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Updated: Apr 5, 2026
Author Spotlight: Obtaining High-Quality CSF and Blood Samples for Epilepsy Biomarker Discovery
Published on: September 1, 2023
Molecular biomarkers in drug-resistant epilepsy: Facts & possibilities
Aparna Banerjee Dixit1, Manjari Tripathi2, P Sarat Chandra3
1Center of Excellence for Epilepsy, National Brain Research Centre, Manesar, 122051, India.
Abstract:
Despite great advances in our understanding of the process of epileptogenesis we are yet to develop reliable biomarkers that have the potential to accurately localize the epileptogenic zone (EZ), and to resolve the issue of heterogeneity in epilepsy surgery outcome. Inability to precisely localize the epileptogenic foci is one of the reason why more than 30% of these DRE patients are not benefited. Molecular and cellular biomarkers in combination with imaging and electrical investigations will provide a more specific platform for defining epileptogenic zone. Potential molecular biomarkers of epileptogenesis including markers of inflammation, synaptic alterations and neurodegeneration may also have the potential for localizing EZ. At molecular level components derived from epileptogenic tissues, such as metabolites, proteins, mRNAs and miRNAs that are significantly altered can serve as biomarkers and can be clubbed with existing techniques to preoperatively localize the EZ. Neurosurgeons across the world face problems while defining the margins of the epileptogenic tissues to be resected during surgery. In this review we discuss molecular biomarkers reported so far in the context of epileptogenesis and some of the unexplored markers which may have the potential to localize EZ during surgery. We also discuss "Intelligent knife" technique that couples electrosurgery and mass spectrometry allowing near-real-time characterization of human tissue and may prove to be instrumental in defining the margins of the epileptogenic zone during surgery.
Insights
Identifying reliable molecular biomarkers is crucial for precisely locating the epileptogenic zone (EZ) in epilepsy surgery. This research explores current and novel biomarkers, including the "Intelligent knife," to improve surgical outcomes for drug-resistant epilepsy patients.
Area of Science:
- Neuroscience
- Biomarker Discovery
- Surgical Innovation
Background:
- Accurate localization of the epileptogenic zone (EZ) remains a challenge in epilepsy surgery, contributing to suboptimal outcomes in over 30% of drug-resistant epilepsy (DRE) patients.
- Current diagnostic methods often lack the specificity to precisely define seizure foci, necessitating improved tools for presurgical evaluation.
Purpose of the Study:
- To review existing and potential molecular biomarkers for localizing the epileptogenic zone (EZ) in epilepsy.
- To explore novel techniques, such as the 'Intelligent knife,' for intraoperative margin definition of epileptogenic tissue.
Main Methods:
- Comprehensive review of molecular biomarkers associated with epileptogenesis, including markers of inflammation, synaptic alterations, and neurodegeneration.
- Analysis of molecular components (metabolites, proteins, mRNAs, miRNAs) altered in epileptogenic tissues.
- Discussion of the 'Intelligent knife' technology, integrating electrosurgery and mass spectrometry for real-time tissue characterization.
Main Results:
- Molecular biomarkers derived from epileptogenic tissues show promise for enhancing the preoperative localization of the EZ.
- The 'Intelligent knife' offers a potential solution for intraoperative guidance in defining resection margins, addressing a critical surgical challenge.
Conclusions:
- Combining molecular biomarkers with existing diagnostic modalities can significantly improve EZ localization and surgical planning.
- Emerging technologies like the 'Intelligent knife' hold promise for real-time tissue analysis, potentially revolutionizing surgical approaches to epilepsy.
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