The potential role of interventions impacting on gut-microbiota in epilepsy

ABSTRACT

Introduction

The gut microbiota seems to be implicated in the functioning and development of basic physiological processes and might also influence central neural processes, through the microbiota-gut-brain (MGB) axis. Pre- and clinical studies support the role of the microbiome in seizure modulation and in the pathogenesis of epilepsy. Acting through different interventions (e.g. diet, supplementations, drugs) could perturb directly and indirectly the MGB axis. Investigating the effects of these interventions might possibly allow better understanding of epilepsy itself, identify biomarkers, or providing new therapeutic options.

Areas covered

PubMed and Google Scholar searches were used to compile a list of relevant publications until January 2020, using data from preclinical studies and clinical trials and gut microbiome/microbiota projects. Furthermore, we evaluate the impact of the antiepileptic drugs on gut microbiota and the influence of intestinal alterations on seizures occurrence.

Expert opinion

Investigating the MGB axis and the role of gut supplementation in epilepsy is challenging due to the numerous potential pathways and variables involved. Few studies have been performed so far and all have been limited making speculation still premature. Studies designed with the similar strictness of pharmaceutical drug development trials, performing taxa, and metabolomic analyses with standard methodologies are needed.

KEYWORDS:

• Epilepsy
• microbiota
• diet
• prebiotics
• probiotics
• gut-supplementations

Article highlights

• The microbiota-gut-brain axis is a bidirectional and multi-pathways network connecting the gut microbiome and the central nervous system, involving several local and systemic mediators.

• Supplementation with probiotics and prebiotics, as well as a combination of both called symbiotic, has increased in popularity and is highly used in clinical practice.

• Antiepileptic drugs could impact on gut microbiota and vice versa, as well as gut-supplements may interfere with other treatments.

• To date, the use of prebiotics and probiotics cannot be considered ‘evidence-based’ in neurologic diseases including epilepsy.

Declaration of interest

E. Russo has received speaker fees from and served on advisory boards for Eisai and has received research fundings by GW Pharmaceuticals, Pfizer, the 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 financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. The other authors report no conflicts of interest.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.