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Factors promoting increased seizure susceptibility in the developing brain

Factors promoting increased seizure susceptibility in the developing brain
Factor Consequence
Input resistance and time constant: Increased in immature neurons Small inputs result in relatively large voltage changes
Voltage-gated ion channels: Earlier maturation of sodium and calcium channels, delayed development of potassium channels Longer action potentials, shorter refractory periods, increased neuron firing
Synapse development: Excitatory synapses appear before inhibitory synapses Relative predominance of excitation over inhibition early in development
Synapse development: Over expression of excitatory synapses during critical period Corresponds to window of heightened seizure susceptibility
Developmental changes in glutamate receptor subunits: NR2B/NR2A ratio favors prolonged depolarizing responses; NR2D relative over expression reduces Mg++ block Favor relative hyperexcitability
Late appearance of functional inhibitory synapses Along with other factors favoring excitation, contributes to neuronal excitatory drive and lack of functional inhibition
Developmental changes in GABAA receptor function and Cl gradient due to differential development of the K+/Cl co-transporters GABA is depolarizing early in life, enhancing excitability
Developmental changes in GABAA receptor subunits Partially accounts for developmental differences in inhibitory effectiveness and benzodiazepine responsiveness
Developmental sensitivity to glutamate toxicity Less glutamate-induced excitotoxicity early in development
Immature GABAA binding pattern in substantia nigra Proconvulsant effect
Electrical synapses: More common early in development Mechanism for enhanced synchrony of neuronal networks
Immature homeostatic mechanisms: NaK-ATPase, glial K+ regulation, K+/Cl co-transporters Prolonged exposure to elevated extracellular K+ leads to further neuronal depolarization
GABAA: gamma-aminobutyric acid A; NaK-ATPase: sodium-potassium adenosine triphosphatase.
Reproduced with permission from: Rho JM, Stafstrom CE. Neurophysiology of epilepsy. In: Pediatric Neurology: Principles and Practice, 4th ed, Swaiman KF, Ashwal S, Ferreiro DM (Eds). Mosby Elsevier. Philadelphia 2006. Copyright © 2006.
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