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Marios Hadjivassiliou - One of the best experts on this subject based on the ideXlab platform.

  • Small fiber neuropathy in coeliac disease and Gluten Sensitivity.
    Postgraduate medicine, 2019
    Co-Authors: Panagiotis Zis, David S. Sanders, Ptolemaios G. Sarrigiannis, Dasappaiah Ganesh Rao, Marios Hadjivassiliou
    Abstract:

    Objectives: The commonest types of peripheral neuropathy in the context of Coeliac Disease (CD) and Gluten Sensitivity (GS) are length-dependent symmetrical sensorimotor neuropathies and sensory ganglionopathies. In patients with such neuropathy, (Gluten neuropathy), peripheral neuropathic pain is prevalent suggesting involvement of small fibers. The purpose of this report was to describe the clinical characteristics of patients with CD or GS and pure small fiber neuropathy (SFN). Methods: We reviewed the records of all patients that had been referred to the Gluten-Related Neurological Disorders clinic who had clinical and neurophysiological evidence of SFN. All patients had serological evidence of Gluten Sensitivity (GS) prior to commencing GFD. All patients were offered a duodenum biopsy. Patients with comorbidities that could cause SFN were excluded. Results: We identified 13 patients (9 males) with SFN and Gluten Sensitivity. Of 11 patients who underwent duodenal biopsy 10 had evidence of enteropathy (CD). Mean age at onset of pain was 53.5 ± 11.4 years (range 34-72) and mean age of CD/GS diagnosis was 50.8 ± 10.4 years (range 34-68). In 8 patients (61.5%) pain was the presenting feature. Neurophysiological assessment suggested a length-dependent small fiber neuropathy in 11 patients, whereas in 2, a non-length dependent pattern was identifying suggesting that the predominant pathology lies in the dorsal root ganglia. Conclusion: SFN can be a presenting feature of CD and GS and, therefore, screening for CD and GS should be included in the diagnostic workup of patients with idiopathic SFN.

  • Gluten Sensitivity and epilepsy: a systematic review
    Journal of Neurology, 2019
    Co-Authors: Thomas Julian, Marios Hadjivassiliou
    Abstract:

    Objective The aim of this systematic review was to establish the prevalence of epilepsy in patients with coeliac disease (CD) or Gluten Sensitivity (GS) and vice versa and to characterise the phenomenology of the epileptic syndromes that these patients present with. Methodology A systematic computer-based literature search was conducted on the PubMed database. Information regarding prevalence, demographics and epilepsy phenomenology was extracted. Results Epilepsy is 1.8 times more prevalent in patients with CD, compared to the general population. CD is over 2 times more prevalent in patients with epilepsy compared to the general population. Further studies are necessary to assess the prevalence of GS in epilepsy. The data indicate that the prevalence of CD or GS is higher amongst particular epileptic presentations including in childhood partial epilepsy with occipital paroxysms, in adult patients with fixation off Sensitivity (FOS) and in those with temporal lobe epilepsy (TLE) with hippocampal sclerosis. A particularly interesting presentation of epilepsy in the context of Gluten-related disorders is a syndrome of coeliac disease, epilepsy and cerebral calcification (CEC syndrome) which is frequently described in the literature. Gluten-free diet (GFD) is effective in the management of epilepsy in 53% of cases, either reducing seizure frequency, enabling reduced doses of antiepileptic drugs or even stopping antiepileptic drugs. Conclusion Patients with epilepsy of unknown aetiology should be investigated for serological markers of Gluten Sensitivity as such patients may benefit from a GFD.

  • Gluten Sensitivity and epilepsy: a systematic review
    Journal of Neurology, 2019
    Co-Authors: Thomas Julian, Marios Hadjivassiliou, Panagiotis Zis
    Abstract:

    Objective The aim of this systematic review was to establish the prevalence of epilepsy in patients with coeliac disease (CD) or Gluten Sensitivity (GS) and vice versa and to characterise the phenomenology of the epileptic syndromes that these patients present with. Methodology A systematic computer-based literature search was conducted on the PubMed database. Information regarding prevalence, demographics and epilepsy phenomenology was extracted. Results Epilepsy is 1.8 times more prevalent in patients with CD, compared to the general population. CD is over 2 times more prevalent in patients with epilepsy compared to the general population. Further studies are necessary to assess the prevalence of GS in epilepsy. The data indicate that the prevalence of CD or GS is higher amongst particular epileptic presentations including in childhood partial epilepsy with occipital paroxysms, in adult patients with fixation off Sensitivity (FOS) and in those with temporal lobe epilepsy (TLE) with hippocampal sclerosis. A particularly interesting presentation of epilepsy in the context of Gluten-related disorders is a syndrome of coeliac disease, epilepsy and cerebral calcification (CEC syndrome) which is frequently described in the literature. Gluten-free diet (GFD) is effective in the management of epilepsy in 53% of cases, either reducing seizure frequency, enabling reduced doses of antiepileptic drugs or even stopping antiepileptic drugs. Conclusion Patients with epilepsy of unknown aetiology should be investigated for serological markers of Gluten Sensitivity as such patients may benefit from a GFD.

