Epilepsy and gastrointestinal disorders: bidirectional links and the choice of antiseizure therapy

The article examines the bidirectional relationship between epilepsy and gastrointestinal (GI) disorders, with particular emphasis on liver pathology and its importance for the choice of antiseizure therapy. Ictal and postictal gastrointestinal manifestations are reviewed, along with the differential diagnosis of abdominal epilepsy and abdominal migraine and the coexistence of epilepsy with functional and organic GI diseases. Data on drug-induced liver injury, pharmacokinetic changes in hepatobiliary disease, malabsorption, and the post-bariatric state are summarized. Current evidence on the gut–brain axis and gut microbiota alterations in epilepsy is analyzed separately. It is shown that inadequate seizure control in the setting of GI pathology does not always indicate true drug resistance and may be related to potentially correctable changes in drug absorption, metabolism, and systemic exposure, as well as to drug–drug interactions. The need to individualize antiseizure therapy according to hepatic and renal function, the drug’s metabolic route, interaction potential, and the clinical situation is substantiated.

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