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Research paper

Neurodegeneration Biomarkers in Epilepsy: A Critical Review of Current Findings

Study of fluid biomarkers (GFAP, NfL, tau) in pediatric epilepsy. Evaluates their utility for detecting ongoing neurodegeneration, astrocyte activation, and axonal injury in DEEs.

Indexed context

Butera A, et al.

biomarkersgfapnfltauneurodegenerationpediatric-epilepsy2026

Markdown path

content/research/papers/2026-butera-neurodegeneration-biomarkers-epilepsy.md

Findings

Study of fluid biomarkers (GFAP, NfL, tau) in pediatric epilepsy. Evaluates their utility for detecting ongoing neurodegeneration, astrocyte activation, and axonal injury in DEEs.

Why it may matter for Levi

GFAP as astrocyte-injury marker could provide a fluid biomarker complement to EEG for monitoring Levi during suppression. Worth discussing with Stanford/UCSF neuroimmunology team as adjunct to CSF workup already on the diagnostic list. Links to Shan 2026 astrocyte-dysfunction framing.

Paper text

Butera et al. (2026) — Neurodegeneration biomarkers in epilepsy

Source

  • Life (Basel) 16(2):296, 2026.

Why in corpus

Comprehensive 2026 review of candidate neurodegeneration biomarkers in epilepsy, extending the inflammatory-marker framework with additional serum/CSF markers of ongoing neuronal injury.

Key findings

  • Microglial activation drives release of TNF-α, IL-1β, IL-6, nitric oxide, and reactive oxygen species — all contributing to seizure susceptibility and drug resistance.
  • Additional biomarkers under investigation:
    • Neurofilament light chain (NfL) — axonal injury marker
    • Glial fibrillary acidic protein (GFAP) — astrocyte activation
    • Ubiquitin C-terminal hydrolase L1 (UCH-L1) — neuronal injury marker
  • These markers have been implicated in seizure-induced neuronal damage and may help quantify ongoing damage beyond SWI measurement.

Levi-relevant takeaways

  • Opens the possibility of adding serum NfL and GFAP to future Levi panels as quantitative measures of ongoing neuronal injury.
  • NfL in particular is increasingly available as a clinical test and has been used pediatrically in related contexts (autoimmune encephalitis, neurodegeneration).
  • Would be worth discussing with Levi's epileptology and immunology teams whether adding NfL/GFAP to the planned repeat LP / serum draw is feasible.
  • Reinforces the broader framing that DEE-SWAS causes active, measurable neuronal injury — not just electrographic abnormality.