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. 2003 Apr;74(4):490–494. doi: 10.1136/jnnp.74.4.490

Neuromuscular and sensory disturbances in patients with well treated coeliac disease

L Luostarinen 1, S Himanen 1, M Luostarinen 1, P Collin 1, T Pirttila 1
PMCID: PMC1738407  PMID: 12640070

Abstract

Objectives: A body of evidence shows that coeliac disease is associated with protean manifestations outside the intestine, and neurological disorders are well recognised. However, it remains obscure whether there are signs of clinical or subclinical nervous system involvement even in patients adopting an adequate gluten free diet. The aim of this study was to assess in a controlled study whether patients with treated coeliac disease carry an increased risk for neuropathy and characterise the type of possible neuropathy.

Methods: Electroneuromyographic findings and vibration, thermal, and tactile thresholds of 26 patients with coeliac disease and 23 patients with reflux disease were analysed.

Results: Six (23.1 %) coeliac disease patients and one (4.3 %) reflux disease patient showed findings of chronic axonal neuropathy in quantitative needle EMG. In addition, two coeliac disease patients showed findings suggestive for myopathy. There were no significant differences in warm, cold, or vibration thresholds between the groups but means of heat pain thresholds and tactile thresholds were significantly higher in coeliac patients than in controls.

Conclusion: An increased occurrence of axonal neuropathy was observed in well treated coeliac disease. This further indicates that neurological manifestations occur even in patients without overt malaborption.

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Selected References

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  1. Banerji N. K., Hurwitz L. J. Neurological manifestations in adult steatorrhoea (probable Gluten enteropathy). J Neurol Sci. 1971 Oct;14(2):125–141. doi: 10.1016/0022-510x(71)90082-7. [DOI] [PubMed] [Google Scholar]
  2. Bischoff C., Stålberg E., Falck B., Eeg-Olofsson K. E. Reference values of motor unit action potentials obtained with multi-MUAP analysis. Muscle Nerve. 1994 Aug;17(8):842–851. doi: 10.1002/mus.880170803. [DOI] [PubMed] [Google Scholar]
  3. Bürk K., Bösch S., Müller C. A., Melms A., Zühlke C., Stern M., Besenthal I., Skalej M., Ruck P., Ferber S. Sporadic cerebellar ataxia associated with gluten sensitivity. Brain. 2001 May;124(Pt 5):1013–1019. doi: 10.1093/brain/124.5.1013. [DOI] [PubMed] [Google Scholar]
  4. Collin P., Pirttilä T., Nurmikko T., Somer H., Erilä T., Keyriläinen O. Celiac disease, brain atrophy, and dementia. Neurology. 1991 Mar;41(3):372–375. doi: 10.1212/wnl.41.3.372. [DOI] [PubMed] [Google Scholar]
  5. Cooke W. T., Smith W. T. Neurological disorders associated with adult coeliac disease. Brain. 1966 Dec;89(4):683–722. doi: 10.1093/brain/89.4.683. [DOI] [PubMed] [Google Scholar]
  6. Cronin C. C., Jackson L. M., Feighery C., Shanahan F., Abuzakouk M., Ryder D. Q., Whelton M., Callaghan N. Coeliac disease and epilepsy. QJM. 1998 Apr;91(4):303–308. doi: 10.1093/qjmed/91.4.303. [DOI] [PubMed] [Google Scholar]
  7. Dyck P. J., Oviatt K. F., Lambert E. H. Intensive evaluation of referred unclassified neuropathies yields improved diagnosis. Ann Neurol. 1981 Sep;10(3):222–226. doi: 10.1002/ana.410100304. [DOI] [PubMed] [Google Scholar]
  8. Haanpä ML, Laippala PA, Nurmikko TJ. Thermal and tactile perception thresholds in acute herpes zoster. Eur J Pain. 1999 Dec;3(4):375–386. doi: 10.1053/eujp.1999.0146. [DOI] [PubMed] [Google Scholar]
  9. Hadjivassiliou M., Chattopadhyay A. K., Davies-Jones G. A., Gibson A., Grünewald R. A., Lobo A. J. Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry. 1997 Dec;63(6):770–775. doi: 10.1136/jnnp.63.6.770. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hadjivassiliou M., Gibson A., Davies-Jones G. A., Lobo A. J., Stephenson T. J., Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369–371. doi: 10.1016/s0140-6736(96)90540-1. [DOI] [PubMed] [Google Scholar]
  11. Hadjivassiliou M., Grünewald R. A., Chattopadhyay A. K., Davies-Jones G. A., Gibson A., Jarratt J. A., Kandler R. H., Lobo A., Powell T., Smith C. M. Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia. Lancet. 1998 Nov 14;352(9140):1582–1585. doi: 10.1016/s0140-6736(98)05342-2. [DOI] [PubMed] [Google Scholar]
  12. Kaplan J. G., Pack D., Horoupian D., DeSouza T., Brin M., Schaumburg H. Distal axonopathy associated with chronic gluten enteropathy: a treatable disorder. Neurology. 1988 Apr;38(4):642–645. doi: 10.1212/wnl.38.4.642. [DOI] [PubMed] [Google Scholar]
  13. McLeod J. G. Investigation of peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1995 Mar;58(3):274–283. doi: 10.1136/jnnp.58.3.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Muller A. F., Donnelly M. T., Smith C. M., Grundman M. J., Holmes G. K., Toghill P. J. Neurological complications of celiac disease: a rare but continuing problem. Am J Gastroenterol. 1996 Jul;91(7):1430–1435. [PubMed] [Google Scholar]
  15. Mäki M., Collin P. Coeliac disease. Lancet. 1997 Jun 14;349(9067):1755–1759. doi: 10.1016/S0140-6736(96)70237-4. [DOI] [PubMed] [Google Scholar]
  16. Partanen J., Niskanen L., Lehtinen J., Mervaala E., Siitonen O., Uusitupa M. Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus. N Engl J Med. 1995 Jul 13;333(2):89–94. doi: 10.1056/NEJM199507133330203. [DOI] [PubMed] [Google Scholar]
  17. Pellecchia M. T., Scala R., Filla A., De Michele G., Ciacci C., Barone P. Idiopathic cerebellar ataxia associated with celiac disease: lack of distinctive neurological features. J Neurol Neurosurg Psychiatry. 1999 Jan;66(1):32–35. doi: 10.1136/jnnp.66.1.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Stålberg E., Bischoff C., Falck B. Outliers, a way to detect abnormality in quantitative EMG. Muscle Nerve. 1994 Apr;17(4):392–399. doi: 10.1002/mus.880170406. [DOI] [PubMed] [Google Scholar]
  19. Stålberg E., Nandedkar S. D., Sanders D. B., Falck B. Quantitative motor unit potential analysis. J Clin Neurophysiol. 1996 Sep;13(5):401–422. doi: 10.1097/00004691-199609000-00004. [DOI] [PubMed] [Google Scholar]
  20. Waylett-Rendall J. Sensibility evaluation and rehabilitation. Orthop Clin North Am. 1988 Jan;19(1):43–56. [PubMed] [Google Scholar]

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