Skip to main content

Advertisement

Log in

Peripheral neuropathy and celiac disease

  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Peripheral neuropathy (PN) is one of the most frequently reported neurologic manifestations associated with celiac disease (CD), a multigenetic, T-cell-mediated autoimmune disorder that results from a loss of tolerance to gluten. Sensory axonal and small fiber sensory polyneuropathies are the most frequently reported PN subtypes. Multifocal motor or sensorimotor neuropathies and a more fulminant neuropathy, associated with ataxia and other neurologic manifestations, also have been reported. The effect of a gluten-free diet on CD-associated PN has not been studied systematically or prospectively; nevertheless, a gluten-free diet currently is the cornerstone of therapy. Although idiopathic ataxia associated with anti-gliadin antibodies and other neurologic complications have been reported to respond to this diet; there is data that indicate that neurologic manifestations may develop or persist, independent of gluten exposure. There is evidence to suggest that inflammatory processes may be involved. Immunomodulatory agents (such as intravenous immunoglobulin or infliximab), described to be beneficial in the treatment of refractory CD or CD-associated ataxia, may have a role in the management of CD-associated PN

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Green PHR, Jabri B: Coeliac disease. Lancet 2003, 362:383–391. This excellent review of CD highlights recent research developments and their therapeutic implications.

    Article  PubMed  CAS  Google Scholar 

  2. Fasano A, Berti I, Gerarduzzi T, et al.: Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003, 63:286–292. This is a large, well-conducted epidemiologic study.

    Article  Google Scholar 

  3. Farrell RJ, Kelly CP: Celiac sprue. N Engl J Med 2002, 346:180–188. This is an excellent review of the CD and its pathogenesis.

    Article  PubMed  CAS  Google Scholar 

  4. Chin RL, Latov N, Green PHR, et al.: Neurologic complications of celiac disease. J Clin Neuromusc Dis 2004, 5:129–137. This is an extensive review of the reported central and peripheral complications of CD and gluten sensitivity.

    Article  Google Scholar 

  5. Hadjivassiliou M, Grünewald RA, Davies-Jones GA: Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry 2002, 72:560–563. This well-written editorial includes a summary of reported neurologic complications of CD from 1964 to 2000 and a summary of neurologic complications of gluten sensitivity that the authors’ have seen during an 8-year period.

    Article  PubMed  CAS  Google Scholar 

  6. Luostarinen L, Himanen SL, Luostarinen M, et al.: Neuromuscular and sensory disturbances in patients with well-treated celiac disease. J Neurol Neurosurg Psychiatry 2003, 74:490–494. This is the first article to assess the incidence of neuropathy in well-controlled CD. The incidence of 23% is higher than in previous retrospective, uncontrolled studies.

    Article  PubMed  CAS  Google Scholar 

  7. Chin RL, Sander HW, Brannagan TH, et al.: Celiac neuropathy. Neurology 2003, 60:1581–1585. This review of 20 patients is the largest series to date of patients with peripheral neuropathy and CD.

    PubMed  CAS  Google Scholar 

  8. Banerji NK, Hurwitz LJ: Neurological manifestations in adult steatorrheoea. (probable gluten enteropathy). J Neurol Sci 1971, 14:125–141.

    Article  PubMed  CAS  Google Scholar 

  9. Kaplan JG, Pack D, Horoupian D, et al.: Distal axonopathy associated with chronic gluten enteropathy: a treatable disorder. Neurology 1988, 38:642–645.

    PubMed  CAS  Google Scholar 

  10. Luostarinen L, Pirttilä T, Collin P: Coeliac disease presenting with neurological disorders. Eur Neurol 1999, 42:132–135.

    Article  PubMed  CAS  Google Scholar 

  11. Cooke WT, Smith WT: Neurological disorders associated with adult celiac disease. Brain 1966, 89:683–722. This landmark paper gives detailed pathologic descriptions of 16 patients, most of whom had severe, progressive neurologic dysfunction that was unresponsive to a gluten-free diet.

    Article  PubMed  CAS  Google Scholar 

  12. Muller AF, Donnelly MT, Smith CM, et al.: Neurological complications of celiac disease: a rare but continuing problem. Am J Gastroenterol 1996, 91:1430–1435.

    PubMed  CAS  Google Scholar 

  13. Hadjivassiliou M, Davies-Jones GAB, Sanders DS, et al.: Dietary treatment of gluten ataxia. J Neurol Neurosurg Psychiatry 2003, 74:1221–1224. The first prospective study to examine the effects of a glutenfree diet on gluten ataxia.

