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Updated: Jun 8, 2026
09:58
Lipidomics and Transcriptomics in Neurological Diseases
Published on: March 18, 2022
Glymphatic system dysfunction in epilepsy: a systematic review and meta-analysis.
Rishu Raj1, Arkansh Sharma2, Annu Singhal3
1Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India.
Epilepsy & Behavior : E&B
|June 6, 2026
Summary
Glymphatic system impairment, measured by Diffusion Tensor Imaging-based Analysis of Longitudinal Perfusion (DTI-ALPS), is significantly reduced in epilepsy patients. This reduction correlates with disease duration, suggesting DTI-ALPS as a potential biomarker for glymphatic dysfunction in epilepsy.
Area of Science:
- Neuroimaging
- Neuroscience
- Biomarkers
Background:
- The glymphatic system clears metabolic waste via astrocytic aquaporin-4-mediated exchange.
- Epilepsy is associated with structural changes that may impair glymphatic function.
- Quantitative neuroimaging data on glymphatic impairment in epilepsy are lacking.
Purpose of the Study:
- To systematically review and meta-analyze studies quantifying DTI-ALPS in epilepsy.
- To assess DTI-ALPS as a proxy marker of glymphatic impairment in epilepsy.
- To evaluate the clinical correlates of DTI-ALPS in epilepsy.
Main Methods:
- Systematic review and meta-analysis following PRISMA 2020 guidelines.
- Searched PubMed, Embase, Web of Science, and Scopus for observational studies.
- Pooled mean differences and correlation coefficients using random-effects models.
- Assessed study quality using Newcastle-Ottawa Scale and publication bias via Egger's test.
Main Results:
- Seventeen studies (1255 participants) were included; 15 contributed to the primary meta-analysis.
- DTI-ALPS values were significantly reduced in epilepsy patients compared to controls (MD -0.157, p < 0.0001).
- Reductions were inversely correlated with disease duration (r = -0.392, p = 0.0014) and age at onset (r = -0.148, p = 0.020).
Conclusions:
- DTI-ALPS is consistently reduced in epilepsy and correlates with disease chronicity.
- DTI-ALPS shows potential as a biomarker for glymphatic burden in epilepsy.
- Limitations include heterogeneity, potential medication confounding, and limited population diversity; further multicenter studies are needed.
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