Cyclooxygenase in epilepsy: from perception to application

Cyclooxygenase (COX) catalyzes the first committed step in the synthesis of prostanoids, a large family of arachidonic acid metabolites comprising prostaglandins, prostacyclin and thromboxanes. The COX enzyme is a major target of nonsteroidal antiinflammatory drugs. Two isoforms of COX enzymes have been identified: the constitutively expressed COX-1 and the inducible, highly regulated COX-2. Recently, COX has been found to be expressed in different areas of the brain, and inhibitors of COX enzyme(s), particularly the COX-2 inhibitors, may attenuate inflammation associated with brain disorders. Although COX-1 is constitutively expressed in different areas of brain, there has been a conceptual neglect of the role of COX-1 inhibitors in various neurodegenerative and neuropsychiatric disorders. The present review summarizes the current understanding of COX expression in the central nervous system and the effects of COX inhibitors (both nonselective and selective COX-2 inhibitors) in epilepsy. It is speculated that COX inhibition will be a useful ameliorative adjunct in the management of epilepsy and related disorders.