Vascular remodeling associated with vascular endothelial growth factor in epilepsy

Epilepsy is a chronic neurological disorder characterized by recurrent unprovoked seizures, frequently associated with resistance to conventional antiseizure drugs. Increasing evidence highlights the critical interplay between neural and vascular systems in epileptogenesis, particularly involving vascular remodeling and blood-brain barrier (BBB) dysfunction. Vascular endothelial growth factor (VEGF), a key regulator of angiogenesis and vascular permeability, plays a dual role in the central nervous system, contributing to neuroprotection, neurogenesis, and synaptic plasticity under physiological conditions, while promoting pathological angiogenesis and BBB disruption when persistently elevated. In epilepsy, upregulated VEGF-primarily through VEGFR-2 signaling-drives aberrant angiogenesis, degradation of tight junction proteins, extracellular matrix remodeling, and increased vascular permeability. These changes facilitate serum protein extravasation, neuroinflammation, and neuronal hyperexcitability, establishing a self-perpetuating cycle that sustains seizure activity and epileptogenesis. Elevated VEGF expression in epileptic brain tissue, particularly in the hippocampus, correlates with seizure frequency and BBB impairment. Given its central involvement in neurovascular dysregulation, targeting VEGF signaling represents a promising disease-modifying strategy. However, due to its context-dependent neuroprotective and pro-epileptogenic effects, therapeutic approaches must carefully consider timing, receptor specificity, and downstream pathways. Further research is required to define optimal intervention windows, biomarkers, and long-term safety profiles for VEGF-targeted therapies in epilepsy.