ArticleAnnals of clinical and translational neurology2023
CSF neopterin and quinolinic acid are biomarkers of neuroinflammation and neurotoxicity in FIRES and other infection-triggered encephalopathy syndromes.
Article in Annals of clinical and translational neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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17 citing papers in PubMed, 24 citations in OpenAlex.
- Infection-triggered encephalopathy syndromes: a meta-analysis of clinical characteristics and outcomes in 1946 cases.EClinicalMedicine · 2026Article
- [Clinical features and prognosis of influenza-associated encephalopathy in children].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2026Article
- Therapeutic Plasma Exchange in Critically Ill Children with Neuroimmunological Disorders: A Single-Center Cohort Study.Children (Basel, Switzerland) · 2026Article
- Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD): a scoping review.Pediatric research · 2026Article
- Microglial GPR35 Ameliorates Epileptogenesis and Neuroinflammation via PDGFA Domain 2 Signaling.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Infection-triggered encephalopathy syndrome in children: a neuroimaging perspective.Pediatric radiology · 2026Review
- Accumulation of Quinolinic Acid Modulates the Pulmonary Immune Response During Influenza Infection.International journal of tryptophan research : IJTR · 2026Article
- Tocilizumab in FIRES: From Treatment Timing to Treat-to-Target Use [Letter].Journal of inflammation research · 2026Article
- De novo pathogenic CSF1R variant implicates microglial dysfunction in pathogenesis of febrile infection-related epilepsy syndrome.Epilepsia · 2025Article
- Review
- Gut Microbiota in Women with Eating Disorders: A New Frontier in Pathophysiology and Treatment.Nutrients · 2025Review
- Advancing FIRES Treatment: The Potential of Intrathecal Dexamethasone.Annals of the Child Neurology Society · 2025Article
- International consensus definitions for infection-triggered encephalopathy syndromes.Developmental medicine and child neurology · 2025Article
- Clinical and neuroimaging features of patients with claustrum sign.Frontiers in neurology · 2025Article
- Development of a Novel Method to Quantify Quinolinic Acid in Biological Samples.International journal of tryptophan research : IJTR · 2025Article
- Brain on Fire: How Brain Infection and Neuroinflammation Drive Worldwide Epilepsy Burden.Epilepsy currents · 2024Review
- Pediatric infection-triggered encephalopathy syndromes: aFrontiers in neurologyArticle
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19 authors at 6 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveInfection-triggered encephalopathy syndromes (ITES) are potentially devastating neuroinflammatory conditions. Although some ITES syndromes have recognisable MRI neuroimaging phenotypes, there are otherwise few biomarkers of disease. Early detection to enable immune modulatory treatments could improve outcomes.
methodsWe measured CSF neopterin, quinolinic acid, kynurenine and kynurenine/tryptophan ratio using a liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) system. The CSF of 18 children with ITES were compared with acute encephalitis (n = 20), and three control groups, namely epilepsy (n = 20), status epilepticus (n = 18) and neurogenetic controls (n = 20).
resultsThe main ITES phenotypes in 18 patients were acute encephalopathy with biphasic seizures and late restricted diffusion (AESD, n = 4), febrile infection-related epilepsy syndrome (FIRES n = 4) and other ITES phenotypes. Influenza A was the most common infectious trigger (n = 5), and 50% of patients had a preceding notable neurodevelopmental or family history. CSF neopterin, quinolinic acid and kynurenine were elevated in ITES group compared to the three control groups (all p < 0.0002). The ROC (area under curve) for CSF neopterin (99.3%, CI 98.1-100) was significantly better than CSF pleocytosis (87.3% CI 76.4-98.2) (p = 0.028). Elevated CSF neopterin could discriminate ITES from other causes of seizures, status epilepticus and febrile status epilepticus (all p < 0.0002). The elevated CSF metabolites normalised during longitudinal testing in two patients with FIRES.
interpretationCSF neopterin and quinolinic acid are neuroinflammatory and excitotoxic metabolites. This CSF metabolomic inflammatory panel can discriminate ITES from other causes of new onset seizures or status epilepticus, and rapid results (4 h) may facilitate early immune modulatory therapy.
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