Anticonvulsant steroids and the GABA/benzodiazepine receptor-chloride ionophore complex.

The ability of steroids to influence brain excitability is well documented. Certain 3 alpha-hydroxylated pregnanes are known to possess anticonvulsant and sedative-hypnotic/anesthetic properties. It has been observed that the seizure susceptibility in menstruating women with catamenial epilepsy appears to be correlated with changes in ovarian steroid levels. However, the underlying mechanism of these steroid influences on brain activity has only been recently revealed by pharmacological studies. These studies have provided compelling evidence for the presence of a novel steroid recognition site on the GABAA-benzodiazepine receptor complex (GBRC). Steroids may interact with this site with high affinity and stereospecificity to enhance chloride channel conductance in a manner similar to that produced by benzodiazepines (BZs) or barbiturates. The existence of such a steroid site on the GBRC is further supported by recent experiments involving the transfection of GABAA receptor cDNAs into a human embryonic kidney cell line. Based on the knowledge of the structure-activity requirements for the interaction of steroids with this novel recognition site, it is conceivable that the development of new anticonvulsant steroids with high therapeutic indices can be achieved.