The possibility that epilepsy may be influenced by the microbiome via the gut-brain axis has been raised by a Dutch neurologist who noticed her patients had relief from seizures when taking antibiotics.

Dr Braakman

Dr Hilde Braakman of the department of Neurology at the University of Maastricht Medical Centre has highlighted a case series of six patients with drug-resistant epilepsy who had reduced seizure frequency or became seizure free for the days or weeks when they took antibiotics for infections.

The seizures returned when the antibiotics – including amoxicillin/clavulanic acid and macrolides such as azithromycin and clarithromycin – were stopped.

Writing in the Journal of Neurology, Dr Braakman says there was no other action or event    – such as changes in drug therapy or diet – to explain the reduction in seizure frequency. And since gut microbiota have been causally linked to other neurological diseases including MS, she postulates that the bidirectional gut-brain axis of communication may also have an effect on epilepsy.

With co-author Dr Jakko van Ingen, a medical microbiologist, she hypothesises that antibiotic treatments may have a short-term effect through disruption of gut microbiota.

“This observed impact of antibiotics on seizure frequency hints at a possible role of the gut microbiota in epilepsy and its manifestations … the  gut microbiota produce neurotropic substances that impact on brain functions, while the brain produces substances and signals that influence the composition of the gut microbiota,” she notes.

The authors observe that drug-resistant epilepsy remains a challenge for up to 30% of people with epilepsy, despite the availability of second line treatments such as surgery, vagal nerve stimulation and ketogenic diets.

“The roles of the gut microbiota and gut–brain interactions in epilepsy warrant further studies as it might be a target for new treatment modalities. Perhaps we can, in some instances, treat epilepsy with antibiotics,”  Dr Braakman concludes.