Clinical findings and anti-neuronal antibodies in coeliac disease with neurological disorders.
BACKGROUND
Little is known about the clinical and immunological features of coeliac disease patients with neurological disorders. In a large series of adult coeliac disease patients, we investigated the prevalence of neurological disorders and anti-neuronal antibodies, along with the clinical course.


METHODS
Neurological symptoms were investigated in 160 consecutive patients (120 F, 40 M) with biopsy-proven coeliac disease. Anti-neuronal antibodies to central/enteric nervous systems were investigated in all neurological patients, 20 unaffected ones and 20 controls.


RESULTS
Thirteen (8%) patients had neurological disorders, including epilepsy (n = 3), attention/memory impairment (n = 3), cerebellar ataxia (n = 2), peripheral neuropathy (n = 2), multiple sclerosis (n = 1), Moyamoya disease (n = 1) and Steinert's disease (n = 1). No significant demographic or clinical differences (gastrointestinal or other gluten-related signs) were found between patients with and without neurological involvement. In all but 2 of the 13 cases, the neurological disorder preceded diagnosis ofcoeliac disease. Neurological symptoms improved or disappeared in 7 patients who started a gluten-free diet within 6 months after neurological onset, and in none of 4 patients who began later. Prevalence of central nervous system anti-neuronal antibodies was significantly higher in neurological (61%) than in other patients (5%) (P = 0.0007) or controls (0%) (P = 0.00001).


CONCLUSIONS
Coeliac disease can sometimes present in the guise of a neurological disorder, which may greatly improve when a gluten-free diet is started promptly. Therefore, the possible presence of coeliac disease needs to be carefully considered in patients with cerebellar ataxia, epilepsy, attention/memory impairment or peripheral neuropathy.
Volta
U
U
Dept. of Internal Medicine, Cardioangiology, Hepatology, University of Bologna, Italy. uvolta@orsola-malpighi.med.unibo.it
De Giorgio
R
R
Petrolini
N
N
Stangbellini
V
V
Barbara
G
G
Granito
A
A
De Ponti
F
F
Corinaldesi
R
R
Bianchi
F B
FB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood / Q000276:immunology*; D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy / Q000276:immunology*; D004035:Diet Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications* / Q000453:epidemiology / Q000276:immunology*; D009474:Neurons / Q000276:immunology*; D015995:Prevalence
D000888:Antibodies, Anti-Idiotypic