Alternative therapy for refractory epilepsy: Bibliographic review

Abstract

Epilepsy is a chronic neurological disease affecting over 65 million people worldwide. One-third of patients suffer from refractory epilepsy, which is resistant to treatment with at least two appropriate antiepileptic drugs, posing a major clinical challenge. While a strong genetic component is acknowledged, environmental factors also play a role. Recently, the role of gut microbiota in epileptogenesis has gained attention, particularly through the gut-brain axis. Alterations in the microbiota may influence neurochemical and inflammatory processes that contribute to seizure activity. This literature review, guided by the PICO strategy and PRISMA protocol, examined the impact of gut microbiota on refractory epilepsy and evaluated three complementary interventions: ketogenic diet, probiotics, and fecal microbiota transplantation. Evidence suggests these strategies can significantly reduce seizure frequency, particularly in children. The ketogenic diet achieved reductions of up to 75%, while probiotics reduced seizures by 60–65%. Fecal microbiota transplantation showed 60% effectiveness in adults. Microbiota remodeling emerges as a promising therapeutic pathway, with the potential to improve patients' quality of life and reduce the economic burden associated with refractory epilepsy.