Predictive value of traditional laboratory parameters and inflammatory indices for same-day seizure recurrence in patients with epileptic seizures

Abstract

Objective: Early recurrence of epileptic seizures within the same day of emergency department (ED) admission poses clinical management challenges. While several blood-based parameters have been proposed as prognostic markers in various neurological disorders, their predictive utility in same-day seizure recurrence remains underexplored. We aimed to investigate whether inflammatory parameters derived from hemogram parameters can predict seizure recurrence within the same day in patients presenting with epileptic seizures or not.

Methods: We included 267 patients who presented to our ED with epileptic seizures within the last 2 years. Patients were grouped into recurrence (n = 68) and non-recurrence (n = 199) cohorts. Hemogram-derived indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte-to-neutrophil ratio (MNR), platelet-to-neutrophil ratio (PNR), immune-platelet inflammation value (IPIV), pan-immune inflammation value (PIV), systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) were calculated and compared between groups. Statistical analyses included receiver operating characteristic (ROC) curve assessment for predictive accuracy.

Results: NLR, PLR, SII, and SIRI values were significantly elevated in the recurrence group (p < 0.05), indicating heightened systemic inflammation. Traditional parameters such as white blood cell count (WBC), glucose, and lactate did not significantly differ. Area under the curve (AUC) values in ROC curve analyses revealed that the NLR (AUC = 0.618) and SII (AUC = 0.601) had moderate discriminative ability, although no parameter achieved a substantial predictive value (AUC ≥ 0.7).

Significance: Elevated inflammatory indices, particularly NLR and SII, are associated with same-day seizure recurrence, suggesting their potential utility in ED triage. However, none demonstrated sufficient stand-alone predictive power, highlighting the need for prospective studies incorporating novel biomarkers.

Plain language summary: This study looked at whether certain blood test values can help predict if a person who comes to the emergency department (ED) with an epileptic seizure will have another seizure on the same day. Researchers focused on inflammation-related markers found in routine blood tests, such as the neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII). We found that these values were higher in patients who had repeated seizures within the same day. However, while these markers showed some association with seizure recurrence, they were not accurate enough to reliably predict it on their own. These findings suggest that simple blood tests might provide helpful clues in emergency settings, but more research is needed to find stronger and more reliable indicators for early seizure recurrence.

Keywords: biomarkers; epilepsy; inflammation; recurrence; seizure.