Table 1.
Studies using Transcranial Magnetic Stimulation (TMS) in patients with celiac disease (adapted from [93]).
| Study | No. of Patients | Sex | Age (Years) | Neurological Features | Main Results | Response to the GFD | Translational Value |
|---|---|---|---|---|---|---|---|
| Pellecchia MT, et al. 1999 [51] | 1 | M | 34 | Progressive cerebellar ataxia | ▼ MEPs amplitude | Partial response | Impairment of central motor pathways in CD, which partially respond to GFD |
| Tijssen MA, et al. 2000 [52] | 2 (only 1 undergoing TMS) | M | 50 | Myoclonic ataxic syndrome | ▲ MEPs latency in the left tibialis anterior muscle; abnormal cortical inhibition | Not reported | The enhanced excitability of sensory-motor cortex may arise as a remote effect of cerebellar pathology in CD |
| Pennisi G, et al. 2014 [53] | 20 | 16 F 4 M |
Median 33.0 (range 24–45) | Dysthymic disorder (5 patients); anxiety (2 patients) | ▼ CSP ▼ ICI ▲ ICF |
GFD was not started yet (de novo patients) | The immune system dysregulation might trigger changes of cortical excitability |
| Bella R, et al. 2015 [54] | 13 | 10 F 3 M |
Median 39.0 (range 24–46) |
Dysthymic disorder (1 patient) | Compared to de novo patients: ▼ rMT ▼ CSP ▼ SICI ▲ ICF |
Increased cortical excitability after a relatively short period of diet | Functional cortical reorganization, probably compensating for the disease progression; insufficient GFD duration |
| Pennisi M, et al. 2017 [55] | (a) 20 de novo CD patients (b) 20 CD patients on GFD |
(a) 4 M 16 F (b) 6 M 14 F |
(a) Mean 35.00 ± 12.03 (SD) (b) Mean 35.10 ± 6.02 (SD) |
(a) Dysthymic disorder (5 patients); higher score for depression, anxiety and irritability (b) Normal |
▼ CSP in de novo patients than GFD patients ▼ motor response amplitude in all patients ▼ SICI and enhanced ICF in all patients ▲ ICF in gluten-restricted patients compared to those non-restricted |
A prolonged dietary regimen induced a recover of most but not all, the electrocortical changes | Although the clinical-neurophysiological recovery, some subtle intracortical synaptic dysfunction may persist notwithstanding the GFD |
CD = celiac disease; CSP = cortical silent period; F = female; GFD = gluten-free diet; ICF = intracortical facilitation; SICI = short-latency intracortical inhibition; M = male; MEPs = motor evoked potentials; rMT = resting motor threshold; SD = standard deviation; ▼ = decrease/reduction/less prolonged; ▲ = increase/enhancement/more prolonged.