Celiac.com 01/19/2010 - A new study says that migraines and carpal tunnel syndrome may point to celiac disease. Moreover, 35% of people with celiac disease report a history of depression, personality changes, or psychosis. Others commonly suffer from neurological issues that are not improved with a gluten-free diet.

Researchers recently screened a cohort of 72 patients with biopsy-proven celiac disease, recruited through advertisements and interviewed using a standard questionnaire.

Nearly one in three celiac patients (28%) reported a history of migraine, though numerous patients showed a decrease in frequency and intensity of migraine attacks after adopting of a gluten-free diet.

While about 20% of patients suffered from carpal tunnel syndrome, epilepsy was, surprisingly, less common than expected," report the researchers. "Only 4 individuals presented with a history of generalized or focal seizures."

In general, doctors believe about 6% to 10% of celiac patients show typical neurological presentations, the study authors note. Prior studies have shown cerebellar ataxia to be the most common celiac disease-associated neurological symptom.

This new study found cerebellar ataxia in 6% of patients, and vestibular dysfunction in another 6%. In all, 26% of patients showed afferent ataxia.

About a third of patients had problems with stance and gait, with numerous cases of deep sensory loss and reduced ankle reflexes.

"Gait disturbances in celiac disease do not only result from cerebellar ataxia but also from proprioceptive or vestibular impairment," report investigators led by Katrin Bürk, MD, from the University of Marburg in Germany.  The bad news is that such neurological problems may develop "despite strict adherence to a gluten-free diet," says Burke.

"Most studies in this field are focused on patients under primary neurological care," the researchers note. "To exclude such an observation bias, patients with biopsy-proven celiac disease were screened for neurological disease."

Motor problems, such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus, were not common. A total of 14% of patients reported problems with bladder function.

The underlying causes for neurological problems in celiac disease are not yet understood.

There has been some evidence to implicate deficiencies in folic acid, vitamin E, and biopterin in the pathogenesis. However, the investigators note that, in most patients, replacement therapy does not resolve clinical symptoms. They note also that hypo-vitaminosis rarely causes obvious abnormalities in celiac patients, and most with neurological symptoms show no evidence of any nutritional deficiencies.

"The prevalence of neurological manifestations in celiac disease is striking and must be considered more than accidental," they say. "The patients' gluten-free diet had resolved intestinal symptoms but had not prevented the development of neurological deficits."

The investigators suggest that, because of the considerable clinical variability, neurological and psychiatric dysfunction in celiac disease is likely the result of numerous pathogenic mechanisms.

Source: Mov Disord. 2009;24:2358-2362.

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