Celiac neuropathy.
BACKGROUND
Celiac disease (CD) is a chronic inflammatory enteropathy resulting from sensitivity to ingested gluten. Neurologic complications are estimated to occur in 10% of affected patients, with ataxia and peripheral neuropathy being the most common problems. The incidence and clinical presentation of patients with CD-associated peripheral neuropathy have not previously been investigated.


OBJECTIVE
To determine the incidence of CD in patients with neuropathy and to characterize the clinical presentation.


METHODS
The records of 20 patients with neuropathy and biopsy-confirmed CD were reviewed.


RESULTS
Six of the 20 patients had neuropathic symptoms alone without gastrointestinal involvement, and neuropathic symptoms preceded other CD symptoms in another 3 patients. All patients had burning, tingling, and numbness in their hands and feet, with distal sensory loss, and nine had diffuse paresthesias involving the face, trunk, or lumbosacral region. Only two had weakness. Results of electrophysiologic studies were normal or mildly abnormal in 18 (90%) of the patients. Sural nerve biopsies, obtained from three patients, revealed mild to severe axonopathy. Using the agglutination assay, 13 (65%) of the patients were positive for ganglioside antibodies. Excluding patients who were referred with the diagnosis of celiac neuropathy, CD was seen in approximately 2.5% of all neuropathy patients and in 8% of patients with neuropathy and normal electrophysiologic studies seen at our center.


CONCLUSIONS
CD is commonly associated with sensory neuropathy and should be considered even in the absence of gastrointestinal symptoms.
Chin
R L
RL
Peripheral Neuropathy Center, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY 10022, USA. RUC9002@med.cornell.edu
Sander
H W
HW
Brannagan
T H
TH
Green
P H R
PH
Hays
A P
AP
Alaedini
A
A
Latov
N
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000918:Antibody Specificity; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy / Q000276:immunology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology* / Q000276:immunology; D005732:Gangliosides / Q000276:immunology; D005903:Gliadin / Q000276:immunology; D005983:Glutens / Q000009:adverse effects; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology* / Q000276:immunology; D012189:Retrospective Studies; D013497:Sural Nerve / Q000473:pathology; D011503:Transglutaminases / Q000276:immunology
D005732:Gangliosides; D007070:Immunoglobulin A; D005983:Glutens; D005903:Gliadin; D011503:Transglutaminases