  • Treatment of Neurological Manifestations of Gluten Sensitivity and Coeliac Disease
    Current treatment options in neurology, 2019
    Co-Authors: Panagiotis Zis, Marios Hadjivassiliou
    Abstract:

    The aim of this paper was to overview the current literature in order to establish the available treatment options for the neurological manifestations of Gluten-related disorders (serologically confirmed Gluten Sensitivity and coeliac disease). A range of debilitating neurological manifestations is increasingly being recognized in patients with Gluten Sensitivity with and without enteropathy even in the absence of gastrointestinal symptoms. Ataxia is the commonest neurological manifestation, followed by peripheral neuropathy. Epilepsy, headache, encephalopathy, various movement disorders, cognitive impairment, and muscle disorders have also been linked to Gluten Sensitivity and coeliac disease and are discussed in this review. Strict Gluten-free diet is an effective first-line treatment of the neurological manifestations of Gluten-related disorders. Very few patients will require additional immunosuppressive treatment usually in the form of mycophenolate.

  • Treatment of Neurological Manifestations of Gluten Sensitivity and Coeliac Disease
    Current Treatment Options in Neurology, 2019
    Co-Authors: Marios Hadjivassiliou
    Abstract:

    Purpose of review The aim of this paper was to overview the current literature in order to establish the available treatment options for the neurological manifestations of Gluten-related disorders (serologically confirmed Gluten Sensitivity and coeliac disease). Recent findings A range of debilitating neurological manifestations is increasingly being recognized in patients with Gluten Sensitivity with and without enteropathy even in the absence of gastrointestinal symptoms. Ataxia is the commonest neurological manifestation, followed by peripheral neuropathy. Epilepsy, headache, encephalopathy, various movement disorders, cognitive impairment, and muscle disorders have also been linked to Gluten Sensitivity and coeliac disease and are discussed in this review. Summary Strict Gluten-free diet is an effective first-line treatment of the neurological manifestations of Gluten-related disorders. Very few patients will require additional immunosuppressive treatment usually in the form of mycophenolate.

Jukka Peltola - One of the best experts on this subject based on the ideXlab platform.

  • Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with Gluten Sensitivity
    Journal of Neurology Neurosurgery and Psychiatry, 2009
    Co-Authors: Maria Peltola, Markku Mäki, Katri Kaukinen, Prasun Dastidar, Katri Haimila, Jukka Partanen, Anna-maija Haapala, Tapani Keränen, Jukka Peltola
    Abstract:

    Previously coeliac disease (CD) and Gluten Sensitivity (defined as the presence of anti-gliadin antibodies and positive immunogenetics) has been associated with cerebellar degeneration and epilepsy with occipital calcifications. Hippocampal sclerosis (HS) in temporal lobe epilepsy (TLE) is a potentially progressive disorder with unknown aetiology, and autoimmunity has been implicated in TLE+HS as one of the possible mechanism leading to HS.The purpose of this study is to analyze CD associated antibodies and Gluten Sensitivity in well characterized group of patients with refractory focal epilepsy.

  • Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with Gluten Sensitivity
    Journal of neurology neurosurgery and psychiatry, 2009
    Co-Authors: Maria Peltola, Markku Mäki, Katri Kaukinen, Prasun Dastidar, Katri Haimila, Jukka Partanen, Anna-maija Haapala, Tapani Keränen, Jukka Peltola
    Abstract:

    Background: Previous studies have associated coeliac disease (CD) and Gluten Sensitivity (defined as the presence of anti-gliadin antibodies and positive immunogenetics) with cerebellar degeneration and epilepsy with occipital calcifications. Hippocampal sclerosis (HS) in temporal lobe epilepsy (TLE) is a potentially progressive disorder with unknown aetiology; however, autoimmunity has been implicated as one of the possible mechanisms leading to HS. The purpose of this study is to analyze CD-associated antibodies and Gluten Sensitivity in a well-characterised group of patients with refractory focal epilepsy. Methods: We measured anti-gliadin, anti-tissue-transglutaminase and anti-endomysium antibodies, and coeliac-type human leukocyte antigen (DQ2 and DQ8), in 48 consecutive patients with therapy-resistant, localisation-related epilepsy. The patients were categorised into the following three groups on the basis of ictal electro–clinical characteristics and the findings of high resolution MRI: TLE with HS (n = 16), TLE without HS (n = 16) and extratemporal epilepsy (n = 16). Patients with suspected CD or Gluten Sensitivity underwent duodenal biopsies. Results: Seven patients in total were Gluten sensitive; all of these patients fell in the TLE with HS group. On the other hand, none of the TLE without HS patients or those with extratemporal epilepsy were Gluten sensitive (p Conclusions: The present study demonstrates a previously unrecognised link between Gluten Sensitivity and TLE with HS. This association was very robust in this well-characterised group of patients; thus Gluten Sensitivity should be added to the list of potential mechanisms leading to intractable epilepsy and HS.

Alessio Fasano - One of the best experts on this subject based on the ideXlab platform.

