Neurological manifestations of atypical celiac disease in childhood

Abstract

Various typical and atypical neurological manifestations can be seen as the initial symptoms of celiac disease (CD). We suggest that gluten toxicity is the most suspicious triggering risk factor for probable pathophysiological pathways of neurological involvement in atypical CD. The medical charts of 117 patients diagnosed with atypical CD were retrieved from a tertiary center in Ankara, Turkey. Eight patients reported as having neurologic manifestations as initiating symptoms were evaluated in detail. The initial neurological manifestations of CD in our study included atypical absence, which was reported first in this study, generalized tonic-clonic seizures, complex partial seizures, severe axial hypotonia and down phenotype, multifocal leukoencephalopathy, mild optic neuritis, attention deficit hyperactivity disorder, and short duration headaches. Seizures mostly emphasizing atypical absence could be the initial presentation manifestation of CD, first described in this literature. Gluten toxicity could be one of the most powerful triggering factors for developing epilepsy in CD. Learning disorders such as attention deficit hyperactivity disorder, short duration headaches, mild optic neuritis, encephalopathy, and DS could also be the initial neurological manifestations of atypical CD. A gluten-restricted diet may improve neurological complaints, epileptic discharges, and neuropsychiatric symptoms. All we found may be a small part of the full range of neurological disorders of unknown origin related to CD. Clinical suspicion should be the rule for accurate diagnosis of the disease.

Psychiatric Manifestations of Coeliac Disease, a Systematic Review and Meta-Analysis

“…Out of eight articles on ADHD, two concluded a significant association between ADHD and CD [34,40]. One of these referred to a sample size of eight participants of which two (siblings) were found to have ADHD as an initial presentation of CD [40]. The eight articles included a total of 12,366 participants.…”

“…The eight articles included a total of 12,366 participants. The prevalence of ADHD in CD was assessed by one case series study [41] two cross sectional studies [42,43] two case-controlled studies [34,44] and one cohort study [40]. Out of 11,965 CD participants, 165 were found to have ADHD resulting in a pooled prevalence of ADHD in CD of 1.4%.…”

“…Two articles examined the role of the GFD in ASD, both observing no significant differences in behavioural symptoms between participants adhering to a GFD and those who did not [33,37]. Similarly, two articles examined the role of GFD in ADHD [40,41]. Both found significant improvements in behavioural symptoms, however, both studies are based on small sample sizes.…”

“…Firstly, several studies had small sample sizes [35][36][37][38][39][40][41]47]. This is especially important due to the heterogeneity of ASD, and therefore there is a particular need for large sample sizes [31].…”

“…Thirdly, despite much deliberation surrounding increases in GI symptoms and intestinal permeability in ASD mentioned in these articles, only two tested these theories [38,39]. Lastly, it is also worth considering that the majority of these studies for both ASD and ADHD concern pediatric populations, which is understandable as ASD and ADHD are both prevalent in childhood [31,34,35,[37][38][39][40][41][42]45,46]. However, unlike ASD and ADHD, CD is not confined to childhood and is very prevalent later on in life [45].…”