Lecture 2 Nervous System 2014 (1)

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  • Lecture 2 Physiology of the Nervous System

    Excitability and ionic transport

    Dr. Ana-Maria Zagrean

    Discipline of Physiology and Fundamental Neurosciences

  • The capacity / condition for a

    live system to recognize

    and respond to specific

    signals, as a form of

    updated information,

    necessary for its adaptive

    and continuous organization.

    Excitability

    1) input

    2) integration

    3) output

    Excitability and Ionic transport

  • Interaction stimulus - receptor

    stimulus

    R e

    c e

    p t

    o r

    ?

    chemical

    physical

    response

    The excitability of neurons is based on ion gradients

    across the cell membrane, and on transport properties

    of the cell membrane.

  • Interrelation between cell membrane properties and the

    complex characteristics of biological systems.

    identity

    Selective membrane

    permeability

    excitability

    adaptability evolution

    Premises

    acquiring

    coordinating

    disseminating

  • Selective membrane permeability: The lipid barrier of the cell membrane and cell membrane transport proteins

    Chemical compositions of

    extracellular and intracellular fluids.

  • Diffusion Versus Active Transport

    Diffusion - random molecular movement of substances molecule by molecule, either

    through intermolecular spaces in the membrane or in combination with a carrier

    protein.

    The energy that causes diffusion is the energy of the normal kinetic motion of matter.

    Active transport - movement of ions or other substances across the membrane in

    combination with a carrier protein in such a way that the carrier protein causes the

    substance to move against an energy gradient, such as from a low-concentration state

    to a high-concentration state; requires an additional source of energy (ATP) besides

    kinetic energy.

  • Cell membrane and its selective permeability

    1.Diffusion

    -Simple diffusion:

    - lipid-soluble subst. (O2, CO2, alcohols) through intermolecular

    spaces of the lipid barrier

    - through a membrane opening - protein channels (e.g., water,

    lipid-insoluble molecules that are water-soluble and small

    enough):

    selective permeable channels non-gated OR gated (open/closed by gates) voltage-gated

    ligand-gated (chemical-gated)

    -Facilitated diffusion = carrier mediated diffusion

    e.g. transport of most of aminoacids and glucose

    Driving force of diffusion and net diffusion depends on:

    -Substance availability, kinetic energy, membrane permeability

    -Concentration difference/gradient

    -Membrane electrical potential effect on diffusion of ions

    (see Nernst potential)

    2.Active transport

    - Primary active (pumps)

    - Secondary active (co- and counter-transport)

    TRANSPORT OF SUBSTANCES THROUGH THE CELL MEMBRANE

  • Pores/channels integral cell membrane proteins

    Always open

    Pore diameter, its shape and its internal electrical charge/chemical bonds provide selectivity

    Aquaporins/water channels (13 different types) - protein pores which permit rapid passage of water through cell membranes but exclude other

    molecules (a narrow pore permits water molecules to diffuse through the

    membrane in single file). The pore is too narrow to permit passage of any

    hydrated ions. Density of aquaporins (e.g., aquaporin-2) in cell

    membranes is not static but is altered in different physiological conditions.

    Simple diffusion through protein channels

  • Conformational changes in the protein molecules

    open or close "gates" guarding the channels:

    voltage or ligand gated

    Na+ channel is only 0.3 by 0.5 nm in diameter,

    the inner surfaces of this channel are strongly

    negatively charged and pull small dehydrated

    sodium ions into these channels selective permeability for Na+.

    K+ channels are up to 0.3 nm in diameter,

    but their inner surfaces are not negatively

    charged K+ are not pulled away from the water molecules that hydrate them the smaller hydrated potassium ions can pass

    easily through the channel, whereas the

    larger hydrated sodium* ions are rejected,

    thus providing selective permeability for K+.

    K+ are slightly larger than Na+ but Na+ attracts far more water molecules...

