Fecal Microbiota Transplantation (FMT) in Multiple Sclerosis (MS): 942

Abstract

Purpose: Recent evidence implicates the GI microbiota in the progression of neurological diseases such as Parkinsons Disease1, Multiple Sclerosis and Myasthenia Gravis2. We report three patients with MS diagnoses who achieved durable symptom reversal with FMT for constipation. Methods: Case study observations on three MS cases Results: Case 1: A 30 yr old male with constipation, vertigo and impaired concentration and a concomitant history of MS and trigeminal neuralgia. Neurological symptoms included severe leg weakness and he required a wheelchair and an indwelling urinary catheter. Previous failed treatments included Mexiletine, Tryptanol and β-interferon. The patient underwent 5 FMT infusions for his constipation, with its complete resolution. Interestingly his MS also progressively improved, regaining the ability to walk and facilitating the removal of his catheter. Initially seen as a ‘remission', the patient remains well 15 yrs post-FMT without relapse. Case 2: A 29 yr old wheelchair-bound male with ‘atypical MS' diagnosis and severe, chronic constipation. He reported parasthesia and leg muscle weakness. The patient received 10 days of FMT infusions which resolved his constipation. He also noted progressive improvement in neurological symptoms, regaining the ability to walk following slow resolution of leg parasthesia. Three years on the patient maintains normal motor, urinary and GI function. Case 3: An 80 yr old female presented with severe chronic constipation, proctalgia fugax and severe muscular weakness resulting in difficulty walking, diagnosed as ‘atypical' MS. She received 5 FMT infusions with rapid improvement of constipation and increased energy levels. At eight months she reported complete resolution of bowel symptoms and neurological improvement, now walking long distances unassisted. Two years post-FMT, the patient was asymptomatic. Conclusion: We report reversal of major neurological symptoms in three patients after FMT for their underlying GI symptoms. As MS can follow a relapsing-remitting course, this unexpected discovery was not reported until considerable time had passed to confirm prolonged remission. It is tempting to speculate that FMT achieved eradication of an occult GI pathogen driving MS symptoms. Our finding that FMT can reverse MS-like symptoms suggests a GI infection underpinning these disorders. It is hoped that such serendipitous findings may encourage a new direction in neurological research.