Neurological manifestation of Coeliac disease in Iraqi patients

Background: Celiac disease (CD/ Non tropical sprue, gluten-sensitive enteropathy) is a malabsorptive conditioning which an allergic reaction to the cereal grain-protein gluten (present in wheat, rye and barley) causes small intestine mucosal injury. Aims: The purpose of the present study was to evaluate neurological manifestation in association with celiac disease. The specific objectives were: To study neurological manifestation of celiac disease. Methods: Seventy-five unselected consecutive patients (32 men, 43women, mean age 25.51±8.473 years) with histologically proven CD, were enrolled and prospectively investigated. The 75patients were seen in Department of Gastroenterological out patient, medical and neurological wards of Baghdad hospital. All patients were on gluten-free diet at recruitment and median duration of disease2.56±1.670). Results: The onset is in the first four decades of life, with a female to male ratio of 2:1. It may be associated with a wide spectrum of neurological manifestations including cerebellar ataxia, epileptic seizures, dementia, neuropathy, myopathies and multifocal leuco encephalopathy. We report three teen patients with neurological manifestations related with CD: two with cerebellar ataxia, two with epilepsy, two with carpel tunnel syndrome, two with myopathies, two with peripheral neuropathy and one with cognitive impairment. The diagnosis of CD was confirmed by serologic tests (antiendomysial,antitransglutaminase antibodies and antigliadin antibodies) and biopsy of the small intestine. In two patients the neurological symptoms preceded the gastrointestinal abnormalities and in all of them gluten restriction failed to improve the neurological disability. Conclusion: CD should be ruled out in the differential diagnosis of neurological dysfunction of unknown cause, including ataxia, epilepsy and dementia. A gluten free diet, the mainstay of treatment, failed to improve the neurological disability.