    Transport of Na+ and K+ through protein channels

    Na +

    K +

  • - four subunits, each with two transmembrane helices.

    - a narrow selectivity filter formed from the pore loops

    carbonyl oxygens line the walls of the selectivity filter, forming sites for transiently binding dehydrated K+. The interaction of the K+ with carbonyl

    oxygens causes them to shed their bound water molecules, permitting the

    dehydrated K+ to pass through the pore.

    The structure of a potassium channel.

  • Gating of protein channels to control channel permeability

    VOLTAGE GATED:

    -for Na+ channel:

    strong negative charge on the inside of the cell membrane outside Na+ gates remain tightly closed

    when the inside of the membrane loses its negative charge, these gates would open suddenly and allow tremendous quantities of Na+ to pass inward through the

    sodium pores.

    -for K+ channel:

    gates are on the intracellular ends of the K+ channels, and they open when the inside of the cell membrane becomes positively charged.

    CHEMICAL (LIGAND) GATING:

    - protein channel gates are opened by the binding of a chemical substance (a

    ligand) with the protein; this causes a conformational or chemical bonding change

    in the protein molecule that opens or closes the gate.

  • Effect of concentration of a substance on rate of

    diffusion through a membrane by simple

    diffusion & facilitated diffusion.

    Note that facilitated diffusion approaches a

    maximum rate Vmax. what limit it?

    Diffusion: simple and facilitated

    Postulated mechanism for

    facilitated /carrier mediated diffusion

    (e.g. glucose or amino acids transport)

    - glucose transport by GLUT4 is increased

    10-20x by insulin (but not in the brain).

  • A. Net Diffusion Rate Is Proportional to the Concentration Difference Across a Membrane.

    B. Effect of Membrane Electrical Potential on Diffusion of IonsThe Nernst Potential.

    C. Effect of a Pressure Difference Across the Membrane.

    Diffusion and the cell membrane potential

  • Net Diffusion Rate Is Proportional to the Concentration Difference Across a Membrane.

    Diffusion and the cell membrane potential

  • Effect of membrane electrical potential on diffusion of ions: the Nernst Potential

    Diffusion and the cell membrane potential

    The concentration of (-) ions is initially the same on both sides of the membrane, but a (+) charge

    applied to the right side of the membrane and a (-) charge to the left, creates an electrical gradient

    across the membrane, moving the ions... When the concentration difference rises high enough, the

    two effects balance each other.

    EMF (mV) = -RT/zF log C inside/C outside

    EMF = +/-61 log C inside/C outside at 37C for any univalent ion (z=1), as Na+ or K+

    R = gas constant, F = Faraday constant, z = valence, T = temp; C = ion conc.

    (+) for negative ions / (-) for positive ions, diffusing from inside to outside.

  • Effect of a Pressure Difference Across the Membrane.

    Diffusion and the cell membrane potential

  • A, Establishment of a "diffusion potential" across a nerve fiber membrane, caused by

    diffusion of K+ from inside the cell to outside through a membrane that is selectively

    permeable only to K+:

    within ~1 msec. diffusion potential becomes great enough to block further net K+

    diffusion to the exterior, despite the high K+ concentration gradient. For a normal nerve

    fiber, the potential difference is ~ 94 mV, with negativity inside the fiber membrane.

    Diffusion and the cell membrane potential

  • Diffusion and the cell membrane potential

    B, Establishment of a "diffusion potential" when the nerve fiber membrane is

    permeable only to Na+: the membrane potential rises high enough within msec. to

    block further net diffusion of Na+ to the inside; however, this time, in the mammalian

    nerve fiber, the potential is ~ 61 mV positive inside the fiber.

    Internal membrane potential is negative when K+ diffuse and positive when Na+

    diffuse because of opposite concentration gradients of these two ions.

  • (Actual potential)

    Calculation of the diffusion potential when the membrane is

    permeable to several different ions Goldman equation

  • Calculation of the diffusion potential when the membrane

    is permeable to several different ions Goldman equation

    The membrane is permeable to several different ions and the diffusion

    potential that develops depends on three factors:

    (1) the polarity of the electrical charge of each ion,

    (2) the permeability of the membrane (P) to each ion,

    (3) the concentrations (C) of the respective ions on the inside (i) and outside

    (o) of the membrane.

    Goldman /Goldman-Hodgkin-Katz (GHK) equation gives the calculated membrane potential (Vm) on the inside of the membrane

    when two univalent positive ions, sodium (Na+) and potassium (K+), and

    one univalent negative ion, chloride (Cl-), are involved.

  • The passive properties of a plasma membrane

    A plasma membrane has resistance, capacitance and conductance

  • Electro-neutrality principle

    The membrane maintains a separation of charges, as an electrical dipole layer. Electrostatic forces between charges keeps them in close proximity to the membrane.

    To establish the normal "resting potential" of -90 mV inside the nerve fiber, only about

    1/3,000,000 to 1/100,000,000 of the total (+) charges inside the fiber needs to be

    transferred. Also, an equally small number of (+) ions moving from outside to inside

    the fiber can reverse the potential from -90mV to as much as +35 mV within 0.1 msec !

    Rapid shifting of ions in this manner causes the nerve signals.

  • Cell Membrane Potential

    Proteins & phosphates are negatively charged at normal cellular pH.

    These anions attract positively charged cations that can diffuse through the membrane

    pores.

    Membrane more permeable to K+ than Na+.

    Relation between cell membrane potential - membrane ionic transport system

  • 1 - Ion channels

    2 - Ion pumps

    3 - Ion exchangers, carriers, co/counter transporters

    Membrane ionic transport system (MITS)

  • 3Na+

    Ca2+

    Cl-

    K+

    H+

    H+

    Ca2+

    K+

    Cl-

    Cl-

    AA

    Na+

    PUMPS CARRIERS

    CHANNELS

    K+

    Components of membrane ionic transport systems

  • 1. Ion channels

    - Voltage gated

    - Ligand gated

    - Mechanic gated

    Gated (active) Ion Channels

    Non-gated (passive) Ion Channels

    The diversity of ion channels is significant, especially in excitable cells

    of nerves and muscles. Of the more than 400 ion channel genes currently

    identified in the human genome, about 170 encode potassium channels,

    38 encode calcium channels, 29 encode sodium channels, 58 encode

    chloride channels, and 15 encode glutamate receptors. The remaining are

    genes encoding other channels such as inositol triphosphate (IP3) receptors,

    transient receptor potential (TRP) channels and others.

  • Gated (active) Ion Channels

  • Gated (active) Ion Channels

    VOLTAGE-GATED ION CHANNELS:

    ion selective pore, voltage sensor, activation/inactivation gate

    1

    2

    3

  • Voltage-gated K+ channel

    At rest, negative cellular potential keep voltage-gated K+ channels closed.

    Depolarization cell potential becomes positive K+ channel is activated and can conduct K+ ions (yellow arrow, right).

    The conformation change from the closed to the open state is driven by the

    movement of the positively-charged amino acids (orange "+" symbols) located in a region of the protein called the voltage sensor surrounding the central ionic pore.

  • The voltage-gated Na+ channel

    - used in the rapid electrical signaling

    - components:

    - ion selectivity filter for Na+:

    Na+ discard the water molecules associated with them in order to pass in single

    file through the narrowest portion of the channel

    - activation gate that can open and close, as controlled by voltage sensors,

    which respond to the level of the membrane potential

    - inactivation gate limits the period of time the channel remains open, despite

    steady stimulation.

    a subunit: polypeptide chain of >1800 am.ac. embedded in cell membrane.

    * Nonpolar side chains coil into transmembrane alpha-helices and face

    outward where they readily interact with the lipids of the membrane.

