Al-Beltagi M, Saeed NK. Epilepsy and the gut: Perpetrator or victim? World J Gastrointest Pathophysiol 2022; 13(5): 143-156 [PMID: 36187601 DOI: 10.4291/wjgp.v13.i5.143]
Corresponding Author of This Article
Mohammed Al-Beltagi, MBChB, MD, MSc, PhD, Chairman, Professor, Department of Pediatrics, Faculty of Medicine, Tanta University, Al Bahr Streat, Tanta 31527, Algharbia, Egypt. mbelrem@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pathophysiol. Sep 22, 2022; 13(5): 143-156 Published online Sep 22, 2022. doi: 10.4291/wjgp.v13.i5.143
Epilepsy and the gut: Perpetrator or victim?
Mohammed Al-Beltagi, Nermin Kamal Saeed
Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, King Abdulla Medica City, Arabian Gulf University, Manama 26671, Bahrain
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, King Abdulla Medical City, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 26612, Bahrain
Nermin Kamal Saeed, Department of Microbiology, Irish Royal College of Surgeon, Busaiteen 15503, Muharraq, Bahrain
Author contributions: Al-Biltagi M and Saeed NK collected the data and wrote and revised the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, MBChB, MD, MSc, PhD, Chairman, Professor, Department of Pediatrics, Faculty of Medicine, Tanta University, Al Bahr Streat, Tanta 31527, Algharbia, Egypt. mbelrem@hotmail.com
Received: May 16, 2022 Peer-review started: May 16, 2022 First decision: June 8, 2022 Revised: June 8, 2022 Accepted: August 25, 2022 Article in press: August 25, 2022 Published online: September 22, 2022 Processing time: 128 Days and 15.7 Hours
Abstract
The brain and the gut are linked together with a complex, bi-path link known as the gut-brain axis through the central and enteric nervous systems. So, the brain directly affects and controls the gut through various neurocrine and endocrine processes, and the gut impacts the brain via different mechanisms. Epilepsy is a central nervous system (CNS) disorder with abnormal brain activity, causing repeated seizures due to a transient excessive or synchronous alteration in the brain’s electrical activity. Due to the strong relationship between the enteric and the CNS, gastrointestinal dysfunction may increase the risk of epilepsy. Meanwhile, about 2.5% of patients with epilepsy were misdiagnosed as having gastrointestinal disorders, especially in children below the age of one year. Gut dysbiosis also has a significant role in epileptogenesis. Epilepsy, in turn, affects the gastrointestinal tract in different forms, such as abdominal aura, epilepsy with abdominal pain, and the adverse effects of medications on the gut and the gut microbiota. Epilepsy with abdominal pain, a type of temporal lobe epilepsy, is an uncommon cause of abdominal pain. Epilepsy also can present with postictal states with gastrointestinal manifestations such as postictal hypersalivation, hyperphagia, or compulsive water drinking. At the same time, antiseizure medications have many gastrointestinal side effects. On the other hand, some antiseizure medications may improve some gastrointestinal diseases. Many gut manipulations were used successfully to manage epilepsy. Prebiotics, probiotics, synbiotics, postbiotics, a ketogenic diet, fecal microbiota transplantation, and vagus nerve stimulation were used successfully to treat some patients with epilepsy. Other manipulations, such as omental transposition, still need more studies. This narrative review will discuss the different ways the gut and epilepsy affect each other.
Core Tip: The brain and the gut have an intense but complex interaction through a strong relationship between the enteric and the central nervous systems. Epilepsy and the gut may affect each other in diverse ways. About 2.5% of patients with epilepsy are misdiagnosed as gastrointestinal disorders, especially at an early age. Gut dysbiosis also has a significant role in epileptogenesis. Epilepsy affects the gastrointestinal tract in different forms, such as abdominal aura, epilepsy with abdominal pain, and the adverse effects of antiseizure medications on the gut and the gut microbiota. Simultaneously, many gut manipulations successfully managed some cases of epilepsy.
