Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Elevated plasma neurofilament light and glial fibrillary acidic protein in epilepsy versus nonepileptic seizures and nonepileptic disorders

Dobson, Hannah ; Al Maawali, Said ; Malpas, Charles ; Santillo, Alexander F. LU orcid ; Kang, Matthew ; Todaro, Marian ; Watson, Rosie ; Yassi, Nawaf ; Blennow, Kaj LU and Zetterberg, Henrik LU , et al. (2024) In Epilepsia
Abstract

Objective: Research suggests that recurrent seizures may lead to neuronal injury. Neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAP) levels increase in cerebrospinal fluid and blood in response to neuroaxonal damage, and they have been hypothesized as potential biomarkers for epilepsy. We examined plasma NfL and GFAP levels and their diagnostic utility in differentiating patients with epilepsy from those with psychogenic nonepileptic seizures (PNES) and other nonepileptic disorders. Methods: We recruited consecutive adults admitted for video-electroencephalographic monitoring and formal neuropsychiatric assessment. NfL and GFAP levels were quantified and compared between different patient groups and an... (More)

Objective: Research suggests that recurrent seizures may lead to neuronal injury. Neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAP) levels increase in cerebrospinal fluid and blood in response to neuroaxonal damage, and they have been hypothesized as potential biomarkers for epilepsy. We examined plasma NfL and GFAP levels and their diagnostic utility in differentiating patients with epilepsy from those with psychogenic nonepileptic seizures (PNES) and other nonepileptic disorders. Methods: We recruited consecutive adults admitted for video-electroencephalographic monitoring and formal neuropsychiatric assessment. NfL and GFAP levels were quantified and compared between different patient groups and an age-matched reference cohort (n = 1926) and correlated with clinical variables in patients with epilepsy. Results: A total of 138 patients were included, of whom 104 were diagnosed with epilepsy, 22 with PNES, and 12 with other conditions. Plasma NfL and GFAP levels were elevated in patients with epilepsy compared to PNES, adjusted for age and sex (NfL p =.04, GFAP p =.04). A high proportion of patients with epilepsy (20%) had NfL levels above the 95th age-matched percentile compared to the reference cohort (5%). NfL levels above the 95th percentile of the reference cohort had a 95% positive predictive value for epilepsy. Patients with epilepsy who had NfL levels above the 95th percentile were younger than those with lower levels (37.5 vs. 43.8 years, p =.03). Significance: An elevated NfL or GFAP level in an individual patient may support an underlying epilepsy diagnosis, particularly in younger adults, and cautions against a diagnosis of PNES alone. Further examination of the association between NfL and GFAP levels and specific epilepsy subtypes or seizure characteristics may provide valuable insights into disease heterogeneity and contribute to the refinement of diagnosis, understanding pathophysiological mechanisms, and formulating treatment approaches.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
biomarker, epilepsy, glial fibrillary acidic protein, neurofilament light chain, nonepileptic seizures
in
Epilepsia
publisher
Wiley-Blackwell
external identifiers
  • pmid:39032019
  • scopus:85199083406
ISSN
0013-9580
DOI
10.1111/epi.18065
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2024 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
id
a64a1e5d-f825-4a35-b5fe-3abd140cebe3
date added to LUP
2024-07-29 12:03:25
date last changed
2024-09-09 15:53:44
@article{a64a1e5d-f825-4a35-b5fe-3abd140cebe3,
  abstract     = {{<p>Objective: Research suggests that recurrent seizures may lead to neuronal injury. Neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAP) levels increase in cerebrospinal fluid and blood in response to neuroaxonal damage, and they have been hypothesized as potential biomarkers for epilepsy. We examined plasma NfL and GFAP levels and their diagnostic utility in differentiating patients with epilepsy from those with psychogenic nonepileptic seizures (PNES) and other nonepileptic disorders. Methods: We recruited consecutive adults admitted for video-electroencephalographic monitoring and formal neuropsychiatric assessment. NfL and GFAP levels were quantified and compared between different patient groups and an age-matched reference cohort (n = 1926) and correlated with clinical variables in patients with epilepsy. Results: A total of 138 patients were included, of whom 104 were diagnosed with epilepsy, 22 with PNES, and 12 with other conditions. Plasma NfL and GFAP levels were elevated in patients with epilepsy compared to PNES, adjusted for age and sex (NfL p =.04, GFAP p =.04). A high proportion of patients with epilepsy (20%) had NfL levels above the 95th age-matched percentile compared to the reference cohort (5%). NfL levels above the 95th percentile of the reference cohort had a 95% positive predictive value for epilepsy. Patients with epilepsy who had NfL levels above the 95th percentile were younger than those with lower levels (37.5 vs. 43.8 years, p =.03). Significance: An elevated NfL or GFAP level in an individual patient may support an underlying epilepsy diagnosis, particularly in younger adults, and cautions against a diagnosis of PNES alone. Further examination of the association between NfL and GFAP levels and specific epilepsy subtypes or seizure characteristics may provide valuable insights into disease heterogeneity and contribute to the refinement of diagnosis, understanding pathophysiological mechanisms, and formulating treatment approaches.</p>}},
  author       = {{Dobson, Hannah and Al Maawali, Said and Malpas, Charles and Santillo, Alexander F. and Kang, Matthew and Todaro, Marian and Watson, Rosie and Yassi, Nawaf and Blennow, Kaj and Zetterberg, Henrik and Foster, Emma and Neal, Andrew and Velakoulis, Dennis and O'Brien, Terence John and Eratne, Dhamidhu and Kwan, Patrick}},
  issn         = {{0013-9580}},
  keywords     = {{biomarker; epilepsy; glial fibrillary acidic protein; neurofilament light chain; nonepileptic seizures}},
  language     = {{eng}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Epilepsia}},
  title        = {{Elevated plasma neurofilament light and glial fibrillary acidic protein in epilepsy versus nonepileptic seizures and nonepileptic disorders}},
  url          = {{http://dx.doi.org/10.1111/epi.18065}},
  doi          = {{10.1111/epi.18065}},
  year         = {{2024}},
}