Chronic dysfunction of blood-brain barrier in patients with post-encephalitic/encephalopathic epilepsy. (December 2018)

• Record Type: Journal Article
• Authors: Kimizu, Tomokazu; Takahashi, Yukitoshi; Oboshi, Taikan; Horino, Asako; Omatsu, Hirowo; Koike, Takayoshi; Yoshitomi, Shinsaku; Yamaguchi, Tokito; Otani, Hideyuki; Ikeda, Hiroko; Imai, Katsumi; Shigematsu, Hideo; Inoue, Yushi
• Is Part Of: Seizure. Volume 63(2018)
• Page Start: 85
• Page End: 90
• Publication Date: 2018-12
• Subjects: BBB blood-brain barrier -- CSF cerebrospinal fluid -- DC disease control -- FCD focal cortical dysplasia -- MAPK mitogen-activated protein kinase -- MMP matrix metalloproteinase -- PEE post-encephalitic/encephalopathic epilepsy -- QAlb albumin quotient -- TGFβ transforming growth factor β; Post-encephalitic/encephalopathic epilepsy -- Refractory epilepsy -- Blood-brain barrier dysfunction -- Albumin quotient; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2018.11.005
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: PEE is recognized as drug-resistant epilepsy. Patients with PEE have severe chronic BBB dysfunction. PEE patients with widespread brain injury have higher seizure frequency. Chronic BBB dysfunction contributes to refractory epilepsy in patients with PEE. Abstract: Purpose: This study aimed to elucidate the characteristics and effects of chronic blood-brain barrier (BBB) dysfunction in patients with post-encephalitic/encephalopathic epilepsy (PEE), using brain images and the cerebral spinal fluid (CSF)/serum albumin ratio (albumin quotient, QAlb) as a marker of BBB function. Methods: We examined the albumin levels in CSF and serum samples from 312 patients with refractory epilepsy in our center between 2004 and 2015. Sixty samples from patients with PEE and 97 samples from age- and sex-matched disease controls (DC) were evaluated. We classified PEE patients into a widespread lesion group and a focal lesion group by severity on brain magnetic resonance images in the chronic phase after acute encephalitis/encephalopathy. Results: Median QAlb was higher in PEE than in DC [median (range) ×10 3 : PEE 3.6 (1.0–10.3) versus DC 2.7 (1.0–6.7), p = 0.007]. In a linear regression analysis of the relationship between QAlb and patient's age at CSF examination or duration of epilepsy, the slope of the regression line was greater in PEE than in DC. Furthermore, in patients under ten years of age, linear regression analysis of QAlb versus seizure frequency showed a weak but positive correlation. Among PEE patients, seizure frequency was higher in the widespread lesion group than in the focal lesion group [300 (4–3000) versus 30 (1–1500) seizures/month, p < 0.001]. Conclusion: Our study suggests that patients with PEE have more severe BBB dysfunction, and that the BBB dysfunction is associated with refractory epilepsy.