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Neurology 2003 May 27; 60(10): 1581-1585  Celiac Neuropathy

Chin RL, Sander HW, Brannagan TH, Green PH, Hays AP, Alaedini A, Latov N.

Department of Neurology and Neuroscience (Drs. Chin, Sander, Brannagan,
Alaedini, and Latov), Weill Medical College of Cornell University, New
York, NY.

BACKGROUND: Celiac disease (CD) is a chronic inflammatory enteropathy
resulting from sensitivity to ingested gluten. Neurologic complications
are estimated to occur in 10% of affected patients, with ataxia and
peripheral neuropathy being the most common problems. The incidence and
clinical presentation of patients with CD-associated peripheral
neuropathy have not previously been investigated. OBJECTIVE: To
determine the incidence of CD in patients with neuropathy and to
characterize the clinical presentation. METHODS: The records of 20
patients with neuropathy and biopsy-confirmed CD were reviewed. RESULTS:
Six of the 20 patients had neuropathic symptoms alone without
gastrointestinal involvement, and neuropathic symptoms preceded other CD
symptoms in another 3 patients. All patients had burning, tingling, and
numbness in their hands and feet, with distal sensory loss, and nine had
diffuse paresthesias involving the face, trunk, or lumbosacral region.
Only two had weakness. Results of electrophysiologic studies were normal
or mildly abnormal in 18 (90%) of the patients. Sural nerve biopsies,
obtained from three patients, revealed mild to severe axonopathy. Using
the agglutination assay, 13 (65%) of the patients were positive for
ganglioside antibodies. Excluding patients who were referred with the
diagnosis of celiac neuropathy, CD was seen in approximately 2.5% of all
neuropathy patients and in 8% of patients with neuropathy and normal
electrophysiologic studies seen at our center. CONCLUSION: CD is
commonly associated with sensory neuropathy and should be considered
even in the absence of gastrointestinal symptoms.

Shelley Case, B. Sc., RD
Case Nutrition Consulting, www.glutenfreediet.ca
<http://www.glutenfreediet.ca>
Author: Gluten Free Diet: A Comprehensive Resource Guide
Co-Author: Celiac Section, Manual of Clinical Dietetics, American
Dietetic Association and Dietitians of Canada
Medical Advisory Board: Celiac Disease Foundation, Gluten Intolerance
Group, Canadian Celiac Association
Dietitian Advisory Board: Gluten-Free Living Magazine
EMail: [log in to unmask] <mailto:[log in to unmask]>

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