Is the regulation of lamotrigine on depression in patients with epilepsy related to cytokines?

Objectives: The purpose of this study was to analyze the effects of lamotrigine on peripheral blood cytokines and depression in patients with epilepsy and to explore the possible mechanism by which lamotrigine regulates depression in patients with epilepsy. Methods: 50 healthy people, 72 patients treated with lamotrigine (LTG group) and 72 patients treated with valproate were enrolled (VPA group). Cytokine levels in the peripheral blood of the subjects were measured and their level of depression was scored according to the self-rating Depression Scale (SDS), Hamilton Depression Scale (HAMD) and Chinese version of Epilepsy Depression Scale (c-NDDI-E). The cytokine levels and depression scale scores were compared between the three groups. The correlation between cytokine levels and depression scale scores was analyzed. Results: The levels of IL-1ß, IL-2, IL-6, and TNF-α and the SDS, HAMD, and c-NDDI-E scores in healthy group was lower than that in epileptic group. After 6 months of treatment, the difference valule of IL-1ß、IL-6、TNF-α、SDS and HAMD before and after treatment in LTG group significantly higher than that in VPA group. Correlation analysis showed that the SDS scores were correlated with the levels of IL-1ß and TNF-α, and the HAMD scores were correlated with the levels of TNF-α. Multiple linear regression analysis showed that the HAMD scores were correlated with the levels of TNF-α. Conclusion: Lamotrigine can inhibit peripheral blood inflammation and improve depression in epileptic patients. Lamotrigine improved depressive mood in epileptic patients, which may be related to reduced TNF-α levels.

TNF-α: A serological marker for evaluating the severity of hippocampal sclerosis in medial temporal lobe epilepsy?

OBJECTIVE: By analysing the difference in TNF-α levels in the peripheral blood of patients with medial temporal lobe epilepsy (mTLE) with or without hippocampal sclerosis and the correlation between TNF-α and N-acetylaspartate levels in the hippocampus, we explored the relationship between TNF-α and the degree of damage to hippocampal sclerosis neurons in medial temporal lobe epilepsy. METHODS: This is a prospective, population-based study. A total of 71 Patients with medial temporal lobe epilepsy diagnosed by clinical seizures, video-EEG, epileptic sequence MRI, and other imaging examinations were recruited from October 2020 to July 2022 in the Department of Neurology, Affiliated Hospital of Xuzhou Medical University. Twenty age-matched healthy subjects were selected as the control group. The patients were divided into two groups: the medial temporal epilepsy with hippocampal sclerosis group (positive group, mTLE-HS-P group) and the medial temporal epilepsy without hippocampal sclerosis group (negative group, mTLE-HS-N group). The levels of IL-1ß, IL-5, IL-6, IL-8, IL-17, IFN-γ and TNF-α in the peripheral blood of the patients in the three groups were detected by multimicrosphere flow immunofluorescence assay. The level of N-acetylaspartate (NAA) in the hippocampus was measured by 1H-MRS. The differences in cytokine levels among the three groups were analysed, and the correlation between cytokine and NAA levels was analysed. RESULTS: The level of TNF-α in the peripheral blood of the patients in the mTLE-HS-P group was significantly higher than that of the patients in the mTLE-HS-N and healthy control groups, and the level of TNF-α in the patients in the mTLE-HS-N group was significantly higher than that of the patients in the healthy control group. The NAA level in mTLE-HS-P group patients was significantly lower than that of mTLE-HS-N patients and healthy controls, but there was no significant difference between mTLE-HS-N patients and healthy controls (P > 0.05). Spearman correlation analysis showed that TNF-α level (rs = -0.437, P < 0.05) and the longest duration of a single seizure (rs = -0.398, P < 0.05) were negatively correlated with NAA level. Logistic regression analysis showed that there was no significant correlation between the longest duration of a single seizure and hippocampal sclerosis, but TNF-α level was closely related to hippocampal sclerosis in patients with mTLE (OR = 1.315, 95 % CI 1.084-1.595, P = 0.005). CONCLUSION: The level of TNF-α in the peripheral blood of patients with medial temporal lobe epilepsy with hippocampal sclerosis was higher, and it was correlated with NAA and hippocampal sclerosis. The high expression of TNF-α may be of important value in the evaluation of hippocampal sclerosis patients.