The Changing Paradigm of Neuroinflammation in Epilepsy: A Bibliometric Analysis from Microglial Activation to Gut-Brain Axis.

BACKGROUND: Neuroinflammation has been increasingly implicated in epileptogenesis and drug-resistant epilepsy, leading to growing research interest beyond the traditional focus on neuronal hyperexcitability. Despite the rapid expansion of research in this interdisciplinary field, a comprehensive structural mapping of its intellectual evolution and emerging frontiers is lacking. METHODS: We performed a systematic bibliometric analysis of 1989 publications (2005-2026) retrieved from Web of Science Core Collection and Scopus. Analytical tools including CiteSpace, VOSviewer, and the Bibliometrix R package were employed to visualize collaboration networks, citation structures, and thematic transitions. The literature search was updated to include publications indexed up to January 4, 2026. RESULTS: Research output followed an exponential growth pattern (R2=0.97), peaking in 2025. China and the USA dominated the global landscape, with the Journal of Neuroinflammation and Epilepsia identified as core academic hubs. Highly cited works, led by pioneers such as Vezzani A and Aronica E, established a knowledge base centered on microglial activation and cytokine signaling. Keyword clustering identified several interconnected thematic domains. Long-standing topics included oxidative stress and hippocampal vulnerability, whereas recent citation bursts indicated increasing attention to autoimmune encephalitis, blood-brain barrier (BBB) dynamics, and the gut-brain axis. Furthermore, emerging trends highlight the ketogenic diet and network pharmacology as promising immunometabolic strategies for seizure control. CONCLUSION: This study provides the first systematic bibliometric landscape of neuroinflammation in epilepsy over the past two decades. Our findings suggest a gradual transition from studies of glial, cytokine, and vascular mechanisms toward translational interest in systemic immune-CNS interactions. These quantitative insights identify the gut-microbiota-inflammation axis and personalized immunotherapy as the next frontiers, offering a strategic roadmap for future disease-modifying interventions in refractory epilepsy.