Abstracts

Rationale: The role of cytokines in people living with epilepsy (PWE) is increasingly being recognized. The mechanisms by which seizures induce the synthesis of cytokines are still unknown but could be due to glutamate release from the neurons during seizures activating the cytokine transcription from the glia. In this study, we analyzed the serum cytokine in PWE and correlated it with their phenotype and other parameters. Methods: One hundred PWE (M:F= 61:39; age at onset and presentation: 22.4± 17.05 and 25.9 ± 16.5 years respectively; duration of epilepsy: 42.6± 70.0 months) were prospectively recruited after obtaining the consent. The serum samples was collected in all (within 24 hours of last seizure) and in 16 patients, second sample was also collected, when they were seizure-free for >2 weeks. The serum cytokine levels [a) Pro-inflammatory: TNFα, IFNγ IL-1β, IL-2; b) anti-inflammatory: IL-4, IL-6] was assessed by ELISA in patients and healthy controls.Results: The type of seizures (n=100) was major (45), partial (41) and status epilepticus (SE=14), while the epilepsy syndromes were idiopathic generalized (53) and localization related (47). The serum cytokines (n=100) were: a) Pro-inflammatory: TNF-α (36), IFN-γ (20), IL-1b (11), IL-2 (22), and b) anti-inflammatory: IL-4 (22) and IL-6 (42) compared to the controls. There was significant correlation between anti-inflammatory and pro-inflammatory cytokines (p=0.002). Correlations were noted between male gender and IL-1b (p=0.04), positive family history and IL -1b (p=0.001), no alcohol use and TNFα (p=0.05), >1 year history of epilepsy and IL-1b (p=0.02), SE and IL-6 (p=0.04). There were no correlations with type or duration of epilepsy, imaging abnormality, and mono or polytherapy. Serial analysis during the seizure-free period revealed decrease in cytokine levels: TNFα (25% to 12.5%), IFNγ (12.5% to 0%), IL-1b (25% to 0) and IL-2 (6.2% to 6.2%), IL-4 (18.8% to 0%) and IL-6 (18.8% to 6.2%). Conclusions: Elevated serum cytokines levels were detected during the immediate post-ictal phase in PWE, which reduced when they were seizure free. Though it might suggest a cytokine-mediated inflammation, its exact pathogenesis remains unclear.