    * By contrast, the polar peptide bonds face inward, separated from the lipid

    environment of the membrane.

    b subunit: anchor the channel to the plasma membrane

    - activation:

    - at resting membrane potential (-90-70 mV) the channel is closed; - the voltage sensor moves outward and the gate opens if any factor depolarize

    the membrane potential sufficiently (threshold ~ -50 mV).

  • From Basic Neurochemistry, 7th Edition

    Voltage gated Na+ channel

  • An experimental strategy to study the ionic currents passing through

    the membrane, is one using agents that specifically block either the

    voltage-gated Na+ channels or the voltage-gated K+ channels.

    Tetrodotoxin (TTX) is a highly potent toxin that inhibits voltage-gated

    Na+ channels. The source of TTX is the puffer fish (fugu), that is a delicacy in some countries. Even minute quantities of ingested TTX

    are fatal!

    Local anesthetics / nerve blocking agents such as lidocaine

    (Xylocaine) and procaine (Novacaine) prevent the generation of APs by inhibiting voltage-gated Na+ channels of sensory neurons.

    Thus, depolarization elicited by sensory stimulation does not lead to

    the generation of action potentials that can travel to the CNS.

    Tetraethyl ammonium (TEA) is a chemical agent that inhibits the

    voltage-gated K+ channels.

    Blockers such as TTX and TEA have been instrumental in revealing

    the workings of ion channels and their roles in neuronal function.

  • Voltage-gated Na+ channel

  • Gated (active) Ion Channels

    Ligand-gated ion channels : ionotropic vs metabotropic

    Ionotropic directly gate ion channels

    Metabotropic indirectly gate channels via 2nd messengers

  • Ligand-gated ion channels - glutamate receptors:

    - NMDA & AMPA ionotropic receptors - metabotropic group I & II receptors (G-prot. coupled)

    PCP- phenylciclidine

  • Cell

    membrane

    gate

    Fibrillary

    protein

    Anchoring

    situs extracellular

    intracellular

    Gated (active) Ion Channels

    Mechanic gating ion channel

  • Non-gated (passive) Ion Channels

    K+ leak channels

  • Functional particularities:

    2. Ion Pumps

    -active transport of ions and organic molecules

    against concentration gradient

    - involve enzymatic reactions, ATP consume

    -decreased transport rate

    Ex: Na+/K+ pump, H+ pump, Ca2+ pump...

  • Ion Pumps

    Na+-K+ ATPase pump can run in reverse: If the electrochemical gradients for

    Na+ and K+ are experimentally increased enough so that the energy stored in their

    gradients is greater than the chemical energy of ATP hydrolysis, these ions will move

    down their concentration gradients and the Na+-K+ pump will synthesize ATP from

    ADP and phosphate.

    The phosphorylated form of the Na+-K+pump can either donate its phosphate to ADP

    to produce ATP or use the energy to change its conformation and pump Na+ out of

    the cell and K+ into the cell. The relative concentrations of ATP, ADP, and phosphate,

    as well as the electrochemical gradients for Na+ and K+, determine the direction of the

    enzyme reaction.

    For nerve cells, 60 to 70 % of the cells energy requirement may be devoted to pumping Na+ out of the cell and K+ into the cell.

  • - The Na+-K+ Pump Is Important For Controlling Cell Volume.

    Inside the cell are large numbers of proteins and other organic molecules that

    cannot escape from the cell. Most of these are negatively charged and

    therefore attract large numbers of potassium, sodium, and other positive ions

    as well. All these molecules and ions then cause osmosis of water to the interior

    of the cell. Unless this is checked, the cell will swell indefinitely until it bursts.

    The normal mechanism for preventing this is the Na+-K+ pump.

