Proposal of an Inflammatory Drug‐Resistant Epilepsy Index (Idrei) as Molecular Composed Biomarker in Focal Epilepsies

Background: Neuroinflammation contributes to epileptogenesis across the different etiological categories of epilepsy. Identifying its biomarkers can be important for dis-tinguishing epilepsy patients from healthy individuals and differentiating well-controlled epilepsy from Drug Resistant Epilepsy (DRE). Methods: An observational case-control study at Malaga’s Regional University Hospital involved epilepsy patients, divided into three groups: Healthy controls (HC), Sei-zure-Free Epilepsy (SFE) and DRE. Demographic and clinical data and plasmatic and/or CSF level of 24 different inflammation-related molecules were collected for each patient and were analysed through a univariate and multivariate analysis. Results: The study included 68 patients: 38 in the DRE group, 14 in the SFE group, and 16 in the HC group. A new Inflammatory Drug-Resistant Epilepsy Index (IDREI) was created using key variables with significant or trending significance. This index com-bined pro-inflammatory mediators (ICAM-1 and NfL) and anti-inflammatory factors (IL-10 and IL-4), showing statistical significance (p=0.002). ROC curve analysis for the IDREI gave an AUC of 0.731 (95% CI: 0.608−0.854). A multivariate logistic regression model's ROC anaysis resulted in a higher AUC of 0.891 (95% CI: 0.791−0.991). Conclusions: IDREI is a molecular index that effectively predicts epilepsy and DRE. Further prospective studies are needed to evaluate its clinical utility.