Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy in adults. Experimental and clinical data indicate that neuroinflammation and neurodegeneration accompanying epileptogenesis make a significant contribution to the chronicity of epilepsy and the development of drug resistance in TLE cases. Changes in plasma and serum concentrations of proteins associated with neuroinflammation and neurodegeneration can be predictive biomarkers of the course of the disease. This study used an enzyme-linked immunosorbent assay of the following plasma proteins: brain-derived neurotrophic factor (BDNF), tumor necrosis factor alpha (TNFa), and high-mobility group protein B1 (HMGB1) in patients with mesial TLE to search for biomarkers of the disease. The objective of the study was to examine biomarkers of the neuroinflammation and neurodegeneration of plasma: BDNF, TNFa, and HMGB1. The aim of the study was to identify changes in the concentration of circulating pro-inflammatory and neurotrophic factors that are prognostically significant for the development of drug resistance and the course of TLE. A decrease in the concentration of BDNF, TNFa, and HMGB1 was registered in the group of patients with TLE compared with the control group. A significant decrease in the concentration of HMGB1 in patients with drug-resistant TLE was observed. Aberrations in plasma concentrations of BDNF, TNFa, and HMGB1 in patients with TLE compared with the controls have been confirmed by earlier studies. A decrease in the expression of the three biomarkers may be the result of neurodegenerative processes caused by the long course of the disease. The results of the study may indicate the acceptability of using HMGB1 and TNFa as prognostic biological markers to indicate the severity of the disease course and the risk of developing drug resistance.

Temporal lobe epilepsy (TLE) is one of the most common forms of focal epilepsy in children and adults. TLE is characterized by variable onset and seizures. Moreover, this form of epilepsy is often resistant to pharmacotherapy. The search for new mechanisms for the development of TLE may provide us with a key to the development of new diagnostic methods and a personalized approach to the treatment. In recent years, the role of non-coding ribonucleic acids (RNA) has been actively studied, among which microRNA (miR) is of the greatest interest. (1) Background: The purpose of the systematic review is to analyze the studies carried out on the role of miRs in the development of mesial TLE (mTLE) and update the existing knowledge about the biomarkers of this disease. (2) Methods: The search for publications was carried out in the databases PubMed, Springer, Web of Science, Clinicalkeys, Scopus, OxfordPress, Cochrane. The search was carried out using keywords and combinations. We analyzed publications for 2016–2021, including original studies in an animal model of TLE and with the participation of patients with TLE, thematic and systemic reviews, and Cochrane reviews. (3) Results: this thematic review showed that miR‒155, miR‒153, miR‒361‒5p, miR‒4668‒5p, miR‒8071, miR‒197‒5p, miR‒145, miR‒181, miR‒199a, miR‒1183, miR‒129‒2‒3p, miR‒143‒3p (upregulation), miR–134, miR‒0067835, and miR‒153 (downregulation) can be considered as biomarkers of mTLE. However, the roles of miR‒146a, miR‒142, miR‒106b, and miR‒223 are questionable and need further study. (4) Conclusion: In the future, it will be possible to consider previously studied miRs, which have high specificity and sensitivity in mTLE, as prognostic biomarkers (predictors) of the risk of developing this disease in patients with potentially epileptogenic structural damage to the mesial regions of the temporal lobe of the brain (congenital disorders of the neuronal migration and neurogenesis, brain injury, neuro-inflammation, tumor, impaired blood supply, neurodegeneration, etc.).

