Celiac crisis presenting with status epilepticus and encephalopathy

Hijaz, Nadia; Bracken, Julia M.; Chandratre, Sonal

doi:10.1007/s00431-013-2097-1

Cited by 14 publications

(8 citation statements)

References 9 publications

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“…3 Celiac crisis presenting with status epilepticus and encephalopathy in the absence of profound GI symptom has been recently described. 4 A meta-analysis of the few evidence-based data available on these disorders in children showed that the relative risk of epilepsy in individuals with CD, and of CD in individuals with epilepsy, compared with the general population, was 2.1 and 1.7, respectively. In the vast majority of these patients, wakefulness EEGs revealed focal abnormalities, mainly localized in one or both occipital regions.…”

Section: Introductionmentioning

confidence: 99%

Role of the gluten-free diet on neurological-EEG findings and sleep disordered breathing in children with celiac disease

Parisi

Pietropaoli

Ferretti

et al. 2015

Seizure

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Section: Introductionmentioning

confidence: 99%

Role of the gluten-free diet on neurological-EEG findings and sleep disordered breathing in children with celiac disease

Parisi

Pietropaoli

Ferretti

et al. 2015

Seizure

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“…In the child reported here, recurrent episodes of GBS occurred several months before the development of classic gastrointestinal signs and symptoms of CD, thus highlighting the possibility that neurologic manifestations may precede gastrointestinal CD manifestations in children as well as adults. This observation has been reported in pediatric patients with headache [ 8 , 9 ], opsoclonus-myoclonus [ 10 ], recurrent optic neuritis [ 11 ], recurrent acute encephalopathy [ 12 ], status epilepticus [ 13 , 14 ], recurrent transient hemiplegia [ 15 ], cerebral venous sinus thrombosis [ 16 ], and transverse myelitis [ 17 ].…”

Section: Discussionmentioning

confidence: 60%

Celiac Disease Presenting with Peripheral Neuropathy in Children: A Case Report

Pacitto

Paglino

Genova

et al. 2017

IJERPH

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Background: Clinically relevant neurological manifestations in children with celiac disease (CD) are unusual, especially when they are considered as signs of the onset of the disease. In this paper, a case of Guillain-Barrè syndrome (GBS) as the first manifestation of CD in a 23-month-old child is reported. Case presentation: We describe a case of CD onset with peripheral neuropathy in a 23-month-old Bulgarian boy presenting with a sudden refusal to walk and absence of deep tendon reflexes in both lower limbs. Neurological symptoms were preceded by two months of gastrointestinal symptoms such as vomiting, abdominal distention, and clear signs of malnutrition and weight loss. When we evaluated the child six months after the onset of the symptoms, clinical and laboratory findings showed clear signs of peripheral neuropathy associated with malnutrition. Serum deamidated gliadin and tissue transglutaminase antibodies were therefore measured. The anti-gliadin levels were more than sixteen times higher than normal and the IgA anti-transglutaminase levels were four times higher than normal. Anti-endomysium antibodies were positive, and human leukocyte antigens (HLA) II typing confirmed a genetic predisposition to CD (DQ2 positive and DQ8 negative). Given the association between the clinical evidence of the disease and the results of the celiac screening tests, a diagnosis of CD was made without biopsy confirmation of the enteropathy. The child began a restricted gluten-free diet that led to complete recovery of the peripheral neuropathy, walking, reflexes, and overall improvement after three months on the diet. Conclusion: Our case underlines the rare but possible associations between CD and peripheral neuropathy in children as an onset symptom, even in the absence of gastrointestinal manifestations, thus suggesting that CD should always be considered in the differential diagnosis of peripheral neuropathy in children. A good knowledge of the extra-intestinal manifestations of CD is essential for the rapid introduction of a gluten-free diet that could be useful for the resolution of the neurological symptoms.

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“…5 Neurologic symptoms as first manifestation of CD in children are even more unusual than complications. 11 Nevertheless, several pediatric cases of CD 11 -18 (all confirmed with biopsy except for 1 patient due to young age 16 ), with varying neurologic presentations have been described, such as headaches, 12 opsoclonus-myoclonus, 13 recurrent optic neuritis in the context of psoriasis and partial IgA and IgG3 deficiency, 14 recurrent acute encephalopathy, 11 status epilepticus/encephalopathy, 15 peripheral neuropathy, 17 recurrent transient hemiplegia with infarction of the brain, 18 and 2 children with cerebral venous sinus thrombosis. 16 A GFD alone 12,17 or combined with other treatments 11,13,15,16,18 led to improvement 13,18 or even complete resolution 11, 12, 15 -17 of the various neurologic symptoms in these pediatric CD cases.…”

Section: Discussionmentioning

confidence: 99%

Transverse Myelitis as Manifestation of Celiac Disease in a Toddler

et al. 2017

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We present a 17-month-old girl with rapidly progressive unwillingness to sit, stand, play, and walk. Furthermore, she lacked appetite, vomited, lost weight, and had an iron deficiency. Physical examination revealed a cachectic, irritable girl with a distended abdomen, dystrophic legs with paraparesis, disturbed sensibility, and areflexia. An MRI scan revealed abnormal high signal intensity on T2-weighted images in the cord on the thoracic level, without cerebral abnormalities, indicating transverse myelitis (TM). Laboratory investigations revealed elevated immunoglobulin A antibodies against gliadin (1980.0 kU/L; normal, 0-10.1 kU/L) and tissue transglutaminase (110.0 kU/L; normal, 0-10.1 kU/L). Gastroscopy revealed villous atrophy in the duodenal biopsies and lymphocytic gastritis according to Marsh IIIb, compatible with celiac disease (CD). After the start of a gluten free diet and methylprednisolone, she recovered completely. To our knowledge, this is the first pediatric case of TM as manifestation of CD. We suggest that all children with TM or other neurologic manifestations of unknown origin should be screened for CD.

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Celiac crisis presenting with status epilepticus and encephalopathy

Abstract: We report herein on the first case of celiac crisis presenting with status epilepticus and encephalopathy in the absence of profound GI symptoms. Our case suggests that celiac crisis should be considered in the differential of seizures and encephalopathy in children.

Cited by 14 publications

References 9 publications

Role of the gluten-free diet on neurological-EEG findings and sleep disordered breathing in children with celiac disease

Role of the gluten-free diet on neurological-EEG findings and sleep disordered breathing in children with celiac disease

Celiac Disease Presenting with Peripheral Neuropathy in Children: A Case Report

Transverse Myelitis as Manifestation of Celiac Disease in a Toddler

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