Epilepsy is a common neurological disorder that is often associated with drug resistance and adverse effects of anti-seizure medications (ASMs). Recent studies have highlighted the role of the gut-brain axis and gut microbiota in seizure activity and neurological health. This review summarizes current preclinical and clinical evidence examining probiotics as a potential adjunctive approach in epilepsy management. This review summarizes findings from 79 studies, including 19 preclinical investigations and 3 clinical studies examining probiotics as a potential adjunctive strategy in epilepsy management. Of the 19 preclinical studies, 14 focused on the effects of probiotics in experimental models of epilepsy, while 5 evaluated interactions between probiotics and ASMs. Preclinical studies suggest that probiotic supplementation may be associated with reduced seizure severity, delayed seizure onset, and improvements in cognitive and emotional outcomes. These effects appear to be related to neuroinflammatory modulation, oxidative stress, neurotransmitter levels, and gut barrier integrity. However, clinical evidence remains limited and largely exploratory. Available studies indicate that probiotic use may be associated with a reduction in seizure frequency and improved quality of life in some patients and may also interact with the pharmacokinetics of ASM, but these results are based on small, heterogeneous groups and predominantly uncontrolled studies. In summary, probiotics may be a potentially useful adjunct to epilepsy therapy, with current evidence based primarily on mechanistic data and preclinical studies. However, the available clinical evidence remains limited and does not allow for firm conclusions regarding their therapeutic efficacy. Further, well-designed and controlled clinical trials are needed to determine the true clinical significance of probiotics, identify optimal strains, formulations, and dosing regimens, and assess long-term safety and potential interactions with ASM.
Gut-Brain Axis