Update on the Neuroimaging and Electroencephalographic Biomarkers of Epileptogenesis: A Literature Review

Abstract

Epilepsy is one of the most common debilitating neurological disorders that lead to severe socio-cognitive dysfunction. While there are currently more than 30 antiseizure medications available for the treatment and prevention of seizures, none address the prevention of epileptogenesis that leading to the development of epilepsy following a potential brain insult. Hence, there is a growing need for the identification of accurate biomarkers of epileptogenesis that enable the prediction of epilepsy following a known brain insult. Although recent studies using various neuroimages and electroencephalography have found promising biomarkers of epileptogenesis, their utility needs to be further validated in larger clinical trials. In this literature review, we searched the Medline, Pubmed, and Embase databases using the following search algorithm: “epileptogenesis” and “biomarker” and “EEG” or “electroencephalography” or “neuroimaging” limited to publications in English. We presented a comprehensive overview of recent innovations in the role of neuroimaging and EEG in identifying reliable biomarkers of epileptogenesis.

The Neurovascular Unit Dysfunction in the Molecular Mechanisms of Epileptogenesis and Targeted Therapy

“…The period between brain injury and the onset of epilepsy presents a potential window for intervention, where effective measures can prevent epileptogenesis. Despite the availability of over 30 anti-seizure medications (ASMs) to treat and prevent seizures, none of them can prevent epileptogenesis, thus leading to limited interventions to prevent epilepsy after potential brain injury [ 107 ]. Furthermore, even though ASMs can reduce the frequency and severity of seizures, 30% of epileptic patients still develop refractory drug-resistant epilepsy.…”

Understanding epileptogenesis from molecules to network alteration

“…Several blood biomarkers have been investigated in the context of epileptogenesis, encompassing a range of nonspecific cellular markers such as ubiquitin C-terminal hydrolase 1, neuronal-specific enolase, glial fibrillary acidic protein, and calcium-binding protein S100β, as well as neuroinflammatory markers MMP-9, high mobility group box 1 (HMGB-1), soluble intercellular adhesion molecule-5, and the CSF/serum ratio of IL-1β [41][42][43]. In addition, advancements in electroencephalography (EEG) biomarkers suggest indicators such as reduction in sleep spindle duration, perilesional high-frequency oscillation, and epileptiform discharges as potential markers for posttraumatic epilepsy following traumatic brain injury [44]. Imaging studies have also been conducted to identify early indicators of epileptogenesis, with the T1ρ sequence of MRI notably predicting seizure susceptibility within the first 2 months after injury [45].…”

Altered neuromagnetic activity in default mode network in childhood absence epilepsy

“…A steady flow of seminal findings advancing our understanding of brain activity continues to emerge from neuroimaging studies ( Engel, 2011 ; Engel et al, 2013 ; Chen et al, 2021 ). Studies using functional magnetic resonance imaging (fMRI), which has a high spatial resolution, detect hemodynamic changes in different brain regions in CAE patients by means of blood oxygen level-dependent (BOLD) sequences ( Killory et al, 2011 ; Luo et al, 2011 ; Xu et al, 2013 ; Li et al, 2015 ).…”