title: Effect of a Gluten-Free Diet on Cortical Excitability in Adults with Celiac Disease.
abstract: BACKGROUND
  An imbalance between excitatory and inhibitory synaptic excitability was observed in de novo patients with celiac disease (CD) in a previous study with Transcranial Magnetic Stimulation (TMS), suggesting a subclinical involvement of GABAergic and glutamatergic neurotransmission in asymptomatic patients. The aim of this investigation was to monitor the eventual changes in the same cohort of patients, evaluated after a period of gluten-free diet.
  
  
  METHODS
  Patients were re-evaluated after a median period of 16 months during which an adequate gluten-free diet was maintained. Clinical, cognitive and neuropsychiatric assessment was repeated, as well as cortical excitability by means of single- and paired-pulse TMS from the first dorsal interosseous muscle of the dominant hand.
  
  
  RESULTS
  Compared to baseline, patients showed a significant decrease of the median resting motor threshold (from 35% to 33%, p<0.01). The other single-pulse (cortical silent period, motor evoked potentials latency and amplitude, central motor conduction time) and paired-pulse TMS measures (intracortical inhibition and intracortical facilitation) did not change significantly after the follow-up period. Antibodies were still present in 7 subjects.
  
  
  CONCLUSIONS
  In patients under a gluten-free diet, a global increase of cortical excitability was observed, suggesting a glutamate-mediated functional reorganization compensating for disease progression. We hypothesize that glutamate receptor activation, probably triggered by CD-related immune system dysregulation, might result in a long-lasting motor cortex hyperexcitability with increased excitatory post-synaptic potentials, probably related to phenomena of long-term plasticity. The impact of the gluten-free diet on subclinical neurological abnormalities needs to be further explored.
authors.affiliation: Department ''G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Bella
authors.affiliation: Department of Neurology I.C., "Oasi" Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), Troina (EN), Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanza
authors.affiliation: Department of Neurology I.C., "Oasi" Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), Troina (EN), Italy.
authors.forename: Mariagiovanna
authors.initials: M
authors.lastname: Cantone
authors.affiliation: Department ''G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giuffrida
authors.affiliation: Department ''G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Puglisi
authors.affiliation: Department ''G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Vinciguerra
authors.affiliation: Spinal Unit, Emergency Hospital "Cannizzaro", Catania, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Pennisi
authors.affiliation: Department ''G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ricceri
authors.affiliation: Gastroenterology and Endoscopy Unit, University of Catania, Catania, Italy.
authors.forename: Carmela Cinzia
authors.initials: CC
authors.lastname: D'Agate
authors.affiliation: Department of Biomedical Sciences, University of Catania, Catania, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Malaguarnera
authors.affiliation: Department of Neurology I.C., "Oasi" Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), Troina (EN), Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Ferri
authors.affiliation: Department"Specialità Medico-Chirurgiche", University of Catania, Catania, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pennisi
mesh_terms: D000293:Adolescent; D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy* / Q000378:metabolism*; D002540:Cerebral Cortex / Q000378:metabolism*; D055050:Diet, Gluten-Free; D005071:Evoked Potentials; D005260:Female; D059330:GABAergic Neurons / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009435:Synaptic Transmission; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult