Evidences for a Role of Gut Microbiota in Pathogenesis and Management of Epilepsy

Abstract

Epilepsy as a chronic neurological disorder is characterized by recurrent, unprovoked epileptic seizures. In about half of the people who suffer from epilepsy, the root cause of the disorder is unknown. In the other cases, different factors can cause the onset of epilepsy. In recent years, the role of gut microbiota has been recognized in many neurological disorders, including epilepsy. These data are based on studies of the gut microbiota–brain axis, a relationship starting by a dysbiosis followed by an alteration of brain functions. Interestingly, epileptic patients may show signs of dysbiosis, therefore the normalization of the gut microbiota may lead to improvement of epilepsy and to greater efficacy of anticonvulsant drugs. In this descriptive review, we analyze the evidences for the role of gut microbiota in epilepsy and hypothesize a mechanism of action of these microorganisms in the pathogenesis and treatment of the disease. Human studies revealed an increased prevalence of Firmicutes in patients with refractory epilepsy. Exposure to various compounds can change microbiota composition, decreasing or exacerbating epileptic seizures. These include antibiotics, epileptic drugs, probiotics and ketogenic diet. Finally, we hypothesize that physical activity may play a role in epilepsy through the modulation of the gut microbiota.

Ketogenic and Low FODMAP Diet in Therapeutic Management of a Young Autistic Patient with Epilepsy and Dysmetabolism Poorly Responsive to Therapies: Clinical Response and Effects of Intestinal Microbiota

“…A fermentative dysbiosis pattern was observed, with Firmicutes dominance, Actinobacteria overgrowth, and high presence of lactate-producing bacteria such as Bifidobacteria, Lactobacillus, and Streptococcus; high lactate production was balanced by the higher presence of Negativicutes. This pattern is not surprising [ 9 ], as it has been observed in similar cases of drug-resistant epilepsy. After these findings, a short treatment with rifaximin was proposed [ 10 ], followed by the administration of a supplement with Streptococcus salivarius K12 [ 11 ] at 1 billion UFC (notified to the Italian Ministry of Health as a food supplement by Pharmextracta SpA, Pontenure, PC, Italy, complying with law No.…”

Neuroprotection of cannabidiol in epileptic rats: Gut microbiome and metabolome sequencing

“…In our study, the abundance of Helicobacter , Prevotellaceae_UCG-001 , and Ruminococcaceae_UCG-005 was significantly decreased in epileptic rats, whereas the abundance of Roseburia , [Eubacterium]_xylanophilum_group , and Ruminococcus_2 was significantly increased. Exposure to various compounds, including drugs for Epilepsy, can positively or negatively alter the gut microbiota and reduce or exacerbate seizures ( 37 ). Although some antiepileptic drugs affect the growth and metabolism of gut bacteria, for example, lamotrigine suppresses ribosome biogenesis in E. coli , and thus may restrain its growth ( 38 ), there is little evidence of direct interaction between antiepileptic drugs and the gut microbiome.…”

Role of Short Chain Fatty Acids in Epilepsy and Potential Benefits of Probiotics and Prebiotics: Targeting “Health” of Epileptic Patients

“…Although NTs derived from GM (except for GABA) cannot cross the BBB to directly affect the CNS, they might induce intestinal enterochromaffin (EC) cells to modulate the enteric nervous system and subsequently the CNS through the gut–brain axis [ 46 ]. A review has hypothesized that an alteration of the GM evokes change in NTs, including glutamate, GABA, and 5-HT, thus shifting the EIB toward an epilepsy-prone direction [ 47 ]. Furthermore, restoring GM can ameliorate disruptions in the EIB.…”