Seizures / Epilepsy

The Gluten File




The relationship between celiac disease and epilepsy has been documented in medical journals for decades. Unfortunately, it is something our neurologists rarely consider as an underlying possibility in cases of idiopathic epilepsy.

Recent research is also showing that gluten sensitivity can manifest outside of intestinal celiac disease, and present solely as neurological disease in the form of ataxia, peripheral neuropathy, and seizures. This means that ruling out "celiac disease" does not absolutely rule out gluten related neurological disease. This is an important distinction to keep in mind should you decide to pursue testing. See the Diagnostic Testing page for more detailed information. 

Particularly those with a family history of autoimmune disease or gastrointestinal problems or vitamin deficiency should give consideration to gluten being a potential cause for seizures. 

Excerpts From: 

Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with gluten sensitivity.   Feb 2009
Peltola M, Kaukinen K, Dastidar P, Haimila K, Partanen J, Haapala AM, Mäki M, Keränen T, Peltola J.
Medical school, University of Tampere, Finland.

Evidence suggests that gluten sensitivity/ celiac disease clearly exist beyond small bowel mucosal villous atrophy (25). Even if AGA is regarded unspecific for classic small bowel lesion that defines celiac disease (26), it has been useful in detecting diverse neurological
manifestations of gluten sensitivity (8 ). Gluten sensitivity has been implicated in cerebellar degeneration (11), where there is emerging data addressing the epidemiology, pathogenetic mechanisms and genetic background of gluten sensitivity and cerebellar degeneration. Interestingly, the findings in the duodenal biopsies from patients with gluten ataxia are similar to our patients with gluten sensitivity and TLE+HS; inflammatory changes are consistent with early developing CD without villus atrophy (27). Furthermore, the presence of class IgA tTG deposits were recently demonstrated both in jejunal tissue
and in the brain of patients with gluten ataxia without an enteropathy (28 ). In the present study the definition of gluten sensitivity included AGA positivity and classical celiac type HLA. However in cerebellar degeneration patients with AGA positivity without the presence
of HLA DQ2/8 have been described and in future studies also this group of patients would be interesting to address in patients with epilepsy.

There are several studies suggesting that autoimmunity is involved in refractory localization-related epilepsy, especially in TLE+HS patients (30). Increased prevalence of anti-GluR3 antibodies (31) and anti-GAD antibodies (15) have been observed in refractory TLE.

Our findings open a possibility for prevention of progression of HS in TLE. In CD gluten free diet (GFD) produces clinical and symptomatic improvement and also decreases the possibility of developing complications of CFD such as lymphoma and osteoporosis (5).
Gluten ataxia responds to GFD even in the absence of an enteropathy (35). In the epileptic syndrome with occipital calcifications the chances of seizure control after GFD seem to be significantly inversely related to the duration of epilepsy before GFD and to the age at the beginning of GFD (36). Thus in temporal lobe epilepsy GFD should most probably to be initiated early in the course of epilepsy to be effective, our patients had a long duration of epilepsy with established HS where GFD is very unlikely to be effective.

Is the prevalence of celiac disease increased among epileptic patients?

June 2003
PRATESI, Riccardo, GANDOLFI, Lenora, MARTINS, Rita C. et al. Is the prevalence of celiac disease increased among epileptic patients?. Arq. Neuro-Psiquiatr. [online]. 2003, vol. 61, no. 2B [cited 2006-08-23], pp. 330-334. Available from: <>. ISSN 0004-282X. doi: 10.1590/S0004-282X2003000300002.

"Taking our findings into account and reviewing previously published studies, some general observations concerning the association between epilepsy and CD can be brought forward:

(a) in many epileptic patients CD is asymptomatic or disclose only mild or atypical features14,15;

(b) epilepsy without cerebral calcifications, may be an early manifestation of CD, with calcifications developing later30;

(c) early identification and treatment of CD may reverse the tendency to epilepsy and probably to the development of calcifications16;

(d) seizures seen in association with CD are frequently difficult to control and, at least in some cases, this is due to poor AEDs absorption resulting from the concurrent enteropathy17;

(e) if CD is not precociously diagnosed, epilepsy will have propensity to progress in severity, evolving to a degree in which, even the introduction of GFD will fail to ameliorate the clinical picture17;

(f) although generalized forms of epilepsy are seen that, at times, rapidly evolve to a severe and progressive encephalopathy suggestive of Lennox-Gastaut syndrome31, partial complex seizures with involvement of the occipital lobes are more frequent16.

In conclusion,
a greater attention is needed to the possible coexistence of CD in epileptic patients. Although a systematic screening for CD in all epileptic patients seems to be, at the present time, neither practical nor cost-effective, it seems reasonable to screen at least all patients with complex partial seizures, especially when associated with occipital paroxysms and resistance to drug therapy."

