Rationale:
The gastrointestinal system communicates with the brain by way of vagus nerve fibers and the microbiota-gut-brain axis (MGBA). There is a well-known relationship between autoimmune diseases and epileptogenesis, and this may explain the involvement of gut microbiota in the course of epilepsy (
Figure 1). The pivotal role of MGBA dysregulation in the pathophysiology of functional gastrointestinal disorders (FGID) has been recognized. The purpose of this study is to investigate the prevalence of FGID in young men with epilepsy (YMWE) and the possible impact of bowel movement abnormalities on seizure recurrence.
Methods:
The study included 80 young men with epilepsy (YMWE) aged from 18 to 44 years and 80 practically healthy men (PHM) were consecutively enrolled. The study were conducted on the basis of the analysis of clinical symptoms and instrumental methods. EEG, EEG-video monitoring and MRI were used as the screening methods. A questionnaire to evaluate the presence of FGID was administrated to all participants.
Results:
A higher prevalence of FGID in MWE (62,5%) than in PHM (39,8%) was found (
p < 0.001). The most frequently observed disorder was constipation, which was significantly higher in MWE than in PHM (43,3% vs. 21,2%,
p < 0,001), and was not associated with antiseizure medication intake according to multivariable analysis. A significant weak negative correlation between the number of days with seizures and the number of days with normal bowel movements was observed (
p = 0,04). According to multivariable logistic regression analysis, FGID was significantly associated with temporal lobe epilepsy as compared with other localization (
p = 0,03).
Conclusions:
Epilepsy and related neurological symptoms may alert the clinician to additional life-threatening conditions and complications during the course of gastrointestinal system-based chronic disease. Since the gut is the only part of inner body exposed to environment, novel therapeutic options that target gut microbiota may be promising in many diseases including epilepsy.
This clinical study shows a complex relationship between epilepsy and MGBA, demonstrating a bidirectional relationship between defecation abnormalities and the occurrence of seizures. However, extensive future research is required to answer for this question.
Funding: This study was not funded by any pharmaceutical company.