Epileptology - with epilepsy as one of the most common neurological diseases - has an urgent need for easily accessible biomarkers to improve diagnosis, prognosis and therapeutic monitoring. Neurofilament light chain (NfL) and Glial Fibrillary Acidic Protein (GFAP) have emerged as promising fluid biomarkers in various neurological disorders. Their potential role in epileptic seizures and epilepsy remains largely unexplored. To assess the current state of research on this topic we comprehensively searched the published literature for studies on GFAP and/or NfL in cerebrospinal fluid and/or blood in adult humans with epileptic seizures, status epilepticus or epilepsy (last data base search on 10th of May 2024). We identified a total of 2285 publications of which 19 fulfilled our search criteria. The studies targeted various outcomes such as prognosis in status epilepticus, differentiation of seizure semiology and etiology, differentiation of epileptic seizures from non-epileptic conditions, prediction of epilepsy in autoimmune epilepsy, after a stroke or after a first unprovoked seizure, the role of the time interval from seizure to sampling, the association with disease duration as well as seizure frequency and the influence of seizure suppressing medication. The results are heterogeneous but indicate promising applications for both NfL and GFAP in diagnosis and prognostication of patients with epileptic seizures and epilepsy. In the present review we summarize the current evidence, future perspectives, but also limitations, of NfL and GFAP as fluid biomarkers in epilepsy and epileptic seizures.
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http://dx.doi.org/10.1016/j.yebeh.2025.110321 | DOI Listing |
Neurology
April 2025
School of Law, University of Virginia, Charlottesville.
This consensus position statement of the American Academy of Neurology, American Epilepsy Society, and Epilepsy Foundation of America updates prior 1994 and 2007 position statements on seizures, driver licensure, and medical reporting. Key consensus positions include the following: (1) in the United States, national driving standards promulgated through a system such as the Uniform Law Commission would reduce confusion and improve adherence with state driving standards; (2) state licensing criteria for medical conditions should be promulgated by regulations and guidelines based on enabling legislation rather than in statutes themselves and should be developed by medical advisory boards working in collaboration with departments of motor vehicles; (3) licensing criteria should be equitable, nondiscriminatory, objective, and compatible with comparable risks in other populations; (4) a minimum seizure-free interval of 3 months should ordinarily be required before driving in all cases and should be extended in individual cases based on review of favorable and unfavorable features by medical advisory boards; (5) individuals with exclusively provoked seizures attributable to provoking factors that are unlikely to reoccur in the future may not require a seizure-free interval before resuming driving; (6) individuals with previously well-controlled epilepsy who experience seizures due to short-term interruptions of antiseizure medications in the setting of hospitalization or practitioner-directed medication-titration may not require a seizure-free interval before driving once previously effective levels of antiseizure medications have been resumed; (7) patients and practitioners should pause driving during tapering and following discontinuation of an antiseizure medication if another such medication is not introduced; (8) individuals whose cognition or coordination is impaired due to medications used to prevent seizures should refrain from driving; (9) health care practitioners should be allowed but not mandated to report drivers who pose an elevated risk; but (10) neither a decision to report a patient suspected of being at elevated risk nor a decision declining to report a patient suspected of being at elevated risk should be subject to legal liability; (11) nations, states, and municipalities should provide alternative methods of transportation and accommodations for individuals whose driving privileges are restricted due to medical conditions.
View Article and Find Full Text PDFClin Dysmorphol
March 2025
Serviço de Genética Médica, Departamento de Pediatria, Unidade Local de Saúde de Santa Maria, Lisboa, Portugal.
Epileptic Disord
March 2025
Freiburg Epilepsy Center, Member of the ERN EpiCARE, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
A systematic review using PRISMA criteria was used to review the literature regarding the specific semiology of seizure arising (a) from the temporal pole or (b) from both medial and lateral temporal cortex. Evidence was analyzed with regard to information provided by intracranial EEG recordings and surgical outcomes, and an estimation of validity of reported signs and symptoms was performed. Semiology of seizures originating from the temporal pole was mostly related to diverse patterns of ictal spread rather than to the localization of seizure origin and comprised a wide variety of early signs and symptoms.
View Article and Find Full Text PDFMetab Brain Dis
March 2025
Department of Biochemistry, Faculty of Sciences, University of Uyo, Uyo, Nigeria.
Kindling is an experimental-induced seizure consistent with epilepsy disease, a chronic neurological disorder characterised by spontaneous and repeated seizures. This disease is associated with oxidative stress, and most therapeutic strategies against epilepsy aim at improving the antioxidant defence mechanism in the brain. However, prolonged usage and associated adverse side effects limit antiepileptics, warranting natural antioxidant patronage.
View Article and Find Full Text PDFEpilepsia
March 2025
Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
The immune system is crucial for the correct brain development, and recent findings also point toward central control of immune response. As the immune system is not fully developed at birth, the early years become an important window for infections and for the development of epilepsy. Both central and even peripheral inflammation may impact brain function, promoting opening of the blood-brain/blood and cerebrospinal barriers and allowing entry of immune cells and cytokines, which in turn may affect neuron function and connections.
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