PubMed Abstracts

RESULTS:At CD diagnosis, 37% of patients complained headache that affected daily activities and 32% showed positive OSA [obstructive sleep apnea] score. The EEG examinations revealed abnormal finding in 48% of children. After 6 months of GFD headache disappeared in 72% of children and EEG abnormalities in 78%; all children showed negative OSA score.
Role of the gluten-free diet on neurological-EEG findings and sleep disordered breathing in children with celiac disease.
PMID:25457448  Oct 2014

Possible Physiopathological Effects of the Transglutaminase Activity on the Molecular Mechanisms Responsible for Human Neurodegenerative Diseases.
PMID:25386917  Nov 2014

Allergic disease is associated with epilepsy in childhood: a US population-based study.
PMID:24251558 Nov 2013

Moreover, data in the literature show a strong, growing association of homocysteine with epilepsy and migraine in non-coeliac subjects.
The role of hyperhomocysteinemia in neurological features associated with coeliac disease.
PMID:23891042 Oct 2013

"A 4-year-old boy presented with occipital seizures but normal initial neuroimaging and proved refractory to antiepileptic medications. On repeat neuroimaging after 1 year, he had developed bi-occipital calcification and was then found to have positive coeliac serology. He was diagnosed with coeliac disease, epilepsy, and cerebral calcifications (CEC) and became seizure free after starting the gluten-free diet." 
Coeliac disease, epilepsy, and cerebral calcifications: association with TG6 autoantibodies.
PMID:2284567  Jan 2013

A 4-year-old boy presented with occipital seizures but normal initial neuroimaging and proved refractory to antiepileptic medications. On repeat neuroimaging after 1 year, he had developed bi-occipital calcification and was then found to have positive coeliac serology. He was diagnosed with coeliac disease, epilepsy, and cerebral calcifications (CEC) and became seizure free after starting the gluten-free diet. Positive antibody binding to neurons and glia was demonstrated on indirect immunofluorescence. High levels of immunoglobulin-A directed against transglutaminase isoenzyme 6 (TG6) were found in the patient's serum. The positive response to the diet, TG6 antibodies, and neuronal antibody binding suggest that CEC might be autoimmune in nature, as in other extra-intestinal manifestations of gluten-related diseases, such as gluten ataxia. 
Coeliac disease, epilepsy, and cerebral calcifications: association with TG6 autoantibodies.
PMID:22845673 July 2012

We present the case of a woman with abdominal pain, headache, syncope. The diagnosis of celiac disease (CD), associated with epilepsy and the brief review of literature, suggest that CD should be considered in neurological disorders of unknown etiology. The diet can be effective only on abdominal pain.  [note: As you can see, other literature suggests otherwise...jcc]
[Celiac disease with epilepsy and minor neurological disorders].
PMID: 22677945  May 2012

The clinical spectrum of epilepsy related to celiac disease (CD) ranges from benign syndromes to intractable epilepsy with evolution to a severe encephalopathy, including progressive myoclonic epilepsy (PME). A more specific syndrome characterised by the association of CD, epilepsy, and occipital calcifications (CEC) has also been reported. This study describes the clinical, neuroradiological and neurophysiological features of eight consecutive epileptic patients with a diagnosis of CD confirmed by laboratory tests and duodenal biopsy, referring to our Epilepsy Centre. Despite its small size, this series reflects the broad spectrum of the association between the two diseases, since it includes four cases of CEC and a more heterogeneous group of patients without cerebral calcifications comprising one case of limbic encephalitis and a case of PME. Our cohort suggests that more complex pathogenic mechanisms may be involved in the association between epilepsy and CD, and that CD should be included in the screening for PME etiology. Our data also confirm the major involvement of the occipital lobe, and minimise both the importance of calcifications in epileptogenesis and folic acid deficit in the development of calcifications.
Epilepsy in coeliac disease: not just a matter of calcifications.
PMID: 21630037  Jun 2011

Systemic and neurologic autoimmune disorders associated with seizures or epilepsy.
PMID: 21542840  May 2011

Celiac disease (CD) is Gluten sensitive enteropathy with a wide spectrum of severity and protean clinical manifestations. Patients with atypical (non-diarrhoeal) presentations are missed as the diagnosis of Celiac Disease is not considered. We present three young girls (ages 18, 19, 23 at presentation) who were admitted to our hospital as intractable seizures. All had low serum calcium, features of rickets/osteomalacia and anaemia. This prompted us to consider malabsorption due to CD. The diagnosis of CD was confirmed by serologic tests (IgA transglutaminase and IgG antigliadin antibodies) and biopsy of the duodenum. In all patients gluten free diet not only provided drug free control of seizures but also helped correct other features of malabsorption like hypocalcaemia and anaemia as the primary pathology behind these symptoms was corrected. We wish to highlight that hypocalcaemia of CD which may present as intractable seizures can be treated only by treating CD with gluten free diet and not by oral vitamin D and Calcium alone.
Intractable seizures and metabolic bone disease secondary to celiac disease.
PMID: 21189704  Aug 2010

