Non-invasive Biomarkers for Predicting Seizures in Pediatric Epilepsy

Overview

This systematic review analyzed 11 observational cohort studies focusing on non-invasive biomarkers to forecast seizures in children with epilepsy. Cardiovascular biomarkers measured via electrocardiogram (ECG) were most commonly studied, with pre-ictal changes detected from seconds up to 40 minutes before seizure onset. However, the overall evidence quality was low or very low in most studies due to methodological limitations.

Background

Epilepsy affects approximately 50 million people worldwide, with 20–40% of patients experiencing refractory seizures despite treatment. Children with epilepsy face risks including sudden unexpected death in epilepsy (SUDEP) and psychological burdens that impact quality of life. Reliable seizure forecasting could reduce unpredictability, improve management, and alleviate caregiver anxiety. Non-invasive biomarkers are sought to develop practical forecasting devices that do not interfere with daily activities.

Data Highlights

Key Findings

• Cardiovascular biomarkers measured by ECG are the most frequently studied non-invasive predictors of seizures in children.
• Pre-ictal changes in cardiovascular signals can occur from a few seconds up to 40 minutes before seizure onset.
• The majority of studies have low or very low certainty of evidence due to methodological flaws and risk of bias.
• There is a lack of large sample size studies and standardized protocols across research.
• Combining cardiovascular biomarkers with other physiologic and environmental factors may improve forecasting accuracy.
• A precision medicine approach tailoring algorithms to individual patients is recommended for future research.

Clinical Implications

Clinicians should be aware that while cardiovascular biomarkers show promise for seizure forecasting, current evidence is insufficient for clinical implementation. Future development of non-invasive forecasting devices will require validation in larger, methodologically robust studies. Integrating multiple biomarker types and personalizing algorithms may enhance predictive reliability and patient outcomes.

Conclusion

Non-invasive cardiovascular biomarkers hold potential for forecasting seizures in pediatric epilepsy, but current evidence is limited by low certainty. Continued research with improved study designs and personalized approaches is essential to develop effective seizure prediction tools.

References

1. Systematic Review PROSPERO CRD42024444250 -- A comprehensive analysis of non-invasive biomarkers for predicting seizures in children with epilepsy