Abstracts

Previously, several studies have shown an increased prevalence of antiphospholipid (aPL) and anti-glutamic acid decarboxylase (GAD) antibodies in patients with refractory localization-related epilepsy (RLRE). Gliadin antibodies (AGA) have been associated with brain pathology, most commonly in patients with cerebellar degeneration. We have recently described an association between AGA antibodies, gluten sensitivity and temporal lobe epilepsy with hippocampal sclerosis.
The first objective of the present study is to compare the frequencies of aPL or GAD antibodies in epilepsy patients with and without AGA. The secondary objective is to compare the frequencies of celiac disease (CD) related antibodies between RLRE and generalized epilepsy (GE)., We measured CD related antibodies [AGA, anti-tissue transglutaminase and anti-endomysium antibodies] in 50 consecutive patients with GE syndromes and 48 consecutive patients with RLRE. The frequencies of aPL and GAD antibodies have been reported previously., Patients with AGA-positivity had a greater prevalence of aPL antibodies and GAD-antibodies. IgG-class AGA were significantly associated with GAD-antibodies (p=0,042) and IgG-class aPL (p=0,018). IgA-class AGA were associated with IgG-class aPL (p=0,029). 50 % of the patients with IgG-class AGA harbour also IgG-class aPL, which is five times more than in AGA-negative patients. In patients with IgG-class AGA-positivity 33% (nine times more common than in AGA-negative patients) had also antibodies against GAD. In multiple regression analysis, age, sex, and duration of epilepsy were not associated with the prevalence of antibodies in patients with AGA-positivity. The frequencies of all measured antibodies were higher in RLRE compared with GE except with AGA-antibodies, which were more common in GE group., In the present study we demonstrated that both aPL antibodies and GAD antibodies were strongly associated with AGA. The co-expression of CD related autoantibodies and anti-GAD autoantibodies is of special interest, because increased expression of various autoantibodies including anti-GAD autoantibodies has been reported in patients with CD and moreover, in patients with cerebellar degeneration and AGA. This study provides additional evidence of immunological activation in epilepsy: sensitivity to dietary gluten may explain partly the presence of antineuronal antibodies such as aPL and GAD.,