Biochemical risk factors associated with refractory epilepsy: alpha synuclein and adenosine deaminase

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Abstract Background Epilepsy is a common chronic neurological disorder affecting all age groups. A significant portion of children with epilepsy develop drug-resistant seizures. These children are at risk of cognitive and behavioral comorbidities and death. Some clinical features provide important information about the prognosis of epilepsy. However, currently, there is no objective biochemical indicator associated with refractory epilepsy. This study aimed to determine whether serum alpha-synuclein (αS), pglycoprotein (P-gp), and adenosine deaminase activity (ADA) were biochemical risk factors for refractory epilepsy. Methods The cross-sectional study included patients diagnosed with refractory epilepsy (n=32), non-refractory epilepsy (n=35) and 20 healthy children under the age of 18 who applied to the Pediatric Neurology outpatient clinic. In the serum samples, αS and P-gp were analyzed by ELISA and ADA activity was analyzed by spectrophotometric method. ROC analysis was applied and the area under the curve (AUC) was calculated to define cut-off values in distinguishing refractory epilepsy patients from non-refractory epilepsy patients. Binary logistic regression analysis was performed to define risk factors associated with resistance in patients with epilepsy. Results Children with epilepsy whose ADA activity and αS values were higher than the determined cut-off values had 10-fold and 5.3-fold increased risk of refractory epilepsy, respectively. Conclusions αS and ADA activity can be used as biochemical risk factors for refractory epilepsy. However, these results need to be confirmed by prospective studies with many patients.