Drug-Resistant Epilepsy and Gut-Brain Axis: an Overview of a New Strategy for Treatment

Structural and functional alterations in MRI-negative drug-resistant epilepsy and associated gene expression features

Neuroimaging techniques have been widely used in the study of epilepsy. However, structural and functional changes in the MRI-negative drug-resistant epilepsy (DRE) and the genetic mechanisms behind the structural alterations remain poorly understood. Using structural and functional MRI, we analyzed gray matter volume (GMV) and regional homogeneity (ReHo) in DRE, drug-sensitive epilepsy (DSE) and healthy controls. Gene expression data from Allen human brain atlas and GMV/ReHo were evaluated to obtain drug resistance-related and epilepsy-associated gene expression and compared with real transcriptional data in blood. We found structural and functional alterations in the cerebellum of DRE patients, which may be related to the mechanisms of drug resistance in DRE. Our study confirms that changes in brain morphology and regional activity in DRE patients may be associated with abnormal gene expression related to nervous system development. And SP1, as an important transcription factor, plays an important role in the mechanism of drug resistance.

A review of the pathogenesis of epilepsy based on the microbiota-gut-brain-axis theory

The pathogenesis of epilepsy is related to the microbiota-gut-brain axis, but the mechanism has not been clarified. The microbiota-gut-brain axis is divided into the microbiota-gut-brain axis (upward pathways) and the brain-gut-microbiota axis (downward pathways) according to the direction of conduction. Gut microorganisms are involved in pathological and physiological processes in the human body and participate in epileptogenesis through neurological, immunological, endocrine, and metabolic pathways, as well as through the gut barrier and blood brain barrier mediated upward pathways. After epilepsy, the downward pathway mediated by the HPA axis and autonomic nerves triggers "leaky brain "and "leaky gut," resulting in the formation of microbial structures and enterobacterial metabolites associated with epileptogenicity, re-initiating seizures via the upward pathway. Characteristic changes in microbial and metabolic pathways in the gut of epileptic patients provide new targets for clinical prevention and treatment of epilepsy through the upward pathway. Based on these changes, this review further redescribes the pathogenesis of epilepsy and provides a new direction for its prevention and treatment.