The central nervous system (CNS) is closely related to the gastrointestinal tract, mainly through regulating its function and homeostasis. Simultaneously, the gut flora affects the CNS and plays an essential role in the pathogenesis of neurologic and neuropsychological disorders such as Parkinson’s and Alzheimer’s disease, multiple sclerosis, amyotrophic lateral sclerosis or autism spectrum disorder. The population of gut microorganisms contains more than one billion bacteria. The most common are six phyla: Proteobacteria, Actinomyces, Verucomicrobia, Fusobacteria, and dominant Bacteroides with Firmicutes. The microbiota–gut–brain axis is a bidirectional nervous, endocrine, and immune communication between these two organs. They are connected through a variety of pathways, including the vagus nerve, the immune system, microbial metabolites such as short-chain fatty acids (SCFAs), the enteric nervous system, and hormones. Age, diet, antibiotics influence the balance of gut microorganisms and probably lead to the development of neurodegenerative disorders. In this article, a review is presented and discussed, with a specific focus on the changes of gut microbiota, gut–brain axis, related disorders, and the factors that influence gut imbalance.

Epilepsy is a common neurological disorder, with approximately one-third of patients experiencing drug-resistant epilepsy (DRE), which imposes significant clinical, social, and economic burdens. Cenobamate, a novel antiseizure medication (ASM), was included to the Polish therapeutic framework in March 2023. This retrospective, multicenter study was conducted at 19 centers. Medical records of adult patients with DRE treated with cenobamate for at least six months were reviewed. Collected data included demographic characteristics, seizure frequency, treatment regimens, and adverse events (AEs). Descriptive statistical methods were employed to assess outcomes, with the primary efficacy endpoint of ≥50 % reduction in seizure frequency. The study cohort consisted of 475 patients with a median age of 37 years. Treatment with cenobamate (median maximal daily dose, 250 mg) resulted in a ≥ 50 % reduction in seizure frequency in 61.9 % of patients, with 16.5 % achieving seizure freedom during the final three months of observation, with better responses when the treatment was initiated earlier. The burden of polytherapy decreased, as 69.7 % of patients reduced or discontinued concomitant ASMs. Adverse events were reported in 48.8 % of patients, most commonly somnolence and dizziness, with no cases of severe dermatological reactions. Discontinuation of cenobamate occurred in 12 % of patients. Cenobamate demonstrated notable efficacy in patients with treatment-resistant epilepsy, and its early initiation may improve outcomes. Treatment has a large potential for significant simplification of treatment regimens. Adverse events were manageable. Cenobamate is a highly effective and well-tolerated ASM for patients with DRE, offering significant clinical benefits, including improved seizure control and reduced polytherapy.

Purpose Tolosa-Hunt syndrome (THS) is a rare cause of painful ophtalmoplegia with different clinical manifestations. It is des­cribed as a unilateral periorbital headache with concomitant dysfunction of at least one out of the IIIrd, IVth and VIth cranial nerves due to the granulomatous...