Background. According to the World Health Organization, about 50 million people worldwide suffer from epilepsy. Almost 1/3 of patients are diagnosed with drug-resistant epilepsy (DRE). There is a relationship between the intestinal microbiome (IM) and the central nervous system, which is carried out throughout life through a bidirectional dynamic network. There is evidence that IM changes in patients with DRE.Objective: to summarize the current literature data on the role of the microbiome-gut-brain axis in DRE, as well as to assess the value of changes in the composition of IM as a prognostic marker of the development of DRE.Material and methods. The authors conducted a search for publications in the electronic databases PubMed/MEDLINE and eLibrary, as well as Google Scholar search engine. The evaluation of the articles was carried out in accordance with the PRISMA recommendations. As a result of the search, 4,158 publications from PubMed/MEDLINE database, 173 publications from eLibrary, and 1,100 publications found with Google Scholar were extracted. After the selection procedure, 121 studies were included in the review.Results. The review provides convincing evidence of a correlation between IM and DRE. There were obvious differences in the composition of the intestinal microbiota in patients with epilepsy, depending on sensitivity to drugs. Dysbiosis of the intestinal microbiota can be corrected by exogenous interventions such as ketogenic diet, probiotic treatment and fecal microbiota transplantation, which subsequently leads to changes in neurochemical signaling in the brain and, consequently, to a decrease in epileptic activity.Conclusion. A ketogenic diet, probiotics and antibiotics may have some potential to influence epilepsy through the correction of dysbiosis of the intestinal microbiota, but the studies available to date do not provide an adequate level of evidence. Future clinical multicenter trials should use standardized protocols and a larger sample to provide more reliable evidence.In addition, further fundamental research is needed to elucidate potential mechanisms and therapeutic targets.
