RESUMEN
Background: Studies suggest that neuron-specific enolase (NSE) levels in the cerebrospinal fluid (CSF) and serum play an important role in childhood epilepsy. However, these investigations remain controversial due to inconsistent clinical results. The present study aimed to quantitatively summarize and assess whether CSF and serum NSE levels are associated with epilepsy in children. Methods : A systematic search of the Harvard Hollis+, Clinicaltrials, Open Gray, China National Knowledge Infrastructure, and Wanfang databases was performed. Studies investigating NSE and epilepsy were identified and retrieved. Original studies with data overlapping those from other investigations and those lacking the necessary data were excluded. The included studies were extracted and synthesized, and data were analyzed using a random-effects model in R Studio and Comprehensive Meta-Analysis version 3 (Biostat, Englewood, NJ, USA). Results: Random-effects meta-analysis of 26 studies, including 1,360 patients, and 1,256 healthy control, revealed that childhood epilepsy exhibited meaningfully increased CSF and serum levels of NSE compared with controls [Hedges' g = 1.962 (95% confidence interval, 1.413-2.512); P < 0.001]. No single study meaningfully influenced the overall association between CSF and serum levels of NSE and epilepsy after sensitivity analysis. Subgroup analyses according to sample source and assay type revealed a significant association between NSE levels and epilepsy. Stratified analysis confirmed that NSE levels were significantly correlated with the severity of neurological compromise. Metaregression analyses revealed that sample size, mean age, and sex may contribute to effect-size reductions; however, sample source, assay type, and country did not moderate effect size. Funnel plots constructed using the trim-and-fill method confirmed that the outcome of the meta-analysis could not be due to publication bias. Conclusion: The results demonstrated that childhood epilepsy exhibits significantly elevated levels of NSE in the CSF and serum, thus strengthening the association between increased NSE levels and epilepsy.
RESUMEN
Importance: Accumulating evidence suggests that serum levels of S100B may play a role in epilepsy. Objective: We performed a meta-analysis to quantitatively summarize the serum S100B data available for patients with epilepsy. Data source: Two independent researchers conducted a systematic investigation of the Harvard Hollis+, Open Gray, Clinicaltrials, Wanfangdata, and CNKI databases through Dec 6, 2018, for all studies published in English and Chinese. The search terms included S100B and calcium-binding protein B in combination with epilepsy. Study selection: Original studies and reported data from these search terms are included. Studies where data overlapped with other studies were excluded. Data extraction and synthesis: investigators extracted, pooled and analyzed data from the included studies using a fixed-effects model in the Comprehensive Meta-Analysis3.3 and R software. Main outcomes and measures: Peripheral blood levels of S100B in patients with epilepsy compared with controls. Aberrations in peripheral blood levels of S100B were hypothesized to be related to epilepsy. Results: a fixed-effects meta-analysis of all 18 studies, including 1,057 unique participants, indicated that patients with epilepsy had significantly increased peripheral blood levels of S100B compared to controls (Hedges g = 1.568, 95% CI =1.431-1.706, P < 0.001). Sensitivity analysis showed that no single study significantly influenced the overall association of peripheral blood levels of S100B and epilepsy. Most of the subgroup analyses, including those of country, assay type and publication language, demonstrated a statistically significant association between peripheral blood levels of S100B and epilepsy. Meta-regression analyses indicated that gender (regression coefficient [SE], -0.2524 [0.0641]; 95%CI, -0.3781 to -0.1267; P = 0.0001) and mean age (regression coefficient [SE], -0.1224 [0.0426]; 95% CI, -0.2058 to -0.0390; P = 0.0040) might present serum S100B reductions, but sample size, years, assay type, publication language and country did not show moderating effects on the effect sizes. Furthermore, the trim-and-fill method used to adjust for funnel plot asymmetry in our meta-analysis confirmed that a positive outcome is unlikely to be due to publication bias. Conclusion and relevance: the results of this meta-analysis provide evidence for a significant increase in serum S100B levels in patients with epilepsy. Serum S100B is the most worthwhile biomarker of epilepsy, which is helpful for the clinical diagnosis and prognosis of epilepsy.