The beneficial effect of probiotics as a supplementary treatment in drug-resistant epilepsy: a pilot study

Abstract

Epilepsy is a neurological disease with high global prevalence. Despite the range of drug-based treatments currently available to control the condition, one in 3 patients experiences epileptic seizures. Therapeutic alternatives for these patients include the ketogenic diet, surgery or the cerebral implantation of neurostimulators; however these are benefits with limits. The target of this study is to find a new complementary treatment for these patients, studying the effectiveness of probiotics for controlling epileptic seizures in patients with drug-resistant epilepsy. A prospective study was designed in which a group of patients with drug-resistant epilepsy was administered a probiotic mixture for 4 months. Patients were assessed before and after taking the probiotics; among other variables, number of seizures and patients' quality of life (QOLIE-10) were monitored. Levels of cD-14, interleukin 6, and γ-aminobutyric acid were also analysed throughout the study. 45 patients were included in the study. In an intention-to-treat analysis, 28.9% of all patients displayed a greater than 50% reduction in the number of seizures (the parameter required in clinical trials). A significant improvement was also observed in patients' quality of life. We found that probiotics may be an option for supplementary therapy. Since the use of probiotics is safe, they may contribute to improving seizure control, and therefore quality of life, in patients with drug-resistant epilepsy. The study has been registered in https://clinicaltrials.gov with number NCT03403907.

Fecal Microbiota Transplantation in Neurological Disorders

“…Importantly, potential direct neurotoxic effects of the antibiotics themselves or proepileptogenic effects of the underlying disease (e.g., infection) that is treated might rather be involved. Furthermore, some studies found a positive effect of probiotics in epilepsy (Gomez-Eguilaz et al, 2018;Yeom et al, 2019).…”

Evaluation of fecal Lactobacillus populations in dogs with idiopathic epilepsy: a pilot study

“…A clinical study evaluating the fecal microbiome in 91 humans with epilepsy demonstrated increased abundance of Bifidobacteria and Lactobacillus in patients with 4 or fewer seizures a year compared to patients with more than 4 seizures a year, suggesting that these bacteria might play a protective role in epilepsy [ 26 ]. An open-label, pilot study involving 45 humans with drug resistant epilepsy reported that 29% of patients experienced a ≥; 50% reduction in seizures after being administered a daily probiotic supplement containing Lactobacillus [ 27 ]. Additional research is needed to substantiate these findings and further evaluate the effect of Lactobacillus in the treatment of epilepsy.…”

“…Consequently, it seems plausible that Lactobacillus could serve a protective role in the development and progression of epilepsy as a result of its ability to alter brain activity through an increase in GABA-mediated inhibitory neurotransmission. This hypothesis has been explored in a few recent studies involving rodent models of epilepsy [25] as well as naturally occurring disease in humans [26,27], with promising results. Our pilot study was undertaken to evaluate the gut microbiota, with a focus on Lactobacilli, in dogs with idiopathic epilepsy.…”

The Gut-Brain-Axis on the Manifestation of Depressive Symptoms in Epilepsy: An Evidence-Driven Hypothesis

“…A case-report involving a 22-year-old Crohn's disease patient received fecal microbiota transplantation (FMT) treatment and displayed seizure-free events despite discontinuation of antiepileptic drug with sodium valproate during the 20 months follow-up (He et al, 2017). It was also revealed that probiotic treatment decrease seizure frequencies (at least 50%) in 28.9% of the patients with drug-resistant epilepsy (Gomez-Eguilaz et al, 2018). Moreover, a study illustrated the differences or the alterations of gut microbiome composition in patients with drug-resistant epilepsy (n = 42) and patients with drug-sensitive epilepsy (n = 49) whereby in drug-resistant patients, there were more abundant rare bacteria from the phylum Firmicutes as compared to the latter.…”

“…It was recently found that the relative abundance of the beneficial gut bacteria, bifidobacteria, E. rectale, and Dialister decreases while E. coli increases in a therapy-resistant epileptic patient after KD diet for 3 months (Lindefeldt et al, 2019). Prebiotics can restore the number of bifidobacteria, while reducing E. coli and enterococci in human trials (Turroni et al, 2016) and probiotics reduced the number of seizures by more than 50% of epileptic patients receiving probiotics as a complementary treatment (Gomez-Eguilaz et al, 2018). Therefore, there is a need to understand the effect of KD-induced changes in gut microbiota on the therapeutic effects of KD, the influence of KD on the overall gut health, and if concurrent intake of prebiotics or probiotics is required during a KD treatment.…”