Systemic Inflammatory markers are associated with drug-resistant pediatric epilepsy in Ghanaian children

Drug-resistant epilepsy (DRE) in children is associated with significant morbidity, yet the contribution of systemic inflammation to its clinical expression remains incompletely defined, particularly in low- and middle-income settings. This study investigated the relationship between systemic inflammatory markers, drug resistance and seizure severity in a paediatric cohort in Ghana. A cross-sectional study was conducted among 180 participants (60 DRE; 60 controlled epilepsy; 60 healthy controls) recruited from a tertiary hospital. Clinical data and peripheral blood samples were obtained at a single time point. Neutrophil-to-lymphocyte ratio (NLR), chemokine (C-C motif) ligand 11 (CCL11), prostaglandin E₂ (PGE₂), and other selected inflammatory markers were quantified. Multivariable regression analyses were used to identify independent associations with DRE and seizure severity. DRE patients exhibited significantly elevated NLR, CCL11 and PGE₂ levels compared with controls. In Firth penalized logistic regression using standardized continuous factors, higher NLR (adjusted OR 7.31, 95% CI 2.00–26.63), CCL11 (adjusted OR 54.97, 95% CI 8.91–339.25), and PGE₂ (adjusted OR 2.51, 95% CI 1.05–5.96) were independently associated with DRE. Although these markers were associated with NHS3 seizure-severity scores in pooled analyses, these relationships were substantially attenuated after accounting for DRE status. These findings demonstrate an association between selected systemic inflammatory markers and pediatric DRE and support further prospective evaluation of their clinical relevance.