Gluten koblet til hjerneskader og epilepsi
Hippocampal Slerosis in Refractory Temporal Lobe Epilepsy is Associated with Gluten SensitivityM. Kaartinen1, K. Kaukinen2, P. Dastidar3, K. Haimila4, A.M. Haapala5, M. Mäki6, T. Keränen7, J. Peltola7
1) Medical school, University of Tampere, 33014 Tampere, Finland 2) Department of Neurology and Rehabilitation, Tampere University Hospital, 33521 Tampere, Finland 3) Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland 4) Department of Radiology, Tampere University Hospital, Tampere, Finland 5) Department of Tissue Typing Laboratory, Finnish Red Cross Blood Transfusion Service, Helsinki, Finland 6) Department of Clinical Microbiology, Center for Laboratory Medicine, Tampere University Hospital, Tampere, Finland 7) Department of Pediatrics, Tampere University Hospital, University of Tampere
Purpose: Previously celiac disease (CD) and gluten sensitivity (defined as the presence of anti-gliadin antibodies and positive immunogenetics) has been associated with cerebellar degeneration and epilepsy with occipital calcifications. Hippocampal sclerosis (HS) in temporal lobe epilepsy (TLE) is a potentially progressive disorder with unknown aetiology, and autoimmunity has been implicated in TLE+HS as one of the possible mechanism leading to HS. The prevalence of CD in patients with epilepsy is not well established, none of the studies has addressed the issue of gluten sensitivity in syndrome specific approach to epilepsy.
Methods: We measured CD associated antibodies (anti-gliadin, antitTG and anti-EMA) and celiac type HLA (DQ2 and DQ8) in 48 consecutive patients with therapy resistant localisation-related epilepsy. The patients were categorised TLE+HS (N=18), TLE-HS (N=18) and extratemporal epilepsy (N=18) based on ictal eletroclinical characteristics and high resolution MRI. Patients with suspected CD or gluten sensitivity underwent duodenal biopsies. Results: Seven patients were gluten sensitive, all of these patients had TLE+HS whereas none of the patients without HS were gluten sensitive (p< 0.0002). In duodenal biopsies three of the patients had histological evidence of CD and four had inflammatory changes consistent with early developing CD without villous atrophy. None of the seven patients with gluten sensitivity had clinical signs of ataxia and there was no MRI evidence of cerebellar degeneration or occipital calcifications.
Conclusion: The present study demonstrates a previously unrecognized association between gluten sensitivity, CD 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.
Dig Liver Dis. 2004 Aug;36(8):513-8.Links
Frontal cortical perfusion abnormalities related to gluten intake and associated autoimmune disease in adult coeliac disease: 99mTc-ECD brain SPECT study.
Usai P, Serra A, Marini B, Mariotti S, Satta L, Boi MF, Spanu A, Loi G, Piga M.
Department of Nuclear Medicine, University of Cagliari, Cagliari, Italy. Denne e-postadressen er beskyttet mot programmer som samler e-postadresser. Du må aktivere javaskript for å kunne se den.
OBJECTIVE: Since brain perfusion abnormalities have been described by single-photon emission computed tomography in some autoimmune diseases, the aim of the present study was to evaluate the incidence of perfusion abnormalities by brain single-photon emission computed tomography in a group of coeliac disease patients, and to investigate whether gluten intake and associated autoimmune diseases may be considered risk factors in causing cerebral impairment. METHODS: Thirty-four adult coeliac patients (16 on a gluten-free diet and 18 on a gluten-containing diet, 18 (53%) with autoimmune diseases) underwent 99mTc-ethyl cysteinate dimer brain single-photon emission computed tomography and qualitative evaluation of brain perfusion was performed together with a semiquantitative estimation using the asymmetry index. Ten subjects on our database, matched for sex, age and ethnic group, who were proved normal by histology ofjejunal mucosa (four males and six females; median age 39 years, range 27-55 years), were included as control group. RESULTS: Twenty-four out of 34 patients (71%) showed brain single-photon emission computed tomography abnormalities confirmed by abnormal regional asymmetry index (>5%; range 5.8-18.5%). Topographic comparison of the brain areas showed that the more significant abnormalities were localised in frontal regions, and were significantly different from controls only in coeliac disease patients on unrestricted diet. The prevalence of single-photon emission computed tomography abnormalities was similar in coeliac disease patients with (74%) and without (69%) associated autoimmune disease. CONCLUSIONS: Abnormalities of brain perfusion seem common in coeliac disease. This phenomenon is similar to that previously described in other autoimmune diseases, but does not appear to be related to associated autoimmunity and, at least in the frontal region, may be improved by a gluten-free diet.
