Case Report: Fecal Microbiota Transplantation Associated with 10 Years of Disease Stability in a Patient with Secondary Progressive Multiple Sclerosis
ECTRIMS Online Library. Makkawi S. Oct 27, 2017; 200657
- Background: Several studies suggest a link between the gut microbiome and the pathogenesis of Multiple Sclerosis (MS). Fecal microbiota transplantation has been used successfully for treatment of recurrent Clostridium Difficile Enterocolitis and reports suggest it may benefit various autoimmune diseases. The short-term efficacy of this procedure has been reported in three patients with multiple sclerosis.
Case presentation: We report a woman with secondary progressive MS (SPMS) who achieved disease stability for over 10 years following fecal microbiota transplant. A 61-year old woman with MS since 1988 (age 33) had seven clinical relapses from 1998 to 2001 when she started glatiramer acetate. While she has remained relapse-free since, and had a stable brain MRI (no new lesions), between 2001 and 2016, her disability gradually progressed between 2001 and 2007. She had worsening balance, ambulation, lower limb power, bladder function, and fatigue. Her Expanded Disability Status Scale (EDSS) increased from 2 (2001) to 6 (2006-2007). During 2005 and 2006 she had several bouts of Clostridium difficile enterocolitis following clindamycin treatment of a gingival infection. She was resistant to multiple courses of metronidazole and vancomycin. Finally, in June 2006, she received a fecal microbiota transplant. Between 2007 and 2017 progression of her MS completely stabilized, even slightly improved. She continues to use a cane but only intermittently. Her Modified Multiple Sclerosis Functional Composite (MSFC) also improved.
Conclusion: This is the first case report suggesting the potential long-term benefit of Fecal Microbiota Transplantation on disease progression in Multiple Sclerosis. Clinical trials are required to confirm this observation.
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