<<Disclaimer: Verify this information before applying it to your situation.>>
========================= Medical Information
Much medical information is of no interest to celiacs, but articles are
a simple way to explain an issue to a medical professional. These
extracts are handy references to show your physician, in his technical
language, what research has been documented throughout the world. When
you encounter a similar problem or if you have a physician willing to
learn from a patient, share these articles for the benefit of all
concerned.
1. Are Oats Acceptable? The article in the New England Journal of
Medicine (Oct. 19, 1995) on the acceptability of oats in the GF diet has
stirred considerable discussion. Currently, there are many reasons for
exercising caution and keeping oats out of the diet The primary
reasons for delaying the inclusion of oats in the diet are: 1. Do oats
have a low level of toxicity that will take years or are large
quantities of oats required to show microscopic damage? 2. Cross
contamination from other grains is a strong possibility. 3. The
medical / celiac community has not officially approved the inclusion of
oats in the diet.
2. Flu Season: Celiacs should contact their doctors about the
advisability of a flu shot.
3. A Celiac Expert is now in the South East: Dr. Ivor Dennis Hill
left the University of Baltimore and is now in North Carolina. He is
the Chief of the Division of Pediatric Gastroenterology and Nutrition,
Bowman Gray School of Medicine, Winston-Salem. His new phone number is
(910) 716 4431. As such he will be very involved in all aspects of
Clinical Pediatric Gastroenterology. Dr. Hill has every intention of
continuing his work with celiac disease and sees this as an opportunity
to open another center of interest. Colleagues at Duke and Chapel Hill
are keen to join Dr. Hill in a Pediatric Gastroenterology Group.
4. Iodine testing for DH is an old procedure used to create DH
blisters. By applying a 30 percent solution of iodine as a patch, a DH
outbreak can be created. This may be applicable in some patients when a
biopsy is needed and no blisters are available.
5. Immunofluorescence: The indirect immunofluorescence test shows that
the serum of a patient contains specific antibodies that bind to
different areas of the epithelium. The direct immunofluorescence tests
by a skin biopsy shows a specific diagnosis pattern of DH.
Traditionally this biopsy is obtained from the buttocks. If no
outbreaks are observed in this area, the biopsy is recommended for
another area where the itching is observed.
DH Drugs: The common drugs used to initially control the blisters are:
Dapsone, Sulfoxone, andSulfapyridine. Each one has different
advantages/disadvantages or availability in the treatment of DH.
Dapsone changes the life span of red blood cells from an average of 120
days to 30 days. Dapsone is known for possible hematologic changes as a
common side effect.
6. Ibuprofen (NSAIDs) types of pain relievers may not be desirable for
DH patients. This type of pain reliever may increase DH problems.iii
7. Stress Effects and Reactions: A speaker with DH brought up a good
point about the effect of being off the diet and exercise. This person
proceeded to be polite and consumed a cheese sandwich with the belief
that politeness would not allow her to offend the hostess' feelings.
Immediately after lunch she went horseback riding. Upon returning to
the house, she went into shock and passed out on the floor. Luckily,
she recovered with no side effects and a new awareness that exercise or
stress may increase the side effects from the consumption of a large
quantity of toxic grains. A shock effect warning is routinely given to
those preparing for a gluten challenge.
8. Medical Reference Material: An excellent source of information for
almost any disease is called The Merck Manual of Diagnosis and Therapy
(ISBN 0911910-16-6.) Most bookstores carry The Merck Manual in their
reference or medical section and it is priced around $30.00.
9. Down Syndrome and Celiac:
*** This item came directly from one or more posts to the CELIAC
*** list. It has been deleted here because it already appears
*** elsewhere in the archives.
10. Celiac disease and epilepsy in pediatric patients is discussed in
the following articles:
1. Among 783 patients referred to our institute with different
types of seizures as presenting symptom, systematic evaluation of
antigliadin and antiendomysial antibodies in the serum has
identified nine in whom jejunal biopsy has subsequently confirmed
the diagnosis of celiac disease (CD). In three of them brain
imaging showed the presence of calcified areas in the occipital
region. They had complex partial seizures (CPS), associated in two
with transient episodes of blindness.
In another patient with CPS and generalized tonic-clonic seizures
(GTCS) progressive multifocal cerebral calcifications were noted.
In the other six patients with CPS and/or GTCS cerebral
calcifications were absent. Symptoms of CD in all these cases were
either not previously taken into account, or they were very mild
or completely absent. In a group of 36 patients with clinically
manifest CD, regular follow-up, and good compliance with the
dietary regimen, no clinical seizures were reported. The
pathogenetic mechanism and the relationship between epilepsy and
an early diagnosis and treatment of celiac disease are discussed.
v
2. Bilateral occipital calcifications, occurring in celiac
disease, are factors coming under a particular cerebral syndrome,
which also includes epilepsy, migraine-like headache, visual
troubles and mental deterioration. They seem to arise from
hypofolatemia following gluten-induced enteropathy. vi
3. There have been anecdotal reports of an association between
coeliac disease and epilepsy with cerebral calcifications that
resemble those of the Sturge-Weber syndrome. A series of patients
who had epilepsy with calcifications, in whom coeliac disease (CD)
was incidentally observed, prompted us to study this association.
