P-EP018. A systematic review on the role of tumor necrosis factor-alpha in post-traumatic epilepsy

Abstract

Introduction. Post-traumatic epilepsy (PTE) is one of the detrimental outcomes of traumatic brain injury (TBI), resulting in unprovoked recurrent seizures which impacts heavily on the quantity of life. However, the pathological relationship between PTE and TBI remains unclear, and commonly prescribed anti-epileptic drugs (AED) are ineffective against PTE. Fortunately, emerging research implicates neuroinflammation particularly the tumor necrosis factor-alpha (TNF-α) as the key mediator for PTE development. Thus, this systematic review aims to examine the currently available literature regarding the role of TNF-α in PTE pathology and consecutively, evaluate TNF-α as a possible target for PTE treatment. Methods. A comprehensive literature search was conducted on four databases including PubMed, CINAHL, Embase, and Scopus. Articles were screened according to the inclusion and exclusion criteria as per the PRISMA guidelines. Articles with relevance in investigating TNF-α expression in PTE were considered in this review. Qualitative analysis on the selected animal studies were performed using SYRCLE tool. Results. Critical evaluation of four articles; one in-vitro study, two in-vivo studies and one computational study, that met the inclusion criteria suggests a proportional relationship between TNF-α expression and seizure susceptibility post injury, and that neutralization or suppression of TNF-α release results in reduced susceptibility to seizures after TBI. Conclusion. In conclusion, this review elucidates the importance of TNF-α expression in epileptogenesis post-injury and urges future research to focus more on clinical studies involving TNF-α which may provide a clearer insight to PTE prevention and therefore improving the lives of PTE patients.