Transformative Research Priorities for the Epilepsies

Accelerate development and validation of biomarkers

Why would this research priority transform epilepsy research, our understanding of the epilepsies, and/or treatment of the epilepsies? :

The American Epilepsy Society agrees that topic is a VERY high priority. We suggest a revision to include "onset of epilepsy" in its scope.

To date there have been numerous studies and meta-analyses on epilepsy biomarkers. Biomarkers for epilepsy versus seizure have often been blurred but should be considered distinct. Clinically useful biomarkers for seizures (i.e., a blood test), would have great value in the emergency department, intensive care unit, labor and delivery areas, operating rooms, and urgent care centers, as well as a huge impact in developing countries where conventional clinical tools and resources are scarce (i.e., EEG, brain imaging). These biomarkers will likely reflect phasic changes in the expression of biomolecules (e.g., protein, mRNA, miRNA) and could easily derive from systemic changes (i.e., muscle, T-cells, gut, etc), rather than brain specific changes released systemically.

In contrast, biomarkers for epilepsy, meaning the change in network functioning causing recurrent seizures, may be more challenging. A diagnostic biomarker for "epilepsy" would obviously have huge prognostic and predictive value from a public health perspective in diagnosis, distinguishing response to medications, clinical course, likelihood of intractability, and potentially genetic risk assessment. We note that development of epilepsy biomarkers requires robust examination of human data.

Likely these discoveries will require large collaborative, multi-center approaches with "big data" analysis, separating "seizures" from "epilepsy". Cohort will need careful and broad stratification for medical co-morbidities i.e., cancer, immune disorders, obesity, diabetes, social determinants of health.

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Idea No. 132