SUMMARY: There are a growing number of specific antibodies associated with new onset epilepsy. These patients are likely to have an immune-mediated disorder that may benefit from immunotherapies. In autoimmune diseases such as systemic lupus erythematosus or coeliac disease, antibodies to specific membrane targets may also prove to be important in the future.
The growing recognition of immunotherapy-responsive seizure disorders with autoantibodies to specific neuronal proteins.
Vincent A, Irani SR, Lang B.
Curr Opin Neurol. 2010 Feb 15.
PMID: 20164770  Feb 2010

Gluten sensitivity presenting as myoclonic epilepsy with cerebellar syndrome.
Mov Disord
. 2009 Oct 30;24(14):2162-3. No abstract available.
PMID: 19705357  Oct 2009

The present study demonstrates a previously unrecognized association between gluten sensitivity and TLE with hippocampal sclerosis. The association was very robust in this well characterised group of patients; thus gluten sensitivity should be added to the list of potential mechanism leading to intractable epilepsy and HS.
Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with gluten sensitivity.
PMID: 19244266  Feb 2009

Gluten sensitivity presenting as myoclonic epilepsy with cerebellar syndrome.
Sallem FS, Castro LM, Jorge C, Marchiori P, Barbosa E.
Mov Disord. 2009 Oct 30;24(14):2162-3. No abstract available.
PMID: 19705357

CONCLUSION. Prevalence of CD was increased among patients with epilepsy of unknown etiology. It is important to investigate CD in any patient with idiopathic epilepsy even in the absence of digestive symptoms.
How frequent is celiac disease among epileptic patients?
PMID: 19104696  Dec 2008

Neurological complications of coeliac disease: what is the evidence?
PMID: 18344378  April 2008

Whole-brain histogram and voxel-based analyses of apparent diffusion coefficient and magnetization transfer ratio in celiac disease, epilepsy, and cerebral calcifications syndrome.
PMID: 17353316 Mar 2007

Increased prevalence of silent celiac disease among greek epileptic children.
PMID: 17352949 Mar 2007

Occult celiac disease presenting as epilepsy and MRI changes that responded to gluten-free diet.
PMID: 17296923   Feb 2007

Epilepsy and Celiac Disease: Favorable Outcome With a Gluten-Free Diet in a Patient Refractory to Antiepileptic Drugs.
PMID: 17122729 Nov 2006

Celiac disease-related antibodies in an epilepsy cohort and matched reference population.
PMID: 15820348 May 2005

Coeliac disease, epilepsy and cerebral calcifications.
PMID: 15737700  April 2005

Neurologic presentation of celiac disease.
PMID: 15825133  April 2005

Coeliac disease, unilateral occipital calcifications, and drug-resistant epilepsy: successful lesionectomy.
PMID: 15691291  March 2005

[Epilepsy, cerebral calcifications and coeliac disease. The importance of an early diagnosis.]
PMID: 15849675   2005

Neurological manifestations of celiac disease.
PMID: 15608953  Dec 2004

Visual disturbances representing occipital lobe epilepsy in patients with cerebral calcifications and coeliac disease: a case series.

PMID: 15489401 Nov 2004

Neurological abnormalities associated with celiac disease.
PMID: 15592736   Nov 2004

Range of neurologic disorders in patients with celiac disease.
PMID: 15173490   June 2004

Celiac disease and epilepsy: favorable outcome in a child with difficult to control seizures
PMID: 12956865  Oct 2003

Neurological complications of inflammatory intestinal diseases
PMID: 12910446   Aug 2003

Is the prevalence of celiac disease increased among epileptic patients?
PMID: 12894262  June 2003

Villous atrophy and idiopathic epilepsy
PMID: 12848011  April 2003

Clinical findings and anti-neuronal antibodies in coeliac disease with neurological disorders.
PMID: 12465725   Nov 2002

Epilepsy, occipital calcifications, and oligosymptomatic celiac disease in childhood.
PMID: 12585717  Nov 2002

Bilateral occipital calcification, epilepsy and coeliac disease: case report
PMID: 12364958  Sept 2002

Silent celiac disease in patients with childhood localization-related epilepsies
PMID: 11580763  Sept 2001