    Na+-K+ ATPase pump initiates osmosis of water out of the cell

    - Electrogenic Nature of the Na+-K+ Pump

    The Na+-K+ Pump

  • Calcium Pump

    Ca2+

    Ca2+

  • - Na/H

    - Cl/HCO3 -

    - Na/K/2Cl

    - K/Cl, etc

    - Na/Ca

    - Na/HCO3

    3. Ion Exchangers/

    Carriers/Cotransporters

    - Na/ aa, Na/G

  • Ion gradients, channels, and transporters in a typical cell (Boron, 2009)

  • Cell membrane potential Resting Membrane Potential

    Na+-K+ pump K+-Na+ leak channels

    Humans

    [Na+]

    [K+]

    Out

    142

    4

    In

    14

    140

    Ratios

    Na+ In:Out = 0.1

    K+ In:Out = 35.0

    Membranes are 100X more

    permeable to K+, as there

    are more leakage channels

    for K+ (see no. of genes)

    The basis for the resting membrane potential:

    Slow rate of Na+ influx is accompanied by slow rate of K+ efflux.

    Na+/K+ pump maintains the concentration gradients.

    Electrochemical gradient membrane potential of ~ - 65 mV

  • diffusion

    3 Na+ 2 K+

    pump

  • Factors that influence the resting membrane potential

    The Na+ /K+ pump contributes to

    resting membrane potential in 2 ways:

    Pumping Na+ & K+ ions in a 3:2 ratio Maintaining a high K+ concentration in the cells interior

    The membrane conductance to K+

    far exceeds that to Na+ :

    K+ leakage results in internal electronegativity

  • How is membrane potential measured?

  • A Motor Neuron

    When the neuron is inactive, the

    membrane is said to be at rest and

    has a resting membrane potential

    When the neuron is active, the flow

    of information is from soma to axon

    terminal action potentials (AP).

  • Membrane responses to stimulus current

    Hyperpolarizing currents produce

    responses 1 and 2.

    A small depolarizing current

    produces response 3.

    These are all graded local

    responses which dissipate locally.

    A sufficiently large current

    (threshold) produces an action

    potential (4), which can be

    propagated along the axon.

    Animation at http://www.sumanasinc.com/webcontent/animations/neurobiology.html

  • -A stimulus initiates a membrane

    electrical change that depend on the

    passive properties of the neuronal

    membrane

    -Electrical signal /potentials are

    initiated by local current flow

    -Local potentials then spread

    electrotonically over short distances,

    and decay with distance from their

    site of initiation (as some of the ions

    leak back out across the cell

    membrane and less charge reaches

    more distant sites);

    Considering the Ohms law and a

    stable membrane resistance, the

    diminished current with distance

    away from the source results in a

    diminished voltage change.

  • - When the potential is equal/over

    threshold, it propagates over a long

    distance

    - at the axon hillock level, the

    potential initiates an action potential

    (AP) that propagates without changing

    its amplitude

    - APs depend on a regenerative wave

    of channel openings and closings in

    the membrane

  • Action Potential (AP)

    nerve impulse = action potential:

    cycle of depolarization & repolarization

    needs no direct energy

    all-or-none principle

    The action potential is essential to our understanding of nervous system function. Its shape, velocity of conduction, and propagation fidelity are essential to the timing, synchrony, and efficacy of neuronal communication.

    G. J. Kress and S. Mennerick / Neuroscience 158 (2009) 211222

  • -The necessary actor in causing both depolarization

    and repolarization of the nerve membrane during the

    action potential is the voltage-gated Na+ channel

    -A voltage-gated K+ channel also plays an important

    role in increasing the rapidity of repolarization of the

    membrane.

    -These two voltage-gated channels are in addition to

    the Na+-K+ pump and the K+-Na+ leak channels.

    Na+ permeability

    increases 500-5000 x

    Action Potential

  • The nerve action potential

    Profile of a Nerve Action Potential

    Threshold

    -Occurs when Na+ entering exceeds K+

    leaving

    -A rise in potential of 15-30 mV is required

    The All-or-None principle An action potential will not occur until the

    initial rise in membrane potential reaches

    threshold. However any larger stimulus

    produces no greater response than that

    produced by the threshold stimulus, i.e.,

    the threshold stimulus produces the

    maximal effect the action potential.

  • The nerve action potential

    Resting Stage Membrane is polarized i.e., a 90 mV membrane resting potential present

    Depolarization Stage Membrane becomes very permeable to Na+ ions Influx of Na+ ions Polarized state is neutralized

    Potential merely approaches in smaller CNS fibres Membrane potentials overshoots beyond zero in large fibres

    Repolarization

    Result of

    Voltage-gated

    Na+ channels

    Na+ channels get inactivated Permeability to K+ increases

    After-Hyperpolarization

    K+ channels remain open after repolarization

  • Cation conductances during an action potential

    Na+ conductance increases faster

    and lasts for a shorter duration.

    K+ conductance is delayed,

    increases slowly and lasts longer

    action potential

    Ion conductance

  • The Action Potential and the

    positive feedback of the

    Na+ channels activation START

  • + feed-back

  • Roles of other ions than Na+ and K+ during the AP

    Impermeant anions inside the nerve axon

    Calcium Ions: - calcium pump pumps calcium ions from the interior to the exterior of the cell

    membrane (or into the endoplasmic reticulum of the cell), creating a calcium ion gradient

    of about 10,000-fold (internal cell conc ~10-7 molar).

    - voltage-gated calcium channels slightly permeable to sodium ions as well as to

    calcium ions; when they open, both calcium and sodium ions flow to the interior of the

    fiber = Ca++-Na+ channels. The calcium channels are slow to become activated (slow

    channels), requiring 10 -20 x as long for activation as the sodium channels

    Increased permeability of the Na channels when there is a deficit of Ca2+

    - extracellular Ca concentration effect on the voltage level at which the Na channels

    become activated: a deficit of Ca2+ of ~50% determine Na channels to become activated

    by very little increase of the membrane potential from its normal, very negative level nerve fiber becomes highly excitable, sometimes discharging repetitively without

    provocation rather than remaining in the resting state spontaneous discharge in peripheral nerves, often causing muscle "tetany" (lethal when triggering tetanic

    contraction of the respiratory muscles).

    -mechanism: Ca2+ appear to bind to the exterior surfaces of the Na channel protein

    molecule. The positive charges of Ca in turn alter the electrical state of the channel

    protein itself, in this way altering the voltage level required to open the sodium gate.

  • Membrane Refractoriness

    Refractoriness = non-responsive state

    Involves Na channel inactivation Absolute refractory period (ARP)- membrane is not responsive to any

    stimulation

    Relative refractory period (RRP) - membrane is responsive to

    supra-threshold stimuli

  • Distribution - function relation for different types of

    channels on nerve cell membrane

    -Nongated ion channels - throughout the neuron

    -Ligand-gated channels - more at sites of synaptic contact

    (dendritic spines, dendrites, somata); also, at non-synaptic sites.

    -Voltage-gated channels - predominantly on axons and axon

    terminals

    A spinal motor neuron.

    Sodium channels (red);

    Microtubule-associated

    protein 2 - MAP2 (green)

    (Shrager Lab)

  • Na channels distribution and

    generation of AP in axon hillock

    The soma membrane has few Na+

    channels it is harder to have sufficient Na+ influx to change membrane potential

    to the threshold potential (-45 mV).

    A voltage change up to +30 mV is required

    Axon hillock membrane has 7x more Na+

    channels than the soma membrane and

    the threshold potential is lower (a voltage

    change of only +10+20 mV is required to bring the membrane potential to threshold)

    = trigger zone for AP

    Action potentials in postsynaptic neurons are initiated at the axon hillock.

  • Simultaneous recording of

    action potentials from different

    parts of a neuron.

    A, an excitatory synapse on a

    dendrite is stimulated, and the

    response near that dendrite is

    recorded in the soma and at the

    initial segment. The excitatory

    postsynaptic potential (EPSP)

    attenuates in the soma and the

    initial segment, but the EPSP is

    large enough to trigger an action

    potential at the initial segment.

    B, The threshold is high (-35 mV) in

    regions of the neuron that have few

    Na+ channels but starts to fall

    rather steeply in the hillock and

    initial segment. Typically, a stimulus

    of sufficient strength triggers an

    action potential at the initial

    segment.

    C, The density of Na+ channels is

    high only at the initial segment and

    at each node of Ranvier.

  • AP generation and conductance along the axon

    - initial depolarization at the axon hillock +f.b. for Na+ channels critical membrane potential = threshold (all-or-none response)

    -AP: depolarization and repolarization, followed by afterhyperpolarization, as

    K+ channels remain open and membrane permeability for K+ is higher

    - propagation of AP to the axon terminals synapses - also backpropagation in the soma & dendrites, without regenerating in the somal membrane, as somal membrane has too few Na+ channels to regenerate APs; also,

    inactivation of Na channels at axom hillock (here, refractory period).

    -Speed of propagation depend on axon diameter & presence of myelin sheath

    -in unmyelinated axons, Na & K voltage-gated channels are

    uniformly distributed AP as a traveling wave -large diameter axons allow a grater flow of ions grated length of the axon to be depolarized increase of the conduction velocity -in myelinated axons, myelin sheath insulate the axon membrane generation of AP between the myelinated segments, at the nodes of Ranvier saltatory conduction

  • Propagation of impulses from the axon hillock

    Once the action potential begins, the potential travels forward

    along the axon and usually also backward toward the soma.

    However it does not regenerate in the soma membrane.

    Why is regeneration impossible in the soma membrane?

    EPSPs arrive and an AP is generated at the axon hillock. The AP is regenerated forward to the axon, depolarization

    spreads backwards to soma and dendrites, but impulse

    potential decays dies because the somal membrane has too few Na+ channels to regenerate APs.

  • Saltatory Conduction

    current flows electronically to the next node action potentials are regenerated only at nodes action potential jumps from node to node

  • Propagation of an Action Potential

  • Action Potential travels along the membrane as a wave

    of depolarization. Directional propagation of an AP

  • Speed of propagation depend on

    the presence of myelin sheath

  • AP generation and conductance in the sensory neurons:

    trigger zone is near the peripheral target.

  • Condition associated with channelopathies (congenital or acquired (often resulting from autoimmune

    attack on an ion channel).

    Channel type

    Alternating hemiplegia of childhood Na/K-ATPase

    Congenital hyperinsulinism Inward-rectifier potassium ion channel

    Cystic fibrosis Chloride channel

    Episodic Ataxia Voltage-gated potassium channel

    Erythromelalgia Voltage-gated sodium channel

    Generalized epilepsy with febrile seizures plus Voltage-gated sodium channel

    Familial hemiplegic migraine various

    Hyperkalemic periodic paralysis Voltage-gated sodium channel

    Hypokalemic periodic paralysis Voltage-gated sodium channel

    or voltage-dependent calcium channel (calciumopathy)

    Long QT syndrome various

    Malignant hyperthermia Ligand-gated calcium channel

    Mucolipidosis type IV Non-selective cation channel

    Myasthenia Gravis Ligand-gated sodium channel

    Myotonia congenita Voltage-dependent chloride channel

    Neuromyotonia Voltage-gated potassium channel

    Nonsyndromic deafness various

    Paramyotonia congenita (a periodic paralysis) Voltage-gated sodium channel

    Retinitis pigmentosa(some forms) Ligand-gated non-specific ion channels

    Short QT syndrome various potassium channels suspected

    Timothy syndrome Voltage-dependent calcium channel

    Seizure Voltage-dependent potassium channel