Abstracts

Celiac disease can be associated with a wide spectrum of neurological manifestations including ataxia, epilepsy, dementia, neuropathy, myopathy, cerebral calcification, cerebellar atrophy and leukoencephalopathy, which are mostly related to the metabolic consequences of severe malabsorption. We describe a four year-old child, presenting with myoclonic epilepsy described as head drops and occasional upper extremity clonus. The seizures continued to happen up to thirty times a day for several months even on multiple antiepileptic medications. An ictal EEG showed generalized high amplitude spike and slow wave activity with duration lasting 1-2 seconds. A brain MRI was normal. As part of an allergy workup, high antigluten antibodies were found and the HLA typing (HLA[minus]DQB1*0302, 0301) was also consistent with celiac disease. Unfortunately, a jejunal biopsy was not preformed. After the patient was started on a gluten-free diet, the seizures resolved completely within three days and the EEG was normalized. The anti-epileptic medications were gradually discontinued without any relapse for at least four more months., , , Gluten from dietary sources may evoke an immune response of the gastrointestinal cells via gliadin and tissue transglutaminase in susceptible individuals and lead to celiac disease with multiorgan manifestations. However, the clinical and immunological consequences of asymptomatic gluten intolerance are not well established. This is the first case report describing a complete resolution of seizure activity with a gluten-free diet alone. Our case suggests a possibility that the epilepsy was caused by a so far unknown immunological process directed to the central nervous system (e.g. antibodies to some ion channels.) Further investigations are necessary to determine a relationship and pathomechanism between intractable epilepsy and gluten intolerance.,