Study Objective: To determine the independent role of the carriage of SNVs genes IL-1β, TNF, BDNF, NTRK-2, clinical, biochemical parameters in predicting the course of mesial temporal lobe epilepsy using statistical modeling methods. Study Design: Prospective study. Materials and Methods. 166 patients with mesial temporal lobe epilepsy were examined. The diagnosis of temporal lobe epilepsy was determined on the basis of clinical and anamnestic data, electroencephalography data, and neuroimaging data. Based on the molecular genetic analysis of the SNVs genes IL-1β, TNF, BDNF, NTRK-2, the study of the concentration of BDNF, NTRK-2, IL-1β, TNFα in blood plasma by enzyme immunoassay, neuroimaging data and clinical anamnestic data, a prognosis of the course was carried out mesial temporal lobe epilepsy using logistic regression analysis and classification trees. Study Results. The method of multiple logistic regression analysis revealed that the combined effect of hippocampal sclerosis and carriage of the A allele rs6265 of the BDNF gene leads to an uncompensated course of temporal lobe epilepsy. The accuracy was 80.3%, sensitivity — 66.7%, 95% CI: 46.0%; 83.5%, specificity — 91.4%, 95% CI: 76.9%; 98.2%. Using the CHAID algorithm, a classification tree was generated, allowing to assign patients with temporal lobe epilepsy to the group of compensated or uncompensated course of the disease. The accuracy of the model was 80.3%, sensitivity — 75.0%, 95% CI: 66.9%; 82.0%, specificity — 87.8%, 95% CI: 79.6%; 93.5%. Conclusion. Prognostically significant clinical characteristics of patients with VE, features of changes in the concentrations of circulating proinflammatory and neurotrophic factors, the carriage of single-nucleotide variants of the genes encoding them to predict the nature of the course of VE were identified which allows in practice to apply a personalized approach to the patient, especially in demand in the case of chronic disease. Keywords: mesial temporal lobe epilepsy, prognosis, logistic regression, classification trees.

Клинический случай ранней диагностики аутоиммунной эпилепсии

Study Objective: To study the features of neuroimaging indicators (magnetic resonance imaging (MRI) of the brain and magnetic resonance spectroscopy of the mediobasal temporal lobes) in patients with mesial temporal epilepsy (TLE). Study Design: A retrospective study. Materials and Methods. Brain MRI was analyzed in 166 patients with mesial TLE, and the results of MR spectroscopy of the mediobasal parts of the temporal lobes in 32 of them were additionally analyzed. There were 69 men (42%), 97 women (58%). The median age was 35 [29; 46] years. The age of onset of TLE is 19 [13; 30.5] years. The median duration of the disease is 11 [9; 20] years. Taking into account the peculiarities of neuroimaging for the analysis of metabolic changes, patients with TLE were divided into three groups: 1st — patients with TLE and hippocampal sclerosis (62 (37.3%) people); 2nd — patients without structural changes, according to MRI of the brain (MR-negative) (40 (24%) people); 3rd — patients with other structural changes of the brain (64 (38.7%) people, excluded from subsequent analysis due to heterogeneity of neuroradiological data). All patients underwent MRI of the brain with a magnetic field power of 1.5 Tesla in T1, T2, FLAIR, DWI and SWI modes. MR spectroscopy of the mediobasal parts of the temporal lobes was carried out with the study of the main metabolites: N-acetylaspartate, choline, creatine, lactate, glutamate-glutamine complex, myonositol. Only qualitative indicators characterizing a decrease or increase in the level of the metabolite, as well as the side of the lesion, were evaluated. Study Results. In patients with TLE and hippocampal sclerosis, focal neurological symptoms (p = 0.019) and interictal regional epileptiform activity (p = 0.002) were statistically significantly more often recorded, they were more likely to receive polytherapy with antiepileptic drugs (p = 0.022) than MR-negative patients. In 93.7% of patients with mesial temporal epilepsy, regardless of the etiology of the disease, one-/two-sided changes in the levels of N-acetylaspartate and other major metabolites were registered, according to MR spectroscopy of the mediobasal temporal lobes. Conclusion. MR spectroscopy of the mediobasal temporal lobes is a sensitive method for diagnosing metabolic disorders in patients with TLE. Keywords: temporal lobe epilepsy, magnetic resonance imaging of the brain, magnetic resonance spectroscopy, hippocampal sclerosis.

На сегодняшний день не существует методов лечения и профилактики для предотвращения развития эпилепсии у лиц группы риска. Всё это указывает на потребность в поиске биомаркеров эпилептогенеза, диагностики, прогрессирования заболевания, ответа на лекарственное средство и безопасности лечения. В качестве биомаркеров эпилепсии на сегодняшний день рассматриваются: электрофизиологические изменения, наличие клинического приступа, генетические изменения, микро рибонуклеиновой кислоты (микроРНК) плазмы / сыворотки / ликвора; белковые биомаркеры, биомаркеры экзосом плазмы, микроРНК мозговой ткани коры головного мозга; биомаркеры, тензометрических изображений / диффузионно-взвешенных изображений магнитно-резонансной томографии (МРТ). Авторами приведен обзор литературы о современных исследованиях различных биомаркеров эпилепсии, которые позволяют персонализированно подходить к оценке диагностики, лечения и ответа на терапию...