The Neurological Manifestations of Gluten

The Gluten File


It has long been accepted that neurological disease can result as a complication of Celiac Disease, due to nutritional deficiency caused by malabsorption.

What is NEW information is that neurological and neuromuscular disease may also be associated with a non-celiac gluten sensitivity, and may involve a direct immunological assault of brain, nerve, and muscle tissue.

This can occur without any signs of intestinal damage, which is the cornerstone for a diagnosis of Celiac Disease. Sometimes, intestinal disease will follow several years later. It is possible that neurological disease is the sole manifestation of gluten sensitivity.

The research regarding gluten sensitivity outside of Celiac Disease is ongoing, and therefore your doctors may be hesitant to acknowledge or accept it. In fact, they may not even know about it.

However, because diagnostic testing is available, and treatment is safe in the form of dietary changes, I don't understand why our neurologists are reluctant to explore this possibility of gluten sensitivity, and let patients know there is at least a chance they might be helped by diet.  Neurological disease within the scope of Celiac Disease is indisputable.


Hadjivassiliou from:

Gluten sensitivity as a neurological illness, M Hadjivassiliou, et al. 2002

"IgG anti-gliadin antibodies have been the best diagnostic marker in the neurological population we have studied. IgG anti-gliadin antibodies have a very high sensitivity for CD but they are said to lack specificity. In the context of a range of mucosal abnormalities and the concept of potential CD, they may be the only available immunological marker for the whole range of gluten sensitivity of which CD is only a part.  "


Hadjivassiliou and Grunewald From:

The Neurology of Gluten Sensitivity: Science vs. Conviction 2004

"Neurologic manifestations of gluten sensitivity are a scientific fact, not a theological issue. Whilst the debate continues, we owe it to our patients to screen them effectively for gluten sensitivity with the simple widely available antigliadin antibody test so that we do not in the meantime deprive them of a harmless but potentially effective treatment in the form of a gluten-free diet."


Mark B. Skeen From:

Neurologic Manifestations of Gastrointestinal Disease, Neurologic Clinics, Volume 20, Number 1, February 2002

"Neurologic disease associated with gluten sensitivity or celiac disease includes a wide range of manifestations:

Central nervous system (CNS) manifestations include dementia, cerebellar ataxia, myelopathy, encephalopathy, brain stem encephalitis, progressive multifocal leukoencephalopathy,chronic, progressive leukoencephalopathy, progressive myoclonic ataxia, seizures, isolated CNS vasculitis, and a syndrome of celiac disease with encephalopathy and bilateral occipital calcifications.”

“Several reports document the existence of peripheral neuropathy in association with celiac disease.”



Gerald Grossman From:

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

WHAT DO WE DO NOW?

"While we wait for more definitive studies to be done, what should be the strategy of the practical neurologist? The everyday practise of  medicine requires weighing costs and benefits for each individual patient under conditions of uncertainty, with inadequate data. When  faced with these dilemmas, we often consider most the concept of harm. We are more willing to propose a therapy with lower degrees of
evidence of therapeutic efficacy when the severity of the neurological illness produces significant pain or disability, and the potential harm of the treatment is low.


Therefore, when faced with a patient who has progressive disability due to ataxia or neuropathy of unknown aetiology or uncontrolled seizures, it is reasonable to discuss with the patient the inadequacy of our knowledge, but offer evaluation for coeliac disease, including anti-tTG, anti-EMA and AGA, as well as a confirmatory intestinal biopsy if the antibodies are positive.


Dietary treatment can be offered to those with either classical coeliac disease (with positive intestinal biopsy) or those with positive serology alone, as long as the patient understands we have no definitive clinical trial data that a gluten-free diet will improve neurological function either in patients with classical coeliac disease or those with just positive serology."