Erythropoietin for Seizures and Epilepsy: Neuroprotective Effects, Mechanisms, and Contradictory Risks

Epilepsy is a widespread neurological disorder, particularly affecting children and the elderly, presenting complex and varied challenges in management. Recently, erythropoietin has gained significant attention due to its neuroprotective effects, which have been demonstrated experimentally in various neurological conditions, including epilepsy. This review aims to analyze current literature on the role of erythropoietin in seizures and epilepsy.

A comprehensive literature search was conducted through PubMed, Scopus, and Web of Science databases up to September 30, 2024. The search terms included "Epilepsy AND Erythropoietin", "Seizures AND Erythropoietin," and "Status Epilepticus AND Erythropoietin", applied to titles, abstracts, and keywords.

The review highlights ongoing debates surrounding erythropoietin's effects on epilepsy. While erythropoietin shows potential in mitigating seizure-induced brain damage and modulating cellular processes such as anti-apoptotic and anti-inflammatory pathways, its clinical application is complicated by conflicting evidence. Some studies suggest that erythropoietin may trigger seizures, with factors such as dosage and individual patient characteristics potentially influencing this risk.

Experimental studies suggest that erythropoietin offers neuroprotective benefits in epilepsy. However, its possible pro-convulsant effects-which might be linked to erythropoietin-induced hypertension, rapid increases in hematocrit levels, dosage, or individual patient characteristics-raise safety concerns. These risks complicate its clinical use, making it premature to endorse erythropoietin as a treatment fully. Future research should focus on non-erythropoietic derivatives that retain neuroprotective effects without stimulating red blood cell production, thereby reducing risks, such as hypertension and thrombosis. Well-designed clinical trials and further investigation into erythropoietin's mechanisms are essential to clarify its role and optimize its therapeutic potential in epilepsy.