Objective To investigate the correlations of the expression of high mobility group box 1 protein (HMGB1) and toll-like receptor 4 (TLR4) with the clinical characteristics of patients with refractory epilepsy, as well as their predictive value.

Methods A retrospective analysis was conducted on the clinical data of 84 patients with refractory epilepsy, and they were included in observation group. During the same period, 35 patients with intracranial hypertension undergoing craniectomy for decompression were selected as control group. Immunohistochemistry was used to detect the expressions of HMGB1 and TLR4, while Nissl staining was applied to observe tissue morphology. The relevant experimental results were analyzed simultaneously.

Results The expression levels of HMGB1 and TLR4 in the observation group were significantly higher than those in the control group (P < 0.05). The optical density values of HMGB1 and TLR4 protein bands as well as internal reference β-actin bands in the observation group were significantly higher than those of the control group (P < 0.05). The intensity of TLR4 expression was correlated with seizure frequency, seizure duration, disease duration, and seizure type, while the intensity of HMGB1 expression was correlated with seizure frequency, seizure duration, and disease duration. In the lesion tissues, the expression of TLR4 was positively correlated with the expression of HMGB1, suggesting a synergistic effect between them. Receiver Operating Characteristic (ROC) curve analysis revealed that the areas under the curve (AUCs) for TLR4 and HMGB1 proteins in predicting refractory epilepsy were 0.888 and 0.923, respectively.

Conclusion HMGB1 and TLR4 are highly expressed in the lesions of patients with refractory epilepsy, and their expression intensities are positively correlated. They can predict the occurrence and development of the disease to a certain extent, providing new biomarkers for the diagnosis and treatment of refractory epilepsy.