Neurological manifestations of celiac disease

Abstract

-Celiac disease (CD/ Nontropicalsprue, gluten-sensitive enteropathy) is a malabsortive condition in which an allergic reaction to the cereal grain-protein gluten (present in wheat, rye and barley) causes small intestine mucosal injury. The onset is in the first four decades of life, with a female to male ratio of 2:1. It may be associated with a wide spectrum of neurological manifestations including cerebellar ataxia, epileptic seizures, dementia, neuropathy, myopathy and multifocal leucoencephalopathy. We report three patients with neurological manifestations related with CD: one with cerebellar ataxia, one with epilepsy and one with cognitive impairment. The diagnosis of CD was confirmed by serologic tests (antiendomysial and antigliadin antibodies) and biopsy of the small intestine. In two patients the neurological symptoms preceded the gastrointestinal abnormalities and in all of them gluten restriction failed to improve the neurological disability. Conclusion: CD should be ruled out in the differential diagnosis of neurological dysfunction of unknown cause, including ataxia, epilepsy and dementia. A gluten free diet, the mainstay of treatment, failed to improve the neurological disability.KEY WORDS: celiac disease, cerebellar ataxia, epilepsy, cognitive impairment. Manifestações neurológicas da doença celíacaRESUMO -A doença celíaca (DC, enteropatia sensível ao glúten) é desordem caracterizada por mal absorção causada por reação alérgica ao glúten, proteína presente em diversos cereais. As manifestações iniciais ocorrem nas primeiras quatro décadas de vida, sendo cerca de duas vezes mais freqüente no sexo feminino. DC pode estar associada a largo espectro de manifestações neurológicas incluindo ataxia cerebelar, epilepsia, demência, neuropatia, miopatia e leucoencefalopatia multifocal. Relatamos três casos de pacientes com manifestações neurológicas da DC: um com ataxia cerebelar, outro com epilepsia e o último com déficit cognitivo. O diagnóstico de DC foi estabelecido com base em testes sorológicos (anticorpos antiendomí-sio e antigliadina) e biópsia intestinal. Em dois pacientes as alterações neurológicas precederam as gastrointestinais. Em todos os casos a dieta livre de glúten não influenciou o quadro neurológico. Concluímos que o diagnóstico de DC deve ser considerado em pacientes com alterações neurológicas de etiologia indeterminada, incluindo ataxia, epilepsia e demência. Uma dieta sem glúten, a base do tratamento das manifestações gastrointestinais, não foi eficiente em melhorar os sintomas neurológicos em nossos pacientes.

Increased Risk for Coeliac Disease in Paediatric Patients with Migraine

“…The potential value of a gluten-free diet in the treatment or prevention remains unproved in various neurological conditions. Although some reports have described limited benefit from diet (34, 35), numerous studies have shown no significant benefit and, moreover, many patients may still develop neurological complications despite a gluten-free diet (36–38). Since the indications for diet treatment in patients with ‘potential’ CD are questionable, we have not offered the treatment at this point.…”

Wheat Belly—An Analysis of Selected Statements and Basic Theses from the Book

“…In a study with a small number of patients with celiac disease, gluten restriction failed to improve the neurological disability (36). In contrast, increased serotonin is associated with a sense of well-being and elevates mood.…”

Physiology of gangliosides and the role of antiganglioside antibodies in human diseases

“…In particular, anti-GM1 antibodies were associated with neuropsychiatric manifestations, highlighting their predictive and, potentially, prognostic value. 66,67 Also celiac disease (CD), which can have a variety of neurological manifestations, e.g cerebellar ataxia, peripheral neuropathy, epilepsy and depression 68,69 , has been associated with anti-GM1 antibodies. 70 The trigger that induces the generation of AGAs is not known.…”