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Brain & Heart Neurologic manifestations of IBD

such as focal muscle pain, tenderness, and swelling. Systemic inflammatory conditions such as systemic lupus
Similar to polymyositis and dermatomyositis, localized erythematosus, rheumatoid arthritis, or IBD are believed
forms of myositis are uncommon in IBD, and specific to be responsible for the impairment of the blood–brain
prevalence data are lacking. Case reports in the literature barrier, which potentially exacerbates epileptogenesis.
provide some insights but are too few to establish a clear Studies in animal models suggest that intestinal
epidemiological pattern. These reports often describe inflammation can lower seizure thresholds by elevating
patients presenting with muscle pain and swelling that levels of inflammatory mediators such as cytokines. 44,45
were initially attributed to more common IBD-related Furthermore, a link between intestinal dysbiosis and
arthralgia but were later identified as localized myositis seizure activity has been established; fecal microbiota
upon further investigation. Hayashi et al. reported a case transplantation (FMT) from stressed rats to naïve rats was
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of a young male presenting with myalgias and weakness, found to induce pro-epileptic effects, whereas FMT from
who was found to have elevated creatinine kinase levels naïve rats to stressed rats appeared to decrease seizure
and localized myositis. A meticulous test and observation incidence. 46
must be conducted to identify these pathological Despite these findings, seizures associated with IBD
aberrations. The mechanism likely involves localized are generally attributed to metabolic disturbances and
immune responses, possibly mediated by cytokines or structural issues rather than to IBD itself. Factors such
immune complexes that specifically target muscle tissues. as dyselectrolytemia, infections, CVT, and medication
This localized inflammation could be a direct extension of toxicity are recognized triggers of epilepsy in IBD patients.
the systemic immune dysregulation observed in IBD. Prevalence studies reveal varying epilepsy rates among
The management of myositis in the context of IBD IBD patients, with 1.1 – 5.9% in CD patients and 0.9% in
involves both treating the muscle inflammation and UC patients. Studies indicate that EEG abnormalities are
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managing the underlying intestinal disease. Corticosteroids more prevalent among CD patients compared to healthy
and immunosuppressants are commonly used to reduce controls, with a significant portion exhibiting epileptiform
muscle inflammation, whereas comprehensive IBD disturbances, albeit in the absence of infections, organic
management is crucial to control systemic inflammation. anomalies, or medications known to lower seizure
Early diagnosis and timely intervention, which are critical thresholds. 47
to prevent irreversible muscle damage and disability in The treatment of epilepsy in IBD patients adheres to
IBD patients, can be achieved with regular monitoring standard protocols; however, the role of gut microbiota in
for musculoskeletal symptoms, with the aim of improving neurological disorders is garnering interest, particularly
clinical outcomes. in refractory epilepsy. Interventions such as the ketogenic
In summary, while polymyositis, dermatomyositis, and diet, probiotics, prebiotics, antibiotics, and even FMT are
localized myositis are rare in IBD, their impact on patients being explored as potential strategies for managing drug-
can be profound. Understanding their associations, resistant epilepsy. Concurrently, vagus nerve stimulation,
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recognizing the clinical presentations, and implementing a already a therapeutic option for epilepsy, shows promise in
coordinated management strategy are key to improving the IBD treatment, as shown in animal studies and preliminary
quality of life for these patients. Further research and more human trials. Yet, the application of these treatments in
detailed case reporting are needed to better understand the IBD remains contentious due to limited and inconclusive
epidemiology and pathophysiology of these disorders. study results. 49

5.1. Epilepsy 5.2. Demyelinating disorders
Epilepsy, a complex neurological disorder marked by Demyelinating diseases are infrequently observed in IBD
spontaneous recurrent seizures, is influenced by multiple patients and can be categorized into those caused by a
factors including genetic predisposition, developmental primary autoimmune mechanism, with MS being the most
issues, and neurological trauma. These factors facilitate prevalent, and those associated with the administration of
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synaptic alterations and heightened neuronal excitability, biological therapy. MS symptoms can vary widely among
contributing to epileptogenesis – the process of developing individuals and may impact any part of the nervous system.
epilepsy. While the exact cellular and molecular Common symptoms include fatigue, mobility difficulties,
mechanisms remain somewhat elusive, it is hypothesized visual impairments, numbness or tingling, muscular stiffness
that uncontrolled inflammatory responses, both focal and and spasms, and challenges with balance and coordination.
systemic, may drive the formation of a hyper-excitable MS may manifest before or during the course of IBD.
neuronal network, thus precipitating the onset of epilepsy. Diagnosing MS in patients with IBD is often complex due
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Volume 2 Issue 4 (2024) 6 doi: 10.36922/bh.3486