Amena R. Mohammed ¹ Wafaa A. Emam ¹ Shaymaa A. Mohammed ¹ Alshaymaa A. Abd Elalim ¹ Eatemad N. Mansour ¹ Haidy M. Nasr ¹ Aya A. Ghamry ¹ Sabah M. Alkhawagah ¹ Doaa S. Fathy ¹ Rasha S. Elattar ¹ Yasser G. Abish ² Abdullah Hussein ³ Boshra A. Zaghloul ¹ Marwa k. Khairallah ⁴ Norah Alharbi ⁵ Salwa Seif Eldin ⁵ Amal F. Dawood ⁵ Marwa A. Sabet ⁶ Marwa G. Gamea ⁷ Suzan E. Elshishtawy Ibrahim ⁸ Aliaa A. Mosa ⁹ Marwa A. Dahpy ^10,9*

• ¹ Faculty of Medicine for Girls, Al-Azhar University, Cairo, Cairo, Egypt
• ² Faculty of Medicine, Al-Azhar University, Gaza, Egypt
• ³ Faculty of Medicine of Boys, Al-Azhar University, Cairo, Beni Suef, Egypt
• ⁴ Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Asyut, Egypt
• ⁵ College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Riyadh, Saudi Arabia
• ⁶ Department of Microbiology and Immunology, Faculty of Pharmacy, Sphinx University, Assiut, Beni Suef, Egypt
• ⁷ Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut., Assiut, Egypt
• ⁸ Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Beni Suef, Egypt
• ⁹ Medical biochemistry and molecular biology department, faculty of Medicine, Assiut university, Assiut, Egypt
• ¹⁰ Department of Medical Biochemistry and Molecular Biology, Armed Forces College of Medicine (AFCM),Cairo, Cairo, Egypt

Background: Approximately 70 million people suffer from epilepsy worldwide. Infants representing significant percentage of cases. Therefore, there is a significant need for a greater understanding of the pathophysiology of epilepsy using laboratory and radiological methods for early detection and optimized management. Interleukin enhancer-binding factor 3-antisense RNA l (ILF3-AS1) is a LnRNA that enhances the expression of matrix metalloproteinase 3 (MMP3) and matrix metalloproteinase 9 (MMP9), which are all thought to be epileptogenic.We aimed to assess serum expression of LncRNA ILF3AS1, MMP3, MMP9, and microRNA 212 (miRNA-212) as predictive biomarkers in children with epilepsy and assessing their correlations with magnetic resonance imaging (MRI) findings.Fivty children with epilepsy and 50 healthy controls. Serum expression of LncRNA ILF3ASI and miRNA-212 were estimated by s q-PCR. Serum concentrations of MMP3 and MMP9 were estimated by ELISA in parallel with the magnetic resonance imaging (MRI) findings and different baseline biochemical parameters of all included subjects.The study revealed significantly higher levels of Lnc RNA ILF3AS1, MMP3, and MMP9 and lower levels of miR-212 in children with epilepsy compered to controls. Fold-change miR-212 was a significant negative predictor (OR= 0.153, P=0.000). The receiver operating characteristic (ROC) curve showed that the areas under the curves (AUC) for MMP3, MMP9, lncRNA ILF3AS1, and fold-change miRNA212 were 0.659, 0.738, 0.656 and 0.965, respectively. Brain lesions were detected in 15 patients (30%) with epilepsy, whereas the remaining 35 patients (70%) had normal results.LncRNA ILF3AS1 serum levels among children with epilepsy children were higher than those in the control group and were associated with the upregulation of MMP3 and MMP9 and the downregulation of miR-212 expression, suggesting their predictive utility in monitoring the development of epilepsy and that a treatment plan that focuses on the ILF3-AS1/miR-212/MMP3 & 9 axis may be an effective strategy for treating epilepsy.