Targeting the gut-brain axis for treatment of epilepsy

Epilepsy is a common neurological disorder that could negatively affect quality of life. In about one third of patients, epilepsy is resistant to common antiseizure medications. Thus, various therapeutic approaches have been used for this group with different efficacies. A topic of great interest which recently has lighted a way to new treatment, is the role of gut microbiota in epilepsy. In this review I aimed to investigate the possible role of these micro-organisms in the development and treatment of epilepsy.Recent studies have suggested an important role for intestinal microbiota in the development of few neurological diseases including multiple sclerosis, Parkinson’s disease, Alzheimer’s disease and also epilepsy. It has been shown that intestinal microbiota is altered by the ketogenic diet and this alteration is needed to achieve protection against seizure in both human and animal models. Moreover, treatment of animal models by probiotics similar to the intestinal flora which are enhanced by ketogenic diet, has led to seizure protection. There are reports of temporary seizure control in children and adults with refractory epilepsy who received antibiotic therapy. Partial improvement in patients with epilepsy who received probiotics is reported in a recent study as well. The results of these studies possibly could be explained by alteration in gut bacteria. However, well-designed placebo-controlled clinical trials with larger sample sizes and fecal microbiota analysis are necessary to clarify this issue and resolve the contradictions.