Peripheral and central inflammatory markers associated with anxiety in epilepsy: A combined biomarker model

Anxiety is a common psychiatric comorbidity in epilepsy and is associated with adverse clinical outcomes. Emerging evidence suggests that inflammatory processes may contribute to its pathophysiology; however, the relationship between peripheral and central inflammatory markers and anxiety in epilepsy remains unclear.

This retrospective study included 184 patients with epilepsy, classified into those with anxiety symptoms (EP-A, n = 107) and without anxiety (EP-nA, n = 77) based on the Hamilton Anxiety Rating Scale. Clinical data and inflammatory markers from peripheral blood and cerebrospinal fluid (CSF) were collected. Logistic regression, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curves were used to identify independent risk factors and evaluate predictive performance.

Patients with anxiety symptoms exhibited significantly elevated peripheral inflammatory markers, including platelet count, monocyte count, CRP, CAR, and PLR (all P < 0.05), as well as increased central markers such as CSF white blood cell count, lactate, and IgG index (all P < 0.05). Multivariate analysis identified CAR, PLR, CSF lactate, and IgG index as independent risk factors. RCS analysis demonstrated nonlinear associations for several markers, with risk increasing sharply beyond specific thresholds. The combined model showed good predictive performance (AUC = 0.814), with satisfactory sensitivity and specificity.

Peripheral and central inflammatory markers are associated with anxiety in epilepsy. A combined biomarker model may provide a clinically useful tool for early risk stratification and supports a potential role of neuroinflammation in epilepsy-related anxiety.