Inverse Correlation Between Nesfatin-1 and Ghrelin O-Acyltransferase (GOAT) in Adolescents with Epilepsy: A Cross-Sectional Study.

Nesfatin-1 and ghrelin O-acyltransferase (GOAT) have established roles in metabolic regulation and neuronal excitability, yet their relationship in epilepsy remains conflicted. This cross-sectional study compared 22 adolescent epilepsy patients (13.1 ± 2.0 years; 11 women/11 men) with 20 age-matched healthy controls (HCs) (12.3 ± 2.2 years; 8 women/12 men). Serum and salivary nesfatin-1 and GOAT levels were measured by enzyme-linked immunosorbent assay; Spearman's rank correlation assessed inter-neuropeptide relationships. Serum nesfatin-1 was markedly elevated in patients with epilepsy compared to HCs (44.04 (interquartile range 38.19-76.72) vs. 8.65 (interquartile range 7.82-9.01) ng/mL, p < 0.001; ~5-fold). Serum GOAT was similarly elevated (4.90 (interquartile range 4.17-6.66) vs. 1.41 (interquartile range 1.21-1.79) ng/mL, p < 0.001; 3.5-fold). A significant inverse correlation between serum nesfatin-1 and GOAT levels was identified in patients with epilepsy (rho = -0.68, 95% CI [-0.86, -0.36], p < 0.001) but not in HCs (p = 0.53) and remained independent of age, sex, body mass index and epilepsy type. This inverse correlation was significant in women (rho = -0.68, p = 0.021) with a similar trend in men (rho = -0.53, p = 0.096). Salivary nesfatin-1 mirrored serum patterns (2.3-fold increase; p < 0.001), while salivary GOAT showed a 9-fold reduction (p < 0.001). This study provides the first evidence of an inverse nesfatin-1/GOAT correlation in adolescent epilepsy, suggesting disease-specific neuroendocrine dysregulation. These exploratory findings support the potential of these neuropeptides as candidate biomarkers warranting further validation and offer new insights into the metabolic-excitability axis in epilepsy.