Inflammatory Biomarkers in Psychogenic Non-epileptic Seizure

Study Overview
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Brief Summary
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Evaluation of the role of TRAIL and MCP-2 in differentiation between epileptic seizure and psychogenic non-epileptic seizure. Possible role to predict the prognosis of patients with epileptic seizure.

Detailed Description
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Epilepsy is one of the most prevalent neurological disorders characterized by frequent somatic and psychiatric co-morbidities(1). Accurate diagnosis of epilepsy is challenging because clinicians rarely observe the actual clinical seizure outside of the hospital. Furthermore, psychogenic nonepileptic seizures (PNES) can mimic epileptic seizures (ES), leading to erroneous diagnosis and inappropriate treatments. A critical gap in the diagnostic assessment of seizures is a blood test that can distinguish ES from PNES (2). Both diagnoses were confirmed by the gold standard diagnostic method video/electroencephalogram (EEG) monitoring (3). Taking all in to account, the notion that neuro-inflammation is the key pathology behind focal epileptic seizure initiation and maintenance and the dynamic and adaptative process of neuro -inflammation is associated with blood-brain-barrier disruption and glial activation is no longer a surprise (4). Tumor necrosis factor related apoptosis inducing ligand (TRAIL) regulates immune responses via apoptosis, with lower levels associated with severe infection, including sepsis (5). Monocyte chemoattractant protein-2 (MCP-2) has been well recognized to participate in immune regulation via binding to chemokine receptors and activation chemotaxis in lymphocytes T, natural killer (NK) cells, and monocytes therefore contributing to the pathogenesis of monocyte-dependent tissue injury (6). Hence, MCP-2 overexpression could result in an increased immune response. Further, since increased levels of MCP-2 have been observed in patients with Alzheimer's disease, this may further support the existence of the biodirections relationship between neurodegeneration and seizures/epilepsy (7).

Official Title
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Possible Role of Inflammatory Serum Biomarkers in Differentiation Between Epileptic Seizure and Psychogenic Non-epileptic Seizure

Conditions
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Localization-Related (Focal) (Partial) Idiopathic Epilepsy and Epileptic Syndromes With Seizures of Localized Onset, TRAIL: Tumor Necrosis Factor Related Apoptosis Inducing Ligand MCP-2, MCP-2: Monocyte Chemo-attractant Protein-2

Intervention / Treatment
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* Other: Measuring inflammatory serum biomarkers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients diagnosed as epileptic seizure are aged >12 years patients diagnosed as psychogenic non-epileptic seizure are aged >12 years Normal healthy control for comparison. Heathy control are aged >12 years with no history of lifetime seizures or suspected seizures or febrile seizure and no treatment with an antiepileptic drug (AED) prior to blood draw Exclusion Criteria: Neurological criteria: Other CNS disorders including Parkinson's disease, amyotrophic lateral sclerosis ,cerebrovascular stroke, Psychiatric disorders {major depression disorder , generalized anxiety, mania and other psychiatric diseases). Others: Tumors and cardiovascular

Ages Eligible for Study
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Minimum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Epileptic seizure<br>Measuring inflammatory serum biomarkers in epileptic seizure patients and psychogenic non-epileptic seizure | Other: Measuring inflammatory serum biomarkers<br>* Measuring inflammatory serum biomarkers<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 1- Evaluation of the role of TRAIL and MCP-2 in differentiation between epileptic seizure and psychogenic non-epileptic seizure | Measurement of TRAIL and MCP-2 in differentiation between epileptic seizure and psychogenic non-epileptic seizure. | in first 24 hours of seizure | 
| 2- Possible role to predict the prognosis of patients with epileptic seizure. | Differentiation between epileptic seizure and psychogenic non-epileptic seizure help in diagnosis and predict prognosis of seizure | in first 24 hours of seizure |