Human hippocampal epilepsy is one of the most difficult epileptic syndromes to control. These intractable and often severe seizures are associated with electrophysiologic hyperexcitability, severe Ammon's horn neuron loss, and evidence of aberrant axonal plasticity, termed hippocampal sclerosis (HS). The etiology of HS is unknown, and it is likewise unclear if HS is the pathophysiologic substrate of chronic epilepsy or the pathologic consequence of multiple seizures. A unique developmental feature of the hippocampus is the postnatal neurogenesis, migration and axon formation of granule cells (GC). The GCs are the parent neurons for mossy fibers (MF), one of the principal aberrantly sprouted axon systems in HS. We recently have had the unique opportunity to study surgically resected hippocampi from epileptic children to discern the evolution of pathologic changes as they relate to seizures and postnatal GC maturation. Preliminary results show evidence of aberrant MF sprouting at the time of postnatal GC development. The size of the MF fibers and boutons increased in older seizure patients, suggesting maturation of these axons. Seizure associated regio inferior neuron loss was found in all epileptic children, but greater neuron loss was found after age 2 years, when the GCs had nearly completed neurogenesis. This proposal is designed to further study hippocampi from epileptic children and will determine the following specific aims. l) Determine the progressive pathologic changes in the hippocampus that might suggest an etiology of adult HS. Our two hypotheses are that adult HS is either the consequence of progressive seizure related pathologic changes or it is a result of some severe perinatal insult that is associated with structural damage. 2) Determine the time course of postnatal hippocampal development. We will look for the in vivo expression of proteins associated with neurogenesis, migration, and axon growth cone formation. Our hypothesis is that postnatal hilar cells and GCs will differentially express these proteins compared with the remaining hippocampus which forms prenatally. 3) Determine the postnatal differential expression of neurotrophic factors (NTF) in the developing hippocampus. Our hypothesis is that mRNA NTF expression is altered in epileptic hippocampi in a manner that promotes and maintains aberrant sprouting during postnatal axon development. Age- matched autopsy hippocampi without evidence of brain pathology will serve as controls. Parallel developmental studies will be performed in rat pups to determine if postnatal hippocampal maturation is different in another mammalian species. These studies on epileptic children form a data base that will be expanded upon in future human and animal experiments to study the cellular mechanisms and pathophysiology of HS. A CIDA is also a training grant. The most significant component of the training will be in acquiring research skills that will complement my existing clinical knowledge and training in Neurosurgery. The research program contains a didactic exposure to basic Neuroscience graduate courses, hands on technical and theoretical exposure to molecular neurobiology, teaching, and close supervision by senior neuroscientists. The goal is sufficient research training and exposure to become an independent clinical investigator familiar with basic research applied to clinical epilepsy related problems.
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