title: Excitability of the motor cortex in de novo patients with celiac disease.
abstract: BACKGROUND
  Celiac disease (CD) may initially present as a neurological disorder or may be complicated by neurological changes. To date, neurophysiological studies aiming to an objective evaluation of the potential central nervous system involvement in CD are lacking.
  
  
  OBJECTIVE
  To assess the profile of cortical excitability to Transcranial Magnetic Stimulation (TMS) in a group of de novo CD patients.
  
  
  METHODS
  Twenty CD patients underwent a screening for cognitive and neuropsychiatric symptoms by means of the Mini Mental State Examination and the Structured Clinical Interview for DSM-IV Axis I Disorders, respectively. Instrumental exams, including electroencephalography and brain computed tomography, were also performed. Cortico-spinal excitability was assessed by means of single and paired-pulse TMS using the first dorsal interosseus muscle of the dominant hand. TMS measures consisted of resting motor threshold, motor evoked potentials, cortical silent period (CSP), intracortical inhibition (ICI) and facilitation (ICF). None of the CD was on gluten-free diet. A group of 20 age-matched healthy controls was used for comparisons.
  
  
  RESULTS
  CD showed a significantly shorter CSP (78.0 vs 125.0 ms, p<0.025), a reduced ICI (0.3 vs 0.2, p<0.045) and an enhanced ICF (1.1 vs 0.7, p<0.042) compared to controls. A dysthymic disorder was identified in five patients. The effect size between dysthymic and non-dysthymic CD patients indicated a low probability of interference with the CSP (Cohen's d -0.414), ICI (-0.278) and ICF (-0.292) measurements.
  
  
  CONCLUSIONS
  A pattern of cortical excitability characterized by "disinhibition" and "hyperfacilitation" was found in CD patients. Immune system dysregulation might play a central role in triggering changes of the motor cortex excitability.
authors: Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
authors: Giovanni
authors: G
authors: Pennisi
authors: Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), Troina (Enna), Italy.
authors: Giuseppe
authors: G
authors: Lanza
authors: Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
authors: Salvatore
authors: S
authors: Giuffrida
authors: Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
authors: Luisa
authors: L
authors: Vinciguerra
authors: Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
authors: Valentina
authors: V
authors: Puglisi
authors: Department of Chemistry, University of Catania, Catania, Italy.
authors: Mariagiovanna
authors: M
authors: Cantone
authors: Department of Chemistry, University of Catania, Catania, Italy.
authors: Manuela
authors: M
authors: Pennisi
authors: Gastroenterology and Endoscopy Unit, University of Catania, Catania, Italy.
authors: Carmela Cinzia
authors: CC
authors: D'Agate
authors: Gastroenterology and Endoscopy Unit, University of Catania, Catania, Italy.
authors: Pietro
authors: P
authors: Naso
authors: Gastroenterology and Endoscopy Unit, University of Catania, Catania, Italy.
authors: Giuseppe
authors: G
authors: Aprile
authors: Department of Biomedical Sciences, University of Catania, Catania, Italy.
authors: Giulia
authors: G
authors: Malaguarnera
authors: Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), Troina (Enna), Italy.
authors: Raffaele
authors: R
authors: Ferri
authors: Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
authors: Rita
authors: R
authors: Bella
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000503:physiopathology*; D002490:Central Nervous System / Q000503:physiopathology*; D055050:Diet, Gluten-Free; D004576:Electromyography; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation