NeuropathyNeuropathy in Celiac Disease
Antibodies to gangliosides and Purkinje cells have
been reported in patients with
celiac disease (CD) with neuropathy
and ataxia, respectively. The response of
neurological symptoms and antibody
titers to a gluten-free diet is
still controversial. The objective
of our study was to assess whether
neurological manifestations in CD
patients correlate with antibody
titers and a gluten-free diet. Thirty-five
CD patients (9 males, 26 females,
mean age 37.1 +/- 12.6 yrs) were
followed prospectively. At initial
evaluation, 23 were on a gluten-free
diet, 12 were not. At recruitment
and during follow-up, patients
underwent neurological and
electrophysiological evaluation. IgG,
IgM, and IgA anti-ganglioside
antibodies were assayed by ELISA;
anti-neuronal antibodies were
assessed by immunohistochemistry and
Western blot. Four patients, all
males, had electrophysiological
evidence of neuropathy; three had
been on a gluten-free diet for
several months, and one was newly
diagnosed. One had reduced tendon
reflexes; another complained of
distal paresthesias. With regard to
anti-ganglioside antibodies, three
patients had a moderate increase in
antibodies without symptoms or signs
of neuropathy. No patients had
ataxia or cerebellar dysfunction,
although in four patients reactivity
to neuronal antigens was found. In
17 patients, an electrophysiological
follow-up (mean duration of
follow-up, 9 months) showed no
changes.
Department of
Neurosciences, University of Padua,
Via Giustiniani Padua, Italy.
In conclusion, the
preliminary results of this
prospective study indicate that
neuropathy, usually subclinical, may
accompany CD. Antibody titers do not
seem to correlate with neurological
symptoms/signs or diet. Ongoing
follow-up will help confirm these
data and clarify the role, if any,
of antibodies in neurological
involvement in CD
.
CIDPUSA
Concludes that other treatments are needed
to help these patients rather then the usual
Gluten free diet.
Neuropathy
Peripheral Neuropathy, which affects up to
20 million people in the U.S., can cause
pain, numbness and weakness in the arms and
legs and, when left untreated, can progress
to debilitation.
In an article published in todays neurology,
five percent of all patients with neuropathy
were found to also have celiac disease,
which results from an allergy to gluten in
bread and other wheat products, and is
estimated to affect one out of every 150
people. Based on the diagnosis, we are now
able to treat a substantial number of
patients with neuropathy who previously
could not be helped, said Dr. Russell Chin,
the first author of the paper.
In addition, patients with celiac disease
tended to have a type of neuropathy called
small fiber neuropathy which often causes
severe burning, stinging, and electric-shock
like pains, but is often misdiagnosed as it
is undetectable with routine tests used by
neurologists to diagnose neuropathy.
Approximately 16% of all patients with small
fiber neuropathy were found to have celiac
disease. Many of our patients were told that
there was nothing physically wrong with
them, and were advised to seek psychiatric
care for presumed anxiety or depression,
noted Dr. Norman Latov, Medical and
Scientific Director of The Neuropathy
Association, and senior author of the study.
You too would be anxious and depressed if
you were in constant pain, and no-one
believed you or offered to help.
Celiac disease is known to run in families,
and in several of the cases, other family
members were affected. Some were erroneously
diagnosed with Charcot-Marie-Tooth disease,
an inherited form of neuropathy due to
genetic mutations. Not all familial cases of
neuropathy are due to Charcot-Marie-Tooth
disease, noted Dr. Latov. Peripheral
neuropathy can also occur in association
with other causes for neuropathy that run in
families, such as diabetes or autoimmunity,
for example.
The article also notes that one third of the
celiac neuropathy patients did not have any
gastrointestinal symptoms such as
malabsorption, abdominal pain or diarrhea,
which are associated with celiac disease.
Please continue to the Migraine
caused by celiac disease
