الفهرس 
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Abstract
Summary
Epilepsy is the most common neurological disorder in children. Epilepsy is an enduring predisposition to generate seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition. The mechanisms underlying the resistance to AEDs in epilepsy treatment are still not well-understood.
Matrix metalloproteinases (MMPs) comprise a family of zinc-dependent proteases whose activities are regulated by tissue inhibitors of metalloproteinases. It has been suggested that MMP-2 may be important in a variety of neurodevelopmental processes.
This cross-sectional study was conducted at the Pediatric neurology outpatient clinic at Beni-Suef University Hospital to evaluate the diagnostic value of serum MMP-2 in children with drug-resistant epilepsy. It included 30 patients with drug-resistant epilepsy, 30 patients with controlled epilepsy, and 30 healthy controls.
The main findings of our study were:
The median age of patients with epilepsy was 7 years and most of them were males (56.7%).
Structural causes were the most common of epilepsy in our study (43.33%) followed by genetic causes (25%) then infections (8.33%). Unknown causes were seen in 21 patients (35%). The most common type of seizures in our study was generalized seizures in 42 patients (70%) while focal seizures were in 18 patients (30%). Generalized tonic clonic and impaired Conscious level were the most frequent subtypes (36.7% and 20.0% respectively). The history of status epilepticus were reported by 12 patients (20%).
The median age of onset of seizures of patients was 1.25 years with a median duration of epilepsy 3.5 years. The median time of last attack of seizure was 0.79 years. There was about 50% of patients had no seizures in the last year, while 15% of patients had seizures daily, 13.3% had seizures weekly and 16.7% had seizures monthly.
Regarding the investigations done for patients, 25% of patients had normal EEG and 48.33% had generalized EEG affection. MRI Brain results showed that around 55% of patients had normal MRI and 36.66% had brain atrophic changes. CT brain results showed that, around 58.33% of patients had normal CT and 25% had brain atrophic changes and calcifications.
Regarding the drugs used for management of cases, around 66.7% of patients used polytherapy and the most frequent drug used were Na valproate and Levetiracetam (85% and 65% respectively). Only 6.7% used non pharmacological treatment.
There was a statistically significant increase of the MMP2 in cases with epilepsy (518.85) than controls (447.4). Cases of epilepsy were subdivided into drug responsive and drug resistant epilepsy (30 in each arm) to assess the role of MMP2 in detection of both. There was a statistically significant increase of the MMP2 in cases with drug resistant epilepsy than controls but, there was insignificant differences of MPP2 in drug resistance than drug responsive epilepsy.
The MMP2 may help in detection of epilepsy at a cut off 471.2 with sensitivity (66.67%), specificity (66.67%), PPV (80%), NPV (50%). Also, the MMP2 could help in detection of drug resistant epilepsy at a cut off 471.2 with sensitivity (77.33%), specificity (66.67%), PPV (68.7%), NPV (71.4%). In the drug responsive epilepsy, the MMP2 can detect it at a cut off 471.2 with sensitivity (60%), specificity (66.67%), PPV (64.3%), NPV (62.5%). There was no significant differences of MMP2 in drug resistant epilepsy cases with last attack less than 1 month and cases with more than or equal 1 month.