43 patients (15 male, age range 4.6-30.7 years) were selected from
two series. 31 patients with cerebral calcifications of
unexplained origin and epilepsy (series A) underwent intestinal
biopsy. 12 patients with CD and epilepsy (series B) underwent
computed tomography. Antibodies to gluten, folic acid serum
concentrations, were measured, and HLA typing was done in most
patients. 24 of the series A patients were identified as having CD
on the basis of a flat intestinal mucosa (15/22 with a high
concentration of serum antigluten), and 5 series B patients showed
cerebral calcifications, giving a total of 29 cases with the
combination of CD, epilepsy, and cerebral calcifications (CEC). In
27 of these CEC patients, calcifications were located in the
parieto-occipital regions. Only 2 of the series A patients had
gastrointestinal symptoms at the time of intestinal biopsy; most
patients had recurrent diarrhoea, anaemia, and other symptoms
suggestive of CD in the first 3 years of life. The epilepsy in CEC
patients was poorly responsive to antiepileptic drugs. Gluten-free
diet beneficially affected the course of epilepsy only when
started soon after epilepsy onset. Cases of "atypical Sturge-Weber
syndrome" (characterised by serpiginous cerebral calcifications
and epilepsy without facial port-wine naevus) should be reviewed,
and CD should be ruled out in all cases of epilepsy and cerebral
calcifications of unexplained origin. vii
4. We report the electroclinical findings of four epileptic
patients with clinically asymptomatic celiac disease (CD). Celiac
disease diagnosis was suspected by past history and/or computed
tomography (CT) fndings in all patients and confirmed by
laboratory tests and jejunal biopsy. All patients had paroxysmal
visual manifestations and ictal EEG discharges arising from the
occipital lobe. Epilepsy evolution was favorable in two patients
and severe in 2, regardless of CT evidence of occipital
corticosubcortical calcifications in 2 patients. Occipital lobe
seizures may be characteristic of the epilepsy related to CD, and
epileptic patients with these seizures of unknown etiology should
be carefully investigated for malabsorption. If past history
and/or laboratory tests suggest gastrointestinal (GI) dysfunction
they should also undergo small intestinal biopsy even if they do
not have GI tract symptoms. viii
A MEDLINE search showed these additional articles on celiac and
epilepsy:
"Convulsive disorder in celiac disease'', Cohen O; River Y;
Zelinger I, Harefuah; 126 (12) p707-10, 763, Jun 15 1994
"Need for follow up in coeliac disease'', Bardella MT; Molteni
N; Prampolini L; Giunta AM; Baldassarri AR, Arch Dis Child; 70 (3)
p211-3, Mar 1994
"Familial unilateral and bilateral occipital calcifications and
epilepsy", Tortorella G; Magaudda A; Mercuri E; Longo M;
Guzzetta F, Neuropediatrics; 24 (6) p341-2, Dec 1993
"Endocranial calcifications, infantile celiac disease, and
epilepsy", Piattella L; Zamponi N; Cardinali C; Porfiri L;
Tavoni MA, Childs Nerv Syst; 9 (3) p172-5, Jun 1993
"Cortical vascular abnormalities in the syndrome of celiac
disease, epilepsy, bilateral occipital calcifications, and folate
deficiency", Bye AM; Andermann F; Robitaille Y; Oliver M; Bohane
T; Andermann E, Ann Neurol; 34 (3) p399-403, Sep 1993
"Progressive cerebral calcifications, epilepsy, and celiac
disease", AU- Fois A; Balestri P; Vascotto M; Farnetani MA; Di
Bartolo RM; Di Marco V; Vindigni C, Brain Dev; 15 (1) p79-82,
Jan-Feb 1993
"Celiac disease, posterior cerebral calcifications and
epilepsy", Gobbi G; Ambrosetto P; Zaniboni MG; Lambertini A;
Ambrosioni G; Tassinari CA, Brain Dev; 14 (1) p23-9, Jan 1992
"Intracranial calcifications--seizures--celiac disease: a case
presentation", Della Cella G; Beluschi C; Cipollina F, Pediatr
Med Chir; 13 (4) p427-30, Jul-Aug 1991
"Coeliac disease, folic acid deficiency and epilepsy with
cerebral calcifications", Ventura A; Bouquet F; Sartorelli C;
Barbi E; Torre G; Tommasini G, Acta Paediatr Scand; 80 (5) p559-
62, May 1991
"Ramsay Hunt syndrome and coeliac disease: a new association?",
Lu CS; Thompson PD; Quinn NP; Parkes JD; Marsden CD, Mov Disord;
1 (3) p209-19, 1986
"Celiac disease associated with epilepsy and intracranial
calcifications: report of two patients", Molteni N; Bardella MT;
Baldassarri AR; Bianchi PA, Am J Gastroenterol; 83 (9) p992-4,
Sep 1988
"Bilateral cerebral occipital calcifications and migraine-like
headache", Battistella PA; Mattesi P; Casara GL; Carollo C;
Condini A; Allegri F; Rigon F Cephalalgia; 7 (2) p125-9, Jun 1987
"Blood selenium content and glutathione peroxidase activity in
children with cystic fibrosis, coeliac disease, asthma, and
epilepsy", Ward KP; Arthur JR; Russell G; Aggett PJ, Eur J
Pediatr; 142 (1) p21-4, Apr 1984
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