Peripheral Neuropathy Electrophysiological Screening in Children With Celiac Disease

Abstract

-Background -The involvement of the peripheral nervous system in children with celiac disease is particularly rare. Objective -The aim of this study was to assess the need for neurophysiological testing in celiac disease patients without neurological symptoms in order to detect early subclinical neuropathy and its possible correlations with clinical and demographic characteristics. Methods -Two hundred and twenty consecutive children with celiac disease were screened for neurological symptoms and signs, and those without symptoms or signs were included. Also, patients with comorbidities associated with peripheral neuropathy or a history of neurological disease were excluded. The remaining 167 asymptomatic patients as well as 100 control cases were tested electro-physiologically for peripheral nervous system diseases. Motor nerve conduction studies, including F-waves, were performed for the median, ulnar, peroneal, and tibial nerves, and sensory nerve conduction studies were performed for the median, ulnar, and sural nerves with H reflex of the soleus muscle unilaterally. All studies were carried out using surface recording electrodes. Normative values established in our laboratory were used. Results -Evidence for subclinical neuropathy was not determined with electrophysiological studies in any of the participants. Conclusion -In this highly selective celiac disease group without any signs, symptoms as well as the predisposing factors for polyneuropathy, we did not determine any cases with neuropathy. With these results we can conclude that in asymptomatic cases with celiac disease electrophysiological studies are not necessary. However, larger studies with the electrophysiological studies performed at different stages of disease at follow-ups are warranted. HEADINGS -Celiac disease. Peripheral nervous system diseases. Electrophysiological phenomena. Child.Declared conflict of interest of all authors: none Disclosure of funding: no funding received

Neurological Manifestations of Neuropathy and Ataxia in Celiac Disease: A Systematic Review

“…After removal of duplicates and screening of titles and abstracts screening, 45 were eligible for full-text review. A total of 16 studies met all eligibility criteria and were included in the systematic review (Figure 1, Table 3) [10,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. Nine studies on gluten ataxia [10,20,21,22,23,26,28,31,32] and 13 articles on gluten neuropathy were included [10,19,20,22,24,25,26,27,28,29,30,32,33].…”

“…Of the studies included, 50% (eight out of 16) were full-text, prospective analyses that reported global prevalence or incidence rates of gluten neuropathy and gluten ataxia [19,20,21,22,23,24,28,29]. See Box 1 for the definitions of CD, gluten ataxia, and gluten neuropathy.…”

“…Thirteen articles reported gluten neuropathy as a manifestation of CD [10,19,20,22,24,25,26,27,28,29,30,32,33]. Estimates of the prevalence of neuropathy in these patients ranged from 0% to 39%, with an increased prevalence/risk in older and female patients.…”

“…Estimates of the prevalence of neuropathy in these patients ranged from 0% to 39%, with an increased prevalence/risk in older and female patients. In retrospective and prospective studies of patients with CD in the US and Europe, prevalence of neuropathy ranged from 4% to 23% of adults [20,25,27], 0% to 7% of children [22,24,25,28,32], and 0.7% to 39% of combined/unspecified populations [20,29,30,32]. While these ranges appear to overlap, a few studies directly compared the prevalence and risk of neuropathy by age and indicated that neuropathy occurs more frequently in older populations [27].…”

“…One study was a prospective case series, representing level 4 evidence [31]. The remaining seven studies [20,21,22,23,24,28,29] were cross-sectional studies, which we have categorized as Level 2c. The levels of evidence for individual studies are shown in Table 4.…”