https://orcid.org/0000-0002-1279-8123
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Sir: we thank the authors for the interest and for their comment on the potential role of unhealthy gut microbial composition in patients with psychogenic non-epileptic seizures (PNES).
PNES are paroxysmal, time‐limited alterations in motor, sensory, autonomic or cognitive signs and symptoms that are not accompanied by ictal epileptiform activity, and are of psychological origin [Citation1,Citation2]. They are a specific subtype of a larger category of disorders (somatic symptoms disorders or dissociative disorders). The optimal treatment strategy does includes psychological approaches and neuropharmacological treatment, due to the frequent psychiatric comorbidity in these patients, including mood disturbances, personality disorders, anxiety, depression, and psychic trauma [Citation2]. The main pathophysiological model for PNES suggests an alteration in the influence and connection of brain areas involved in emotion processing onto other brain areas responsible for sensorimotor and cognitive processes.
Recent research has shown that variations in the gut microbiome may influence behavior, and vice versa [Citation3,Citation4] that may support dysfunction at the level of arousal tolerance, cognitive-emotional information processing and volitional control reported in PNES [Citation5]. Accordingly, we agree that patients with PNES may have colonization of harmful microbiome in their gut with potential therapeutic implications and eventually opening new horizons in understanding the neurobiological origin of this condition.
As suggested in the comment letter, it could be also worthy to investigate the effects of consumption of a probiotic combination for PNES treatment. However, it is crucial to avoid methodological flaws in design and execution of such study and to have a careful assessment of the several variables known to affect the gut microbiome, including inflammation, diet, weight, and medications [Citation4,Citation6]. On the other hand, it is critical the development of international large‐scale collaborative efforts, e.g. the Human Microbiome Project, to prove insightful going forward in this area of research with the aim of identifying biomarkers and to improving therapeutic strategies.
Declaration of interest
P. Striano has received speaker fees and participated at advisory boards for Biomarin, Zogenyx, GW Pharmaceuticals, and has received research funding by ENECTA S.R.L, GW Pharmaceuticals, Kolfarma S.R.L and Eisai.
E. Russo as received speaker fees and participated at advisory boards for Eisai and has received research funding by GW Pharmaceuticals, Pfizer, Italian Ministry of Health (MoH) and the Italian Medicine Agency (AIFA). 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.
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References
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