NEUROLOGICAL MANIFESTATIONS OF GLUTEN RELATED DISORDERS

Abstract

Objective: To determine the frequency and pattern of neurological features in patients diagnosed with gluten related disorder (GRD). Study Design: Cross sectional analytical study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2016 to Jun 2018. Patients and Methods: This study included cases who presented initially with neurological manifestations and later diagnosed having GRD, including coeliac disease (CD) or non-coeliac gluten sensitivity (NCGS). Cases fulfilling inclusion and exclusion criteria were selected. Record of patients was obtained from the hospital stats office. Cases were analyzed for clinical symptomatology, laboratory and neuro-radiological findings. Data was collected using performa and analysis was done using SPSS version 20. Results: Out of 31 patients, 18 (58.1%) were male and 13 (49.9%) were females. Mean age was 28.8 ± 10.4 years. Nineteen (61.3%) were diagnosed with CD while 12 (38.7%) had NCGS. Anti-TTG antibodies were detected in 17 out of 19 patients with CD, while anti Gliadin antibodies were positive in 11 out of 12 patients with NCGS. These results were statistically significant with p-value <0.001. Headache was the commonest manifestation in GRD, in 17 (54.8%) patients while 11 (34.5%) had seizures. Six cases (19.3%) presented with variable generalized weakness. Moreover 10 (32.2%) patients had MRI brain abnormalities. Conclusion: CD and NCGS should be kept in differential diagnosis, in various central and peripheral nervous system clinical manifestations. Moreover even if biopsy is negative for CD even then gluten sensitivity can be present in the form of NCGS with neurological manifestations.

Keywords

• anti gliadin antibodies
• coeliac disease
• gluten sensitivity