title: Effect of intravenous immunoglobulin on cerebellar ataxia and neuropathic pain associated with celiac disease.
abstract: BACKGROUND
  Cerebellar syndrome and small fiber neuropathy may complicate celiac disease (CD) and may be resistant to a strict gluten-free diet.
  
  
  METHODS
  Case series.
  
  
  RESULTS
  We report three patients with biopsy-proven CD who developed cerebellar ataxia and neuropathic pain despite strict adherence to a gluten-free diet. A small fiber neuropathy was suggested by skin biopsy findings in two patients. All patients' symptoms, including small fiber neuropathy symptoms, responded to treatment with intravenous immunoglobulin (IVIG). Discontinuation of IVIG in two patients resulted in worsened ataxia that reversed after resumption of IVIG.
  
  
  CONCLUSIONS
  Intravenous immunoglobulin may be effective in treating cerebellar ataxia and small fiber neuropathy associated with CD, suggesting an immune pathogenesis. Further prospective, controlled studies are necessary to determine the long-term response to IVIG or other immunomodulation therapy.
authors.affiliation: Department of Neurology, New Jersey Medical School, Newark, NJ, USA. souayani@umdnj.edu
authors.forename: N
authors.initials: N
authors.lastname: Souayah
authors.forename: R L
authors.initials: RL
authors.lastname: Chin
authors.forename: T H
authors.initials: TH
authors.lastname: Brannagan
authors.forename: N
authors.initials: N
authors.lastname: Latov
authors.forename: P H R
authors.initials: PH
authors.lastname: Green
authors.forename: A
authors.initials: A
authors.lastname: Kokoszka
authors.forename: H W
authors.initials: HW
authors.lastname: Sander
mesh_terms: D000328:Adult; D000344:Afferent Pathways / Q000187:drug effects / Q000276:immunology / Q000503:physiopathology; D002446:Celiac Disease / Q000150:complications*; D002524:Cerebellar Ataxia / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D002531:Cerebellum / Q000187:drug effects / Q000276:immunology / Q000503:physiopathology; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D036421:Nerve Fibers, Unmyelinated / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D009619:Nociceptors / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D010525:Peripheral Nerves / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D020824:Spinocerebellar Tracts / Q000187:drug effects / Q000276:immunology / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous