“EEG abnormalities” may represent a confounding factor in celiac disease: A 4-year follow-up family report

Abstract

ObjectiveThe occurrence of celiac disease (CD), electroencephalographic (EEG) abnormalities (with “subtle” seizures or even without any clinical seizures), and neurological disorders has been reported since the 1980s, though there has been no definitive consensus about the possible causal relationship. This topic is further complicated by the occurrence in infancy of ‘clinical–EEG pictures’ called ‘benign epilepsy of infancy’.Methods and resultsHere, we report a 4-year follow-up on two siblings with newly diagnosed biopsy-proven celiac disease showing EEG abnormalities not responsive to a gluten-free diet.ConclusionsThis family report indicates that in patients with neurologically asymptomatic CD and EEG abnormalities, it is advisable to make a differential diagnosis between EEG abnormalities associated with CD and an incidental association with cortical hyperexcitability, with “subtle” seizures or even without any clinical seizures.Practice implicationsA long follow-up may sometimes be required, as it was in the family described here, to clarify the etiopathogenetic and therapeutic relationships between clinical and EEG features in CD.

Neurophysiology of the “Celiac Brain”: Disentangling Gut-Brain Connections

“…Finally, it is mandatory to make a differential diagnosis between hyperexcitability-related seizures and incidental EEG findings in neurologically asymptomatic CD subjects. In the latter case, EEG changes represent a confounding factor and a long follow-up is required (Parisi et al, 2014 ).…”

“…The spectrum of electroencephalography (EEG) features associated with CD is rather wide, although focal activity in terms of unilateral or bilateral spike or slow waves, mainly localized in the occipital regions, have been reported in most of the wakefulness EEG studies (Magaudda et al, 1993 ; Labate et al, 2001 ; Pratesi et al, 2003 ; Ranua et al, 2005 ; Lionetti et al, 2010 ; Licchetta et al, 2011 ; Aksoy et al, 2016 ). However, as recommended (Parisi et al, 2014 ), EEG patterns should not be considered disease-specific.…”

Increased Tissue Transglutaminase Levels Are Associated With Increased Epileptiform Activity in Electroencephalography Among Patients With Celiac Disease

“…Parisi et al (19) and Cakir et al (2) also studied on the subclinical neurological findings in children with CD and reported increased neurological activities in CD cases. In this study we have determined a correlation of tissue transglutaminase levels with the epileptiform activities.…”

A celiac case mimicking mitochondrial neurogastrointestinal encephalomyopathy (MNGIE)

“…stated that 7% of the patients presented with neurological findings. The best described neurological complications of CD are ataxia, peripheral neuropathy and epilepsy, and more controversial ones include myopathy, autonomic neuropathy, migraine, cognitive impairment, multiple system atrophy, dystonia, dysarthria, ophthalmoplegia, optic neuritis, multiple sclerosis, difficulty of walking, tremor, white matter and basal ganglion lesions, pyramidal and extra-pyramidal symptoms, childhood stroke, and sensorineural hearing loss 3,4,[13][14][15][16][17][18] .…”