Peripheral Neurological Disturbances, Autonomic Dysfunction, and Antineuronal Antibodies in Adult Celiac Disease Before and After a Gluten-Free Diet

Abstract

Thirty-two consecutive adult celiac disease (CD) patients (pts), complaining of peripheral neuropathy (12 pts), autonomic dysfunction (17 pts), or both (3 pts), were evaluated to assess the presence of neurological damage (by clinical neurological evaluation and electrophysiological study) and antineuronal antibodies and to assess the effect of a gluten-free diet (GFD) on the course of the neurological symptoms and on antineuronal antibodies. At entry, 12 of 32 (38%) pts showed signs and symptoms of neurological damage: 7 of 12 (58%), peripheral neurological damage; 3 of 12 (25%), autonomic dysfunction; and 2 (17%), both peripheral neurological damage and autonomic dysfunction. The overall TNS score was 105 at entry. Anti-GM1 antibodies were present in 5 of 12 (42%) pts: 3 showed peripheral neurological damage and 2 showed both peripheral neurological damage and autonomic dysfunction. One year after the GFD was started, histological lesions were still present in only 10 of 12 (83%) pts. TNS score was 99, 98, 98, and 101 at the 3rd, 6th, 9th, and 12th month after the GFD was started, so it did not improve throughout the follow-up. None of the pts showed disappearance of antineuronal antibodies throughout the follow-up. We conclude that adult CD patients may show neurological damage and presence of antineuronal antibodies. Unfortunately, these findings do not disappear with a GFD.

The progression of coeliac disease: its neurological and psychiatric implications

“…Research findings regarding the effect of a GFD on peripheral neuropathy have been mixed, with some reports indicating positive outcomes and others reporting no significant changes (63,74) . A study which investigated neurological damage and glutenfree foods showed that neurological peripheral disorders, and autonomic dysfunctions with anti-neuronal antibodies in adults with CD did not disappear with a GFD (75) . On the contrary, important evidence comes from a case report of a 14-year-old patient with rare neurological symptoms (76) .…”

Systematic review: the evidence base for long‐term management of coeliac disease

“…Patients with CD must be considered as having an ongoing risk. Improved glycaemic control and increased body mass index in children with type-1 diabetes mellitus 357 No differences in height, BMI, HbA1C, insulin dose and haemoglobin between type-1 diabetes mellitus with or without CD at diagnosis of CD 347 Liver disease Normalization of isolated mild elevations in transaminase activity and nonspecific hepatic histological changes 34,207,209 Prevention of progression to hepatic failure in severe liver disease (n = 5) 223,348 Neurological disease No improvement in peripheral neuropathy and ⁄ or autonomic dysfunction (n = 32) 349 Significant improvements in muscle strength and neurophysiological abnormalities in motor neuropathy (n = 2) 241 Psychiatric disorders Reduced proportion with anxiety from 74% vs. 26% (P < 0.001) 254 No change in the proportion of patients with depression (57% vs. 48%) -higher than in controls 254 Improvement in depressive symptoms 2-5 months after the commencement of a GFD -case reports 256 Increase in major serotonin and dopamine metabolite concentrations in brain -in parallel with improvements in symptoms 358 …”

Anti-GM1 ganglioside antibodies, neuron specific enolase and interleukin 10 concentrations as potential markers of autonomic nervous system impairment in celiac disease - preliminary findings

“…15,31,33,34 According to Volta et al, up to 64% of patients suffering from CD with neurologic manifestation present with positive antiganglioside antibody titer.…”