Rationale: Epilepsy is a chronic disorder marked by sudden, abnormal neuronal discharges. Patients often develop functional gastrointestinal disorders (FGIDs), anxiety, and depression, which further diminish their employability and quality of life. Although standard antiepileptic drugs can control seizures, they frequently worsen these comorbidities, underscoring the need for alternative approaches. Recent findings implicate the brain–gut axis in both epilepsy and its associated gastrointestinal and mood disturbances. In particular, FGIDs are linked to gut microbiota dysbiosis; these microbial imbalances affect central emotional and cognitive functions by producing bioactive neurotransmitters (e.g., 5-HT, GABA) and modulating BDNF signaling. This study therefore examines the relationship between FGIDs and anxiety/depression across different epilepsy subgroups, aiming to inform clinical decision-making and foster novel therapeutic strategies.
Methods:
We performed a cross-sectional analysis of 306 epilepsy patients from Longhua Hospital (March 2020–June 2021). For each patient, we collected demographics, diagnosed functional bowel disorder (Rome IV), and measured anxiety/depression using SAS and SDS. We then stratified patients by FBD status (with vs. without), FBD timing (before vs. after EP onset), age (young, middle-aged, elderly), and epilepsy duration (short, intermediate, long). Finally, we compared baseline characteristics, FBD prevalence, and mean SAS/SDS scores across these subgroups to assess associations between FBD and anxiety/depression.
Results: 1）Among the 306 EP patients, 56.2% had FBD, 59.5% had anxiety, and 56.9% had depression.
2）Functional bowel disorder (FBD) typically develops after epilepsy (EP) onset. Compared to the group whose FBD began before EP, the group whose FBD began after EP had a longer epilepsy duration and higher SAS and SDS scores. In the age-based EP subgroups, older patients had longer disease durations and higher SDS scores; the young subgroup had a lower rate of cognitive impairment than the other two groups; the elderly subgroup had higher SAS scores than the young subgroup and a higher FBD prevalence than the other two groups. In the duration-based EP subgroups, patients in the longer-duration group were older; the short-duration subgroup had lower rates of EEG abnormalities and FBD than the other two groups, and its rate of cognitive impairment was lower than that of the long-duration group. Moreover, in the longer-duration subgroup, SAS and SDS scores were higher (P < 0.05).