PMID: 15334770 [PubMed]
Am J Med. 2004 Mar 1;116(5):312-7.
Regional cerebral hypoperfusion in patients with celiac disease.
Addolorato G, Di Giuda D, De Rossi G, Valenza V, Domenicali M, Caputo F, Gasbarrini A, Capristo E, Gasbarrini G. Institute of Internal Medicine, Catholic University, Rome, Italy. Denne e-postadressen er beskyttet mot programmer som samler e-postadresser. Du må aktivere javaskript for å kunne se den.
BACKGROUND: Neurological and psychiatric disorders occur in approximately 10% of patients with celiac disease. Although some of these alterations respond to a gluten-free diet, the etiology of these abnormalities is uncertain. Because of a case report that cerebral hypoperfusion in a celiac patient resolved after a gluten-free diet, we studied brain perfusion changes in untreated celiac patients, treated celiac patients, and healthy controls. METHODS: A total of 15 untreated celiac patients without conditions affecting brain perfusion were enrolled; none had neurological or psychiatric disorders other than anxiety or depression. We also studied 15 celiac patients who were on a gluten-free diet for almost 1 year, and 24 healthy volunteers of similar sex and age. All subjects underwent cerebral single photon emission computed tomography examination. RESULTS: Of the 15 untreated celiac patients, 11 (73%) had at least one hypoperfused brain region, compared with only 1 (7%) of the 15 celiac patients on a gluten-free diet and none of the controls (P = 0.01). Cerebral perfusion was significantly lower (P <0.05) in untreated celiac patients, compared with healthy controls, in 7 of 26 brain regions. No significant differences in cerebral perfusion were found between celiac patients on a gluten-free diet and healthy controls. CONCLUSION: There is evidence of regional cerebral blood flow alteration in untreated celiac patients.
PMID: 14984816 [PubMed - indexed for MEDLINE]
1: Intern Med. 2006;45(3):135-40. Epub 2006 Mar 1.
Gluten sensitivity in Japanese patients with adult-onset cerebellar ataxia.
Ihara M, Makino F, Sawada H, Mezaki T, Mizutani K, Nakase H, Matsui M, Tomimoto H, Shimohama S.
Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto.
OBJECTIVE: Gluten sensitivity is associated with multiple neurological abnormalities including gluten ataxia, motor neuron disease-like neuropathy, small fiber type neuropathy, cognitive impairment, and even parkinsonism. We investigated whether or not gluten sensitivity is involved in Japanese patients with idiopathic cerebellar ataxia with extracerebellar presentation. PATIENTS OR MATERIALS: Fourteen patients with idiopathic cerebellar ataxia with extracerebellar presentation (autonomic instability, parkinsonism, or pyramidal dysfunction in varying combinations) were screened for anti-gliadin antibodies (AGA) to analyze for the presence or absence of gluten sensitivity. Patients with typical MR findings of multiple system atrophy of the cerebellar type were excluded. As disease controls without cerebellar ataxia, 9 patients with Parkinson's disease and 18 patients with amyotrophic lateral sclerosis were screened for AGA. Forty-seven normal controls were also screened for AGA. RESULTS: We found a high prevalence of AGA in 5 (36%) of 14 cerebellar ataxia patients, but in only 1 (4%) of 27 disease controls without cerebellar ataxia (odds ratio, 14.4; 95% CI, 1.41147; p<0.05) and in only 1 (2%) of 47 normal controls (odds ratio, 25.6; 95% CI, 2.66246; p<0.001). Among the cerebellar ataxia patients, atypical features such as sensorimotor neuropathy and/or mild cognitive impairment were more prevalent in the AGA-positive group (60%) than in the AGA-negative group (0%). In one of the ataxic patients with AGA, a gluten-free diet had positive effects on neurological symptoms and nutritional status. CONCLUSION: Gluten sensitivity is involved in at least some of the unexplained neurological symptoms of Japanese patients with adult-onset, sporadic cerebellar ataxia.
PMID: 16508226 [PubMed - indexed for MEDLINE]