Diagnostic and prognostic significance of serum interleukins in epileptic encephalopathy with spike wave activation in sleep (EE-SWAS) syndrome

• Published in: European journal of paediatric neurology 2024-11, Vol.53, p.33-38
• Main Authors: Jauhari, Prashant, Kaur, Prabhjot, Gulati, Sheffali, Meena, Ankit Kumar, Pandey, Tapish, Upadhyay, Ashish
• Format: Article
• Language: English
• Subjects: Biomarker in epilepsy; Child; Child, Preschool; Drug refractory epilepsy; Drug Resistant Epilepsy - blood; Electroencephalography - methods; ESES; Female; Humans; Interleukin-10 - blood; Interleukin-6; Interleukin-6 - blood; Interleukin-8 - blood; Interleukins - blood; Male; Prognosis; Proinflammatory cytokines; Steroid therapy
• ISSN: 1090-3798; 1532-2130; 1532-2130
• DOI: 10.1016/j.ejpn.2024.09.006

To study serum interleukin-6(IL-6), interleukin-8(IL-8) and interleukin-10(IL-10) levels in Epilpetic encephalopathy with spike-wave activation in sleep(EE-SWAS), drug refractory epilepsy(DRE) and well controlled epilepsy(WCE). Children(2–12 years) with immunotherapy naïve EE-SWAS, DRE and WCE were enrolled. Valid psychometric tools were used to assess cognition and behavior. Children with EE-SWAS were longitudinally followed. They received a three-month steroid course alongwith the ongoing antiseizure drugs. Electroclinical responders were defined as change in social quotient by 5-points with improvement in atleast one behavioral domain by 5-points and 50 % reduction in mean seizure frequency if active seizures were present alongwith a 25 % reduction in Spike-wave-index(SWI) at three months. Change in serum Interleukin levels at one month follow up was compared between participants who eventually became responders or non-responders at three months. Twenty children with EE-SWAS, 18 with DRE and WCE each were enrolled. Serum IL-6(pg/ml){(EE-SWAS: 3.775(IQR 2.205, 11.28); DRE: 3.01(IQR 2.04, 4.56); WCE: 1.655(IQR 1.27, 2.29), p = 0.0065} and IL-8(pg/ml){(EE-SWAS: 103.2(IQR 34.01, 200.82); DRE: 19.595(IQR 16.54, 39.7); WCE: 18.97(IQR 16.54, 21.91) p = 0.0002} was significantly different between the three groups. In EE-SWAS group 12/20(60 %) showed electroclinical response to steroids. Responders had significant reduction in IL6 levels (pg/ml){4.045(IQR 2.605, 18.96) to 1.13(IQR 054, 1.74)} at one month follow up compared to non responders {3.12(IQR 1.655, 5.27) to 4.37(IQR 2.83, 9.855)} (p = 0.0069). Proinflammatory cytokines (IL-6 and IL-8) are significantly elevated in EE-SWAS compared to DRE and WCE. Reduction in IL-6 levels at one month post-therapy predicted electroclinical responders at 3months follow up. •The neuroinflammatory nexus of EE-SWAS is distinct from DRE and WCE with elevated serum IL-6 and Il-8.•Serum IL-6 is elevated in both DRE and EE-SWAS suggesting a role in epileptogenesis in both these conditions.•A decline in serum IL-6 levels at 4-weeks post steroid therapy in EE-SWAS may predict response to steroids at 3 months.