine. After prolonged withdrawal, CRF-induced LTP was dependent on activation of CRF2, CaV2.3 (R-type) calcium channels and intracellular signalling through protein kinase C in both saline- and cocaine-treated groups. The enhanced CRF-induced LTP after 2 weeks of withdrawal was mediated through augmented CRF1 receptor function, associated with an increased signalling through protein kinase A, and required N-methyl-D-aspartate (NMDA) receptors. Accordingly, single-cell recordings revealed a significantly increased NMDA/AMPA ratio after prolonged withdrawal from the cocaine treatment. These results support a role for CRF1 receptor antagonists as plausible treatment options during withdrawal from chronic cocaine and suggest Ca(V)2.3 blockers as potential candidates for pharmaceutical modulation of CRF systems.

Electrophysiological recordings from identified synapses in CNS slice preparations in vitro provide important information regarding the connectivity of neuronal circuits and the underlying cellular mechanisms responsible for neuronal excitability and synaptic transmission. We present an anatomical, electrophysiological, and pharmacological characterization of a novel brain slice preparation (BLA-mPFC) to investigate basolateral amygdala synaptic input to rat layer V medial prefrontal cortex pyramidal neurons. A fluorescent tracer (DiI) unilaterally infused in vivo into the basolateral amygdala was used to detect amygdala efferent fibers innervating layer V of the prelimbic and infralimbic cortices within prefrontal cortex slices. In vitro, evoked synaptic responses elicited by stimulating identified basolateral amygdala pathway terminals within the acute BLA-mPFC slice preparation yielded monosynaptic excitatory postsynaptic responses in layer V pyramidal neurons from the prelimbic cortex as determined by extracellular and intracellular recordings. The BLA-mPFC preparation provides essential knowledge of amygdaloid input to the medial prefrontal cortex where information from various brain areas is integrated and returned to subcortical structures, such as the amygdala itself. In addition to investigating normal synaptic function, this preparation provides opportunities to investigate this synapse in animals which have received drugs chronically or have been manipulated genetically to model specific mental diseases known to involve prefrontal cortex and/or amygdala pathology (e.g., schizophrenia, addiction, anxiety, and depression).

Corticotropin-releasing factor (CRF or CRH) and its family of related peptides have long been recognized as hypothalamic-pituitary-adrenal (HPA) axis peptides that function to regulate the release of other hormones, e.g., ACTH. In addition, CRF acts outside the HPA axis not as a hormone, but as a regulator of synaptic transmission, pre- and post-synaptically, within specific CNS neuronal circuits. Synaptic transmission within the nervous system is today understood to be a more complex process compared to the concepts associated with the term 'synapse' introduced by Sherrington in 1897. Based on more than a century of progress with modern cellular and molecular experimental techniques, prior definitions and functions of synaptic molecules and their receptors need to be reconsidered (see Glossary and Fig. 1), especially in light of the important roles for CRF, its family of peptides and other potential endogenous regulators of neurotransmission, e.g., vasopressin, NPY, etc. (see Glossary). In addition, the property of 'constitutive activity' which is associated with G-protein coupled receptors (GPCRs) provides a persistent tonic mechanism to fine-tune synaptic transmission during both acute and chronic information transfer. We have applied the term 'regulator', adapted from the hormone literature, to CRF, as an example of a specific endogenous substance that functions to facilitate or depress the actions of neuromodulators on fast and slow synaptic responses. As such, synaptic neuroregulators provide a basic substrate to prime or initiate silently plastic processes underlying neurotransmitter-mediated information transfer at CNS synapses. Here we review the role of CRF to regulate CNS synaptic transmission and also suggest how under a variety of allostatic changes, e.g., associated with normal plasticity, or adaptations resulting from mental disorders, the synaptic regulatory role for CRF may be 'switched' in its polarity and/or magnitude in order to provide a coping mechanism to deal with daily and life-long stressors. Thus, a prominent role we assign to non-HPA axis CRF, its family of peptides, and their receptors, is to maintain both acute and chronic synaptic stability.

The effect of 8-OH-DPAT on the induction of long-term potentiation (LTP) in the lateral nucleus of the amygdala was investigated using rat horizontal brain slice preparations. Bath-applied 8-OH-DPAT decreased the field potential amplitudes in a dose-dependent manner. In the lateral amygdala synapses, 8-OH-DPAT significantly suppressed the induction of LTP evoked by a weak theta burst stimulation. This suppression of LTP was also found using a concentration of 8-OH-DPAT, which did not influence the baseline activity significantly. The specific 5-HT(1A) receptor antagonist, WAY 100,635 blocked the inhibitory effect of 8-OH-DPAT on the induction of LTP. The inhibitory effect of 5-HT(1A) receptor stimulation on amygdaloid neuronal plasticity suggests that the amygdala is a site for serotonin to exert its influence on memory of aversive events.