Upto 30% of children with epilepsy experience drug-resistant seizures. Traditional monitoring relies on clinical observation and EEG, but there is growing interest in serum biomarkers that reflect seizure activity or predict treatment response. Recent studies (within the last 5–10 years) have explored various blood-based indicators – including inflammatory cytokines, neurotrophic factors, metabolic signatures, and markers of neural injury – to correlate with seizure control in children. Identifying reliable biomarkers could improve prognostication (e.g. early identification of drug resistance) and enable more personalized management, much like HbA1c is used in diabetes to gauge disease control. Below, we summarize key findings on candidate serum biomarkers associated with seizure frequency, severity, and treatment response in pediatric epilepsy, noting each study’s strengths or limitations and the implications for clinical practice and future research.
Inflammatory Cytokines and Chemokines
- Chronic neuroinflammation: Strongly linked to epilepsy; cytokine levels in children have been studied to assess disease activity and drug resistance.
- Interleukin-6 (IL-6):
- Pro-inflammatory cytokine often elevated in epilepsy.
- Positively correlated with seizure frequency and severity; considered a potential biomarker of disease activity.
- Facilitates epileptogenesis and seizure propagation via neuroinflammatory pathways.
- Mendelian randomization study suggests IL-6 receptor blockade may reduce epilepsy risk.
- However, some inconsistencies exist: one case–control study found lower IL-6 levels in epilepsy vs. controls.
Neurotrophic and Growth Factors
- Implicated in epileptogenesis; data in children are mixed.
- Elevated in long-standing drug-resistant epilepsy (DRE) in several studies.
- Higher IL-1β levels correlated with the number of antiseizure medications needed (Choi, J et al., 2020).
- Not significantly correlated with seizure frequency in some cohorts—may reflect treatment resistance rather than seizure burden.
- Conflicting evidence: some studies found decreased IL-1β in DRE (Aguilar-Castillo MJ et al., 2024)
- Considered a plausible but not definitive biomarker for uncontrolled epilepsy.
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