    Article  PubMed  CAS  Google Scholar 

  14. Pellecchia MT, Scala R, Perretti A, et al.: Cerebellar ataxia associated with subclinical celiac disease responding to gluten-free diet. Neurology 1999, 53:1606.

    PubMed  CAS  Google Scholar 

  15. Bürk K, Bösch S, Müller CA, et al.: Sporadic cerebellar ataxia associated with gluten sensitivity. Brain 2001, 124:1013–1019.

    Article  PubMed  Google Scholar 

  16. Sander HW, Magda P, Chin RL, et al.: Cerebellar ataxia and coeliac disease. Lancet 2004, 362:1548. The first case report to report a beneficial response to IVIg in a woman with biopsy-proven CD and a 12-year history of progressive dysarthria and ataxia.

    Article  Google Scholar 

  17. Kelkar P, Ross MA, Murray J: Mononeuropathy multiplex associated with celiac sprue. Muscle Nerve 1996, 19:234–236.

    Article  PubMed  CAS  Google Scholar 

  18. Hadjivassiliou M, Chatoopadhyay AK, Davies-Jones GAB, et al.: Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry 1997, 63:770–775. This is a review of nine patients with various neuromuscular disorders and biopsy-confirmed CD.

    Article  PubMed  CAS  Google Scholar 

  19. Polizzi A, Finocchiaro M, Parano E, et al.: Recurrent peripheral neuropathy in a girl with celiac disease. J Neurol Neurosurg Psychiatry 2000, 68:104–105.

    Article  PubMed  CAS  Google Scholar 

  20. Viader F, Chapon F, Dao T, et al.: Celiac disease in adults revealed by sensory-motor neuropathy. Presse Med 1995, 24:222–224.

    PubMed  CAS  Google Scholar 

  21. Brannagan TH, Hays AP, Sander HW, et al.: Small fiber neuropathy associated with celiac disease: skin biopsy findings. Neurology 2004, 62:A262. This is the first report of skin biopsy findings in CDassociated neuropathy.

    Google Scholar 

  22. Connolly CE, Kennedy M, Stevens FM, McCarty CF: Brown bowel syndrome occurring in celiac disease in the West of Ireland. Scand J Gastroenterol 1994, 29:91–94.

    PubMed  CAS  Google Scholar 

  23. Alaedini A, Green PHR, Sander HW, et al.: Ganglioside reactive antibodies in the neuropathy associated with celiac disease. J Neuroimmunol 2002, 127:145–148. This paper raises insights into the pathogenesis of CDassociated PN.

    Article  PubMed  CAS  Google Scholar 

  24. Laurière M, Bouchez I, Doyen C, Eynard L: Identification of glycosylated forms of wheat storage proteins using two-dimensional electrophoresis and blotting. Electrophoresis 1996, 17:497–501.

    Article  PubMed  Google Scholar 

  25. Hadjivassiliou M, Boscolo S, Davies-Jones GA, et al.: The humoral response in the pathogenesis of gluten ataxia. Neurology 2002, 58:1221–1226. This is an interesting paper detailing the cerebellar staining characteristics of sera from patients with gluten ataxia, compared with a control group and patients with CD who lacked neurologic disease.

    PubMed  CAS  Google Scholar 

  26. Gentile V, Cooper AJ: Transglutaminases — possible drug targets in human diseases. Curr Drug Targets CNS Neurol Disord 2004, 3:99–104.

    Article  PubMed  CAS  Google Scholar 

  27. Vaidya A, Bolanos J, Berkelhammer C: Azathioprine in refractory sprue. Am J Gastroenterol 1999, 94:1967–1969.

    Article  PubMed  CAS  Google Scholar 

  28. Longstreth GF: Successful treatment of refractory sprue with cyclosporine. Ann Intern Med 1993, 119:1014–1016.

    PubMed  CAS  Google Scholar 

  29. Gillett HR, Arnott ID, McIntyre M, et al.: Successful infliximab treatment for steroid-refractory celiac disease: a case report. Gastroenterology 2002, 122:800–805.

    Article  PubMed  Google Scholar 

  30. Brannagan III TH: Peripheral neuropathy pain: mechanisms and treatment. J Clin Neuromusc Dis 2003, 5:61–71. This is a recent review of the pathogenesis and treatment of neuropathic pain.

    Article  Google Scholar 

  31. Murphy D, Laffy J, O’Keeffe D: Electrical spinal cord stimulation for painful peripheral neuropathy secondary to coeliac disease. Gut 1998, 42:448.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chin, R.L., Latov, N. Peripheral neuropathy and celiac disease. Curr Treat Options Neurol 7, 43–48 (2005). https://doi.org/10.1007/s11940-005-0005-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-005-0005-3

Keywords

Navigation