KEYWORDS:
To the editor,
We read with interest the article by Dr. Iannone et al. entitled: ‘Microbiota-gut brain axis involvement in neuropsychiatric disorders.’ [Citation1] We enjoyed this article and would like to add to it by hypothesizing that there is an association between abnormal emotional processing in patients with psychogenic non-epileptic seizures (PNES) and gut microbiota; patients with PNES may have unhealthy gut microbial composition. Psychogenic non-epileptic seizures are a relatively common reason why patients attend epilepsy clinics [Citation2]. It has been speculated that patients with PNES may process their emotional and cognitive information inconsistently and within a limited range of options [Citation3]. On the other hand, alterations in bidirectional gut–brain interactions are implicated in brain disorders [Citation1]. Alterations in gut microbiota have also been associated with marked changes in behaviors relevant to mood and cognition, suggesting the critical importance of the bidirectional pathway of communication between gut microbiota and brain in health and disease [Citation4]. Findings from a study suggest that the microbial colonization process initiates signaling mechanisms that affect neuronal circuits involved in anxiety behavior [Citation5]. Moreover, a functional MRI study in healthy women demonstrated that a four-week intake of a fermented milk product with probiotics affected activity of the brain regions that control central processing of emotion and sensation [Citation6].
Considering these observations, we hypothesize that there is an association between abnormal emotional processing in patients with PNES and their gut microbiota. We hypothesize that patients with PNES may have colonization of harmful microbiome in their gut. If the hypothesis is confirmed, it would have potentially important implications for the area of science under discussion (i.e., PNES). This would open a new horizon in understanding the neurobiological origin of PNES [Citation7], at least in some patients. For example, it would be reasonable to design clinical trials to investigate the effects of consumption of a probiotic combination in patients with PNES.
Declaration of interest
A. A. Asadi-Pooya has been a consultant for UCB Pharma and received honoraria from Hospital Physician Board Review Manual and Cobel Daruo. They have also received royalties from Oxford University Press related to book publication. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.
References
- Iannone LF, Preda A, Blottière HM, et al. Microbiota-gut brain axis involvement in neuropsychiatric disorders. Expert Rev Neurother. 2019;19:1037–1050.
- Asadi-Pooya AA, Sperling MR. Epidemiology of psychogenic non-epileptic seizures. Epilepsy Behav. 2015;46:60–65.
- Baslet G. Psychogenic non-epileptic seizures: A model of their pathogenic mechanism. Seizure. 2011;20:1–13.
- Borre YE, Moloney RD, Clarke G, et al. The impact of microbiota on brain and behavior: mechanisms & therapeutic potential. Adv Exp Med Biol. 2014;817:373–403.
- Diaz Heijtz R, Wang S, Anuar F, et al. Normal gut microbiota modulates brain development and behavior. Proc Natl Acad Sci USA. 2011;108:3047–3052.
- Bravo JA, Forsythe P, Chew MV, et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad Sci USA. 2011;108(38):16050–16055.
- Asadi-Pooya AA. Neurobiological origin of psychogenic nonepileptic seizures: A review of imaging studies. Epilepsy Behav. 2015;52:256–259.