Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Epilepsy Behav. 2024 Nov;160:110070. doi: 10.1016/j.yebeh.2024.110070. Epub 2024 Oct 10.
Epilepsy is one of the most common neurological diseases. Current evidence suggests that the apolipoprotein E (APOE) gene may be related to epilepsy. The purpose was to explore whether the APOE gene is associated with the risk, characteristics, and prognosis of epilepsy.
The study was a systematic review and meta-analysis. We searched WANFANG, VIP, CNKI, Embase, CENTRAL, and Medline for relevant studies published in English and Chinese inception up to December 27, 2023. Studies containing both APOE genotypes or at least one type of APOE allele and epilepsy were included.
A total of 46 studies were included. Fourteen studies reported APOE genotypes and epilepsy risk (2539 patients and 2847 controls). The meta-analyses showed that the APOE 4 was higher in epilepsy (OR [95 % CI] = 1.32 [1.07, 1.62], I = 30 %), the APOE 2 was lower in epilepsy (OR [95 % CI] = 0.73 [0.62, 0.87], I = 0 %), and the APOE 3 didn't differ between epilepsy and controls (OR [95 % CI] = 1.01 [0.86, 1.19], I = 29 %). Our findings highlight that the risk of epilepsy is different depending on the subtype, with the APOE gene being more associated with temporal lobe epilepsy, drug-refractory epilepsy, and late-onset epilepsy. Patients with the ɛ4 allele have an earlier onset, worse cognition, and are more likely to have a history of febrile convulsion. No association between the ɛ4 allele and psychiatric symptoms and seizure-free after surgery.
These findings will help inform the provision of epilepsy services, including clinical management an important option for epilepsy patients with cognitive impairment, temporal lobe epilepsy, late-onset epilepsy, and drug-refractory epilepsy. However, whether APOE gene testing should be used as a routine test in people with epilepsy remains to be determined.
癫痫是最常见的神经系统疾病之一。现有证据表明载脂蛋白 E（APOE）基因可能与癫痫有关。本研究旨在探讨 APOE 基因是否与癫痫的风险、特征和预后相关。
本研究为系统评价和荟萃分析。我们检索了万方、维普、中国知网、Embase、CENTRAL 和 Medline，检索时限为 2023 年 12 月 27 日以前发表的中英文文献。纳入包含 APOE 基因型或至少一种 APOE 等位基因与癫痫的研究。
共纳入 46 项研究。14 项研究报道了 APOE 基因型与癫痫风险（2539 例患者和 2847 例对照）。荟萃分析显示，癫痫患者 APOE ε4 更高（OR [95%CI] = 1.32 [1.07, 1.62]，I² = 30%），APOE ε2 更低（OR [95%CI] = 0.73 [0.62, 0.87]，I² = 0%），APOE ε3 在癫痫组与对照组间无差异（OR [95%CI] = 1.01 [0.86, 1.19]，I² = 29%）。本研究结果提示癫痫的风险因亚型而异，APOE 基因与颞叶癫痫、药物难治性癫痫和晚发性癫痫关系更密切。携带 ε4 等位基因的患者发病更早、认知功能更差，且更易有热性惊厥史。ε4 等位基因与精神症状和术后无癫痫发作无关联。
这些发现有助于为癫痫患者提供服务，包括临床管理。APOE 基因检测可能是认知功能障碍、颞叶癫痫、晚发性癫痫和药物难治性癫痫患者的重要选择。但是否应将 APOE 基因检测作为癫痫患者的常规检测，仍需进一步研究。
