Systemic Inflammatory markers are associated with drug-resistant pediatric epilepsy in Ghanaian children

Drug-resistant epilepsy (DRE) in children is associated with significant morbidity, yet the contribution of systemic inflammation to its clinical expression remains incompletely defined, particularly in low- and middle-income settings. This study investigated the relationship between systemic inflammatory markers, drug resistance and seizure severity in a paediatric cohort in Ghana. A cross-sectional study was conducted among 180 participants (60 DRE; 60 controlled epilepsy; 60 healthy controls) recruited from a tertiary hospital.

Clinical data and peripheral blood samples were obtained at a single time point. Neutrophil-to-lymphocyte ratio (NLR), chemokine (C-C motif) ligand 11 (CCL11), prostaglandin E₂ (PGE₂), and other selected inflammatory markers were quantified. Multivariable regression analyses were used to identify independent associations with DRE and seizure severity.

DRE patients exhibited significantly elevated NLR, CCL11 and PGE₂ levels compared with controls. In Firth penalized logistic regression using standardized continuous factors, higher NLR (adjusted OR 7.31, 95% CI 2.00–26.63), CCL11 (adjusted OR 54.97, 95% CI 8.91–339.25), and PGE₂ (adjusted OR 2.51, 95% CI 1.05–5.96) were independently associated with DRE. Although these markers were associated with NHS3 seizure-severity scores in pooled analyses, these relationships were substantially attenuated after accounting for DRE status.

These findings demonstrate an association between selected systemic inflammatory markers and pediatric DRE and support further prospective evaluation of their clinical relevance. Authors received no funding for this work. Priscilla Kolibea Mante, Jemimah Afia Bamiyi Ntewusu and John Danquah contributed equally to this work.

Department of Pharmacology, Private Mail Bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana Priscilla Kolibea Mante, Jemimah Afia Bamiyi Ntewusu, John Danquah, George Oduro Owusu & Delali Akusika Dotse School of Nursing, Johns Hopkins University, Baltimore, USA Correspondence to Priscilla Kolibea Mante. The authors declare no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Below is the link to the electronic supplementary material. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it.