S3437 Antibiotic Therapy Followed by Faecal Microbiota Transplantation Alleviates Epilepsy – A Case Report

Abstract

INTRODUCTION: Epilepsy is a neurological disorder characterised by recurrent seizures which are caused by a temporary disruption of electrical activity in the brain. There are many different types of epilepsy and people’s experiences differ greatly. Epilepsy can start at any age although it is more likely to be diagnosed in childhood. Half of the causes of epilepsy are still unknown. One hypothesis is that epilepsy may be due to dysbiosis of the gastrointestinal microbiome and molecules generated there subsequently influence the gut-brain-axis. CASE DESCRIPTION/METHODS: Our case is a 33-year-old male patient who has a long history of seizures and gastrointestinal problems, treated at our institute since 2011. He was diagnosed with epilepsy at the age of five after having approximately five seizures per day. Treatment with anticonvulsants was exhaustive as he had both single and combination drug dosages to maximal levels from age 5 to 17 years. Investigation for surgical intervention was proposed to which he refused to consent. At the age of six, he had stomach pains and sleep disturbances which led to diagnosis of ileitis and sleep apnoea. He was commenced on Continuous positive airway pressure for sleep apnoea but discontinued due to lack of improvement. At the same time, he had “gut feelings” with confusion like sensations 2-7 times/day and sleepiness which led to diagnosis of reactive hypoglycaemia and insulin resistance. He presented to our institute for treatment for ileitis. He was assessed and prescribed antibiotics. At the time that antibiotic treatment was commenced, he was sleeping in his mother’s room as convulsions were occurring every 2 hours from 3am to 9am with abnormal breathing noted ahead of time. On the first night after antibiotic treatment commenced, his breathing became regular and interestingly he could be moved back to his own bedroom. Extraordinarily, his sleep apnoea ceased, and seizures reduced in frequency and severity. He was then treated with Faecal Microbiota transplantation (FMT) via rectal enema followed by oral FMT capsules which further reduced seizures (no full seizures for 3-4 months) and “gut feelings” in frequency and improved his quality of life. DISCUSSION: This case indicates that antibiotics and FMT treatment may be effective in alleviating epilepsy symptoms. It also provides further evidence of possible gut dysbiosis as a contributing factor to the pathogenesis of epilepsy.