Astrocytic Biomarkers in Epilepsy: A Critical Review on Clinical Utility and Mechanistic Implications

Epilepsy is one of the most common neurological disorders in both children and adults, characterized by significant clinical heterogeneity and dynamic natural course. The pathophysiological roles of astrocytes in epilepsy have been increasingly recognized. Fluid biomarkers derived from astrocytes are actively studied in epileptic disorders, although their use remains limited in clinical practice. This review aims to compile and analyze clinical and experimental findings concerning astrocytic biomarkers in epilepsy and related conditions, with a focus on glial fibrillary acidic protein (GFAP) and S100 calcium-binding protein B (S100B). Herein we examine their roles in assessing seizure burden and temporal dynamics, explore their potential in distinguishing epileptic from psychogenic non-epileptic seizures, and discuss their therapeutic, prognostic, and mechanistic implications in the context of epileptic disorders.