Gluten ataxia is a rare immune-mediated neurological disorder caused by the ingestion of gluten. The diagnosis is not straightforward as antibodies are present in only up to 38% of patients, but often at lower titers. The symptoms of ataxia may be mild at the onset but lead to permanent damage if remain untreated. It is characterized by damage to the cerebellum however, the pathophysiology of the disease is not clearly understood. The present study investigated the neurochemical profile of vermis and right cerebellum and structural changes in various brain regions of patients with gluten ataxia (n = 6, age range 40–65 years) and compared it with healthy controls (n = 10, 40–55 years). Volumetric 3-D T1 and T1-weighted magnetic resonance imaging (MRI) in the three planes (axial, coronal, and sagittal) of the whole brain and single-voxel 1H- magnetic resonance spectroscopy (MRS) of the vermis and right cerebellum were acquired on 3 T human MR scanner. The metabolite concentrations were estimated using LC Model (6.1–4A) while brain volumes were estimated using the online tool volBrain pipeline and CERES and corrected for partial volumes. The levels of neuro-metabolites (N-acetyl aspartate + N-acetyl aspartate glutamate, glycerophosphocholine + phosphocholine, and total creatine) were found to be significantly lower in vermis, while N-acetyl aspartate + N-acetyl aspartate glutamate and glycerophosphocholine + phosphocholine was lower in cerebellum regions in the patients with gluten ataxia compared to healthy controls. A significant reduction in the white matter of (total brain, cerebellum, and cerebrum); reduction in the volumes of cerebellum lobe (X) and thalamus while lateral ventricles were increased in the patients with gluten ataxia compared to healthy controls. The reduced neuronal metabolites along with structural changes in the brain suggested neuronal degeneration in the patients with gluten ataxia. Our preliminary findings may be useful in understanding the gluten-induced cerebral damage and indicated that MRI and MRS may serve as a non-invasive useful tool in the early diagnosis, thereby enabling better management of these patients.
Present study evaluated the neurochemical profile of vermis and right cerebellum of GA patients using 1H MRS. The concentration of N-acetyl aspartate (NAA), glycerophosphocholine (GPC)+phosphocholine (PC), creatine (Cr) + phosphocreatine (PCr) and glutamine (Gln)+glutamate (Glu) were significantly lower in the right cerebellum of patients with GA compared to HC. The concentration of NAA, Cr and Glu were significantly lower in vermis region of patients with GA compared to HC indicating altered cerebral metabolism in GA patients that would have contributed to cerebral damage. The metabolites NAA, GPC+PC, Glu+Gln may have the potential to serve as early indicators of neuronal damage.
Present study investigated volumetric changes in the brain of Indian patients suffering from Major Depressive Disorder (MDD) using Magnetic Resonance Imaging (MRI). These patients were seen to have significantly reduced brain and cerebellar volumes. Volume of caudate, putamen and globus pallidus were seen to be reduced but no significant changes were seen in hippocampus and amygdala. Volume of cerebellum and lobule VI of cerebellum was also reduced. Our results suggest that cerebellum as well as VI lobule of cerebellum may be associated with MDD.
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