The role of cerebrospinal fluid and brain imaging biomarkers in status epilepticus

My field of research concern epilepsy and in particular patients with status epilepticus (SE), a neurological emergency and a possible life-threating condition due to recurrence of seizures. In these three years of PhD route, I focus my studies on possible predictors of neurological and epileptic outcomes in patients with SE, to improve knowledge and management. We started with prospective collection of all cases of SE in our district (follow literature criteria of definition and treatment). Then we select those patients that undergone to simultaneous serum and CSF detection, and neuroradiological brain investigation. We divided our research in three categories: 1) Analysis of possible CSF biomarkers of neuronal damage in patients with SE and possible correlation with timing from SE’s onset and SE evolution (refractory or responsive SE). 2) Analysis of serum and CSF endogenous molecules (neurosteroids) with a direct influence in neuronal activity. In animals, Allopregnanolone seems to have an anticonvulsant effect, due to GABAergic activity close to benzodiazepines’ one; on the contrary, Pregnanolone sulfate seems to have a proconvulsant activity. Evaluation of these molecules in healthy subject and in patients with SE could expand knowledge of neurosteroids panel and address new therapeutic approaches for SE, especially for resistant/refractory cases. 3) Identification of possible neuro-radiological markers of refractoriness, through serial brain MRI in cases of new onset refractory SE with early aggressive course and potential immuno-mediated aetiology (NORSE). Bilateral claustrum hyperintensity seems to represent a transient radiological markers in these cases in which unfortunately autoantibodies are not yet discovered.