Neurofilament heavy chain and heat shock protein 70 as markers of seizure‐related brain injury

Summary Purpose: Status epilepticus (SE) has deleterious effects on brain tissue, but whether brief recurrent seizures may also damage neurons represents a matter of controversy. Therefore, it remains a central area of epilepsy research to identify individuals at risk where disease progression can be potentially prevented. Biomarkers may serve as tools for such identification. Thus the present study aimed at analyzing the levels of heat shock protein 70 (HSP‐70, also designated as HSPA1A) and neurofilament heavy chain protein (NfH SMI35 ) in cerebrospinal fluid (CSF) of patients with seizures of different severity. Methods: Forty‐one patients were included, of whom 20 patients had a single generalized tonic–clonic seizure (GTCS) episode (SS), 11 had repetitive GTCS (RS), and 10 experienced convulsive SE. The control group consisted of 18 subjects. HSP‐70 levels were measured using a conventional enzyme‐linked immunosorbent assay (ELISA), whereas the NfH SMI35 protein levels were detected by an electrochemiluminescence (ECL) immunoassay. Key Findings: Patients with SE (p < 0.001) and RS (p < 0.05) had significantly higher NfH SMI35 levels than controls, and SE was associated with increased concentrations when compared with SS (p < 0.001). NfH SMI35 levels in SS did not differ from controls. Patients with SE had significantly raised HSP‐70 levels compared to RS (p < 0.05), SS (p < 0.05), and controls (p < 0.001). SS and RS did not differ from each or from controls. Levels of NfH SMI35 and HSP‐70 showed a significant correlation (r = 0.34; p = 0.007) in the group of all study subjects, which was not apparent when controls and patients with seizures were considered separately. The correlation between NfH SMI35 and HSP‐70 tended to be inverse in patients with SE, but it did not reach statistical significance (r = −0.3; p > 0.05). Significance: Studying biochemical markers as additional quantitative tools for the measurement of neuronal damage (especially subclinical), complementary to available techniques of imaging, and clinical assessment might prove useful for identifying patients at risk of accumulating neuronal injury resulting from uncontrolled seizures. NfH SMI35 and HSP‐70 are of potential value as sensitive and specific biomarkers of seizure‐related pathologic events. Future longitudinal studies are needed to monitor such patients by correlating biochemical, neuroimaging, and clinical methods of assessment.