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Celiac Disease, Neurological Variants

Neurological manifestations of gastric disorders,

Dr. Zaffaroni M

.

Università di Milano, Gallarate, Varese, Italy.

Celiac disease causes neurological disorders like Alzheimers, myoclonous, multiple, sclerosis, neuropathy, epilepsy ,ataxia, cerebellar disease , myasthenia gravis and movement disorders.

So be aware as all these diseases are reversible with diet.

Neurological manifestations of gastrointestinal disorders , with particular reference to those resembling multiple sclerosis (MS) on clinical or MRI grounds. Patients with celiac disease can present cerebellar ataxia (walking like a drunk), progressive myoclonic, (body jerks or fits), myelopathy (stiff legs) , or cerebral, brainstem and peripheral nerve involvement (CIDP).

Antigliadin antibodies can be found in subjects with neurological dysfunction of unknown cause, particularly in sporadic cerebellar ataxia ("gluten ataxia").

Patients with Whipples disease can develop mental and psychiatric changes, supranuclear gaze palsy (cannot look up), upper motoneuron signs (weakness stiffness), hypothalamic dysfunction (sleep & sex , anger issues), cranial nerve abnormalities, seizures (epilepsy), ataxia (difficulty walking or walking like a drunk) , myorhythmia (rhythmic alternating movement of any part of body) and sensory deficits like numbness, burning sensations.

Neurological manifestations can complicate inflammatory bowel disease (e.g. ulcerative colitis and Crohns disease) due to vascular or vasculitic mechanisms. Cases with both Crohns disease and MS or cerebral vasculitis are seen in many people. Alzheimers like memory problems have been seen with Celiac disease.

Epilepsy (fits), chronic inflammatory polyneuropathy (numbness weakness in feet) , muscle involvement and myasthenia gravis ( weakness double vision hoarsness) are also reported. The central nervous system can be affected in patients with hepatitis C virus (HCV) infection because of vasculitis associated with HCV-related cryoglobulinemia.

Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is a disease caused by multiple deletions of mitochondrial DNA. It is characterized by peripheral neuropathy, ophthalmoplegia (NO EYE MOVEMENTS) , deafness, leukoencephalopathy (GENERALISED WEAKNESS due to nerves inside brain being damaged), and gastrointestinal symptoms due to visceral neuropathy.

So its very important to consider Celiac disease as causing any disease from Alzheimers to CIDP, MS or epilepsy.

 

Neurological manifestations can be the consequence of vitamin B1, nicotinamide, vitamin B12, vitamin D, or vitamin E deficiency and from nutritional deficiency states following gastric surgery.

CONCLUSION: CD should be ruled out in the differential diagnosis of neurological dysfunction of unknown cause, including ataxia, epilepsy , neuropathy, myasthenia and dementia. A gluten free diet, the mainstay of treatment, to improve the neurological disability.

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