The following is a summary of “Common Pathways of Epileptogenesis in Patients With Epilepsy Post-Brain Injury: Findings From a Systematic Review and Meta-analysis,” published in the August 2023 issue of Neurology by Misra et al.

Epilepsy from various injuries (stroke, trauma, infections). Identifying shared pathways/biomarkers might lead to prevention strategies. Researchers performed a retrospective study systematically reviewing biofluid biomarkers to assess their link with the risk of post-brain injury epilepsy.

They searched MEDLINE, Embase, PsycINFO, Web of Science, and Cochrane for articles on January 25, 2022. Focused on mean biomarker level disparities in post-brain injury epilepsy patients, a modified prognostic study quality score was employed for bias evaluation. Pooled standardized mean differences (SMD) with 95% CIs were calculated. Molecular interaction network and enrichment analyses were performed in Cytoscape.

The results showed 22 studies, 1,499 cases of post-brain injury epilepsy, and 7,929 controls. Analyzed 45 biomarkers in blood-cerebrospinal fluid (CSF). Among them, 21 held a moderate-to-high risk of bias. The majority of biomarkers (28/45) were examined in solitary studies. Merely nine offered validation data, with differing definitions for early and late-onset seizures. A meta-analysis was feasible for 19 biomarkers. Blood glucose levels increased in post-stroke epilepsy (PSE) patients across four studies. Across, 15 blood-based and 7 CSF-based biomarkers displayed significant connections to post-brain injury epilepsy. Enrichment analysis pinpointed inflammation-related biomarkers as the primary vital findings.

They concluded that included studies show methodological heterogeneity, limiting anti-epileptogenesis trials due to bias and insufficient validation.