Stress is a major trigger of seizures in people with epilepsy. Exposure to stress results in the release of several stress mediators throughout the brain, including the hippocampus, a region sensitive to stress and prone to seizures. Stress mediators interact with their respective receptors to produce distinct effects on the excitability of hippocampal neurons and networks. Crucially, these stress mediators and their actions exhibit unique spatiotemporal profiles, generating a complex combinatorial output with time- and space-dependent effects on hippocampal network excitability and seizure generation.

The majority of epilepsies that arise from numerous etiologies commence early in life. Therefore, understanding the special characteristics of epileptogenic processes that take place during infancy and childhood is critical. This understanding requires knowledge of the basis of the unique vulnerability of the developing brain to the inciting or causal events, as well as the age-specific mechanisms that lead to epilepsy early in life. This article will introduce these concepts and review some of the factors that predispose to seizures early in life, as well as those that might contribute to the evolution of these seizures into epilepsy. Mechanisms of epileptogenesis unique to the developing brain will be highlighted, together with the significant gaps in our knowledge.

Previous studies of CRH-induced status epilepticus in infant rats demonstrated neuronal loss in several limbic structures, including the CA3 region of the hippocampus. The goal of the present study was to identify the neurons affected by CRH-induced seizures and determine whether they formed synapses with afferent axon terminals. Clusters of neurons in the CA3 region of the hippocampus were osmiophilic when viewed in thick sections. Semi-thin 2-microns sections of the pyramidal cell layer contained dark, shrunken neurons with apical and basal dendrites among normal appearing pyramidal cells. Electron microscopy revealed degenerating pyramidal cells with intact cell membranes and electron dense nuclei and cytoplasm. The shrunken dendrites of these cells had spines and were postsynaptic to large immature-appearing mossy fibers. Thus, CA3 pyramidal neurons that are linked via mossy fibers to the tri-synaptic excitatory hippocampal circuit die subsequent to CRH-induced status epilepticus. The shrunken appearance and selective loss of these neurons are incompatible with necrosis as the mechanism of degeneration.

A variety of stressors activate the hypothalamic-pituitary-adrenal axis, with secretion and compensatory enhanced synthesis of hypothalamic corticotropin-releasing hormone (CRH). Whether CRH is a major effector in the stress response of the neonatal rat and whether the peptide's gene expression is subsequently up-regulated are not fully understood. We studied the effect of cold-separation stress on plasma corticosterone (CORT) levels and CRH messenger RNA (CRH-mRNA) abundance in the paraventricular nucleus. Rats (4-16 days old) were subjected to maximal tolerated cold-separation. CORT and CRH-mRNA abundance were measured before and at several time points after stress. Cold-separation stress resulted in a significant plasma CORT increase in all age groups studied. This was abolished by the administration of an antiserum to CRH on both postnatal days 6 and 9. CRH-mRNA increased in rats aged 9 days or older, but not in 6-day-old rats, by 4 h after stress. These results suggest the presence of robust CRH-mediated adrenal responses to cold-separation stress in neonatal rats. Before postnatal day 9, however, the compensatory increase in CRH-mRNA abundance is minimal.