Predictive value of peripheral blood inflammatory markers for epilepsy occurrence in traumatic brain injury patients

TL;DR

This study shows that blood markers like neutrophil count and NLR can predict the risk of epilepsy after traumatic brain injury.

Contribution

The study identifies neutrophil count and NLR as novel predictive biomarkers for post-traumatic epilepsy in TBI patients.

Findings

PTE patients had higher neutrophil counts and NLR compared to TBI, epilepsy of unknown origin, and healthy control groups.

Neutrophil levels and NLR showed high sensitivity and specificity in predicting PTE, with AUCs of 0.908 and 0.960, respectively.

TBI severity, injury location, and surgical intervention were found to influence peripheral blood inflammatory markers.

Abstract

Post-traumatic epilepsy (PTE) is characterised by recurrent epileptic seizures following traumatic brain injury (TBI). PTE has a high incidence and leads to significant disability rates, posing a substantial socioeconomic burden. This study aimed to evaluate the predictive value of peripheral blood inflammatory markers—including neutrophils, lymphocytes, platelets, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR)—for seizure risk in patients with TBI.

This investigation involved the enrollment of patients admitted to the Department of Neurology/Surgery at the First Affiliated Hospital of Dali University in Yunnan Province, China, spanning the period from January 2020 to May 2023. Our cohort comprised 138 individuals with PTE, 150 with TBI, 142 with epilepsy of unknown origin, and 130 healthy controls (HC). We retrospectively analysed demographic characteristics and peripheral blood cell inflammation markers for all participants.

1. In the PTE group, both neutrophil count and NLR exhibited higher levels compared to the TBI group, the epilepsy of unknown origin group, and the HC group. Conversely, the lymphocyte count, platelet count, and PLR in the group were lower in contrast to the TBI group, the epilepsy of unknown origin group, and the HC group. 2. Neutrophil count, lymphocyte count, platelet count, NLR, and PLR were significantly different between the PTE and TBI, PTE and HC groups (P < 0.05). Marked distinctions were detected in neutrophil count, platelet count, NLR, and PLR between the PTE group and the epilepsy of unknown origin group (P < 0.05). 3. Furthermore, our multivariate linear regression analysis unveiled that the TBI site (temporal lobe) (P < 0.05), the severity of TBI (mild, moderate, severe) (P < 0.05), and surgical intervention (P < 0.05) are the risk factors affecting the peripheral blood inflammation indicators. 4. Finally, the ROC analysis produced an AUC of 0.908 for neutrophil levels (cut-off: 4.05, sensitivity: 0.783, specificity: 0.992) and an AUC of 0.960 for NLR (cut-off: 2.945, sensitivity: 0.797, specificity: 0.992).

Both neutrophil count and the NLR were significantly increased in the PTE group, suggesting that these parameters may serve as predictors of epilepsy development in TBI patients

The online version contains supplementary material available at 10.1186/s42494-025-00226-2.

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