Celiac disease can be associated with severe neurological symptoms. Analysis of gliadin antibodies should be considered in suspected cases
PMID: 11571796  Aug 2001

Brain white-matter lesions in celiac disease: a prospective study of 75 diet-treated patients.
PMID: 11483831 Aug 2001

Association between coeliac disease, epilepsy and brain atrophy.
PMID: 11721124  2001

The neurology and neuropathology of coeliac disease
PMID: 11123714  Dec 2000

Progressive myoclonic ataxia associated with celiac disease presenting as unilateral cortical tremor and dystonia.
PMID: 10928587  July 2000

Neurological diseases associated with celiac disease
PMID: 10833932  Feb 2000

Coeliac disease and epilepsy
PMID: 9666954  April 1998

Epilepsy, cerebral calcifications and clinical or subclinical coeliac disease. Course and follow up with gluten-free diet.
PMID: 9548226 Feb 1998

CSF antigliadin antibodies and the Ramsay Hunt syndrome.
PMID: 9339701  Oct 1997

Epilepsy, cerebral calcifications and celiac disease
PMID: 9296173  June 1997

Atypical evolution of benign partial epilepsy in children
PMID: 8974748  Nov 1996

Celiac disease, cerebral calcifications and epilepsy syndrome
PMID: 8952798  Oct 1996

Celiac disease with cerebral calcium and silica deposits: x-ray spectroscopic findings, an autopsy study.
PMID: 8780097  April 1996

Celiac disease with occipital calcifications: 2 late cases
PMID: 8558980   Dec 1995

Progressive myoclonic ataxia associated with coeliac disease. The myoclonus is of cortical origin, but the pathology is in the cerebellum
PMID: 7496772  Oct 1995

Bilateral occipital calcification associated with celiac disease, folate deficiency, and epilepsy.
PMID: 7484640  Aug 1995

Early onset bilateral calcifications and epilepsy
PMID: 7575857  July 1995

Partial seizures, cerebral calcifications and celiac disease
PMID: 7558773  April 1995

Celiac disease and epilepsy in pediatric patients
PMID: 7842435  Sept 1994

Convulsive disorder in celiac disease
PMID: 7927014  June 1994

Familial unilateral and bilateral occipital calcifications and epilepsy.
PMID: 8133982   Dec 1993

Cortical vascular abnormalities in the syndrome of celiac disease, epilepsy, bilateral occipital calcifications, and folate deficiency
PMID: 8363357  Sept 1993

Bilateral occipital calcification, epilepsy and coeliac disease: clinical and neuroimaging features of a new syndrome
PMID: 8350105   Aug 1993

Endocranial calcifications, infantile celiac disease, and epilepsy.
PMID: 8374923  June 1993

Epilepsy with bilateral occipital calcifications: Sturge-Weber variant or a different encephalopathy?
PMID: 8504785  May 1993

Progressive cerebral calcifications, epilepsy, and celiac disease.
PMID: 8338215   Jan 1993

Cerebral occipital calcifications in celiac disease.
PMID: 1407390  Aug 1992

Coeliac disease, epilepsy, and cerebral calcifications. The Italian Working Group on Coeliac Disease and Epilepsy.
PMID: 1354781  Aug 1992

Occipital lobe seizures related to clinically asymptomatic celiac disease in adulthood.
PMID: 1592023  May 1992

Celiac disease, posterior cerebral calcifications and epilepsy
PMID: 1590524  Jan 1992

Intracranial calcifications--seizures--celiac disease: a case presentation
PMID: 1754479  July 1991

Coeliac disease, folic acid deficiency and epilepsy with cerebral calcifications
PMID: 1908173  May 1991

Celiac disease associated with epilepsy and intracranial calcifications: report of two patients.
PMID: 3414652   Sept 1988 

Bilateral cerebral occipital calcifications and migraine-like headache.
PMID: 3111714  June 1987

Isolated vasculitis of the central nervous system in a patient with celiac disease
PMID: 3799641  Dec 1986

Ramsay Hunt syndrome and coeliac disease: a new association?
PMID: 3504245  1986


SOME are finding seizure control through the Specific Carbohydrate Diet~ geared toward healing the gut in Celiac Disease and other intestinal disease, and showing helpful to children with autism spectrum disorders, seizures, and more.

An inspiring story of a successful search for the underlying cause of seizures:

A mother's quest (on B6 dependency)

Other treatable causes for seizure

Pyroluria , related to zinc and B6 deficiency, can also cause seizures and is associated with gluten/casein sensitivity.

Hashimoto's Encephalopathy 

Additional Sites of Interest~ Things to Consider

Controlling Seizures: A Nutritional Approach 

LEF on Epilepsy

Seizures and Epilepsy: Hope through Research

DogtorJ on diet