  • Pediatric Nonceliac Gluten Sensitivity: A Gluten-related Disorder Treatment Center Experience
    Journal of pediatric gastroenterology and nutrition, 2019
    Co-Authors: Stephanie Camhi, Alessio Fasano, Kajal Sangal, Victoria Kenyon, Rosiane Lima, Maureen M. Leonard
    Abstract:

    ABSTRACTObjective:The aim of the study was to identify the prevalence and clinical characteristics of children with nonceliac Gluten Sensitivity (NCGS) presenting to a tertiary care center specialized for evaluation of Gluten-related disorders.Methods:The medical records of all patients aged 0 to 18

  • Celiac disease and nonceliac Gluten Sensitivity: A review
    JAMA - Journal of the American Medical Association, 2017
    Co-Authors: Maureen M. Leonard, Anna Sapone, Carlo Catassi, Alessio Fasano
    Abstract:

    Importance The prevalence of Gluten-related disorders is rising, and increasing numbers of individuals are empirically trying a Gluten-free diet for a variety of signs and symptoms. This review aims to present current evidence regarding screening, diagnosis, and treatment for celiac disease and nonceliac Gluten Sensitivity. Observations Celiac disease is a Gluten-induced immune-mediated enteropathy characterized by a specific genetic genotype (HLA-DQ2 and HLA-DQ8 genes) and autoantibodies (antitissue transglutaminase and antiendomysial). Although the inflammatory process specifically targets the intestinal mucosa, patients may present with gastrointestinal signs or symptoms, extraintestinal signs or symptoms, or both, suggesting that celiac disease is a systemic disease. Nonceliac Gluten Sensitivity is diagnosed in individuals who do not have celiac disease or wheat allergy but who have intestinal symptoms, extraintestinal symptoms, or both, related to ingestion of Gluten-containing grains, with symptomatic improvement on their withdrawal. The clinical variability and the lack of validated biomarkers for nonceliac Gluten Sensitivity make establishing the prevalence, reaching a diagnosis, and further study of this condition difficult. Nevertheless, it is possible to differentiate specific Gluten-related disorders from other conditions, based on currently available investigations and algorithms. Clinicians cannot distinguish between celiac disease and nonceliac Gluten Sensitivity by symptoms, as they are similar in both. Therefore, screening for celiac disease must occur before a Gluten-free diet is implemented, since once a patient initiates a Gluten-free diet, testing for celiac disease is no longer accurate. Conclusions and Relevance Celiac disease and nonceliac Gluten Sensitivity are common. Although both conditions are treated with a Gluten-free diet, distinguishing between celiac disease and nonceliac Gluten Sensitivity is important for long-term therapy. Patients with celiac disease should be followed up closely for dietary adherence, nutritional deficiencies, and the development of possible comorbidities.

  • Nonceliac Gluten Sensitivity
    Gastroenterology, 2015
    Co-Authors: Alessio Fasano, Anna Sapone, Victor F. Zevallos, Detlef Schuppan
    Abstract:

    During the past decade there has been an impressive increase in popularity of the Gluten-free diet (GFD)—now the most trendy alimentary habit in the United States and other countries. According to recent surveys, as many as 100 million Americans will consume Gluten-free products within a year. Operating under the concept that the GFD benefits only individuals with celiac disease, health care professionals have struggled to separate the wheat from the chaff; there are claims that eliminating Gluten from the diet increases health and helps with weight loss, or even that Gluten can be harmful to every human being. However, apart from unfounded trends, a disorder related to ingestion of Gluten or Gluten-containing cereals, namely nonceliac Gluten Sensitivity (NCGS), has resurfaced in the literature, fueling a debate on the appropriateness of the GFD for people without celiac disease. Although there is clearly a fad component to the popularity of the GFD, there is also undisputable and increasing evidence for NCGS. However, we require a better understanding of the clinical presentation of NCGS, as well as its pathogenesis, epidemiology, management, and role in conditions such as irritable bowel syndrome, chronic fatigue, and autoimmunity. Before we can begin to identify and manage NCGS, there must be agreement on the nomenclature and definition of the disorder based on proper peer-reviewed scientific information. We review the most recent findings on NCGS and outline directions to dissipate some of the confusion related to this disorder.

  • Gluten Sensitivity and relationship to psychiatric symptoms in people with schizophrenia
    Schizophrenia Research, 2014
    Co-Authors: Jessica Jackson, Alessio Fasano, William W Eaton, Nicola G Cascella, Debby Santora, Kelli M. Sullivan, Stephanie Feldman, Heather Raley, Robert P. Mcmahon, William T. Carpenter
    Abstract:

    The relationship between Gluten Sensitivity and schizophrenia has been of increasing interest and novel mechanisms explaining this relationship continue to be described. Our study in 100 people with schizophrenia compared to 100 matched controls replicates a higher prevalence of Gluten Sensitivity and higher mean antigliadin IgG antibody levels schizophrenia (2.9 ± 7.7 vs. 1.3 ± 1.3, p = 0.046, controlled for age). Additionally, we examined symptoms within the schizophrenia group and found that while positive symptoms are significantly lower in people who have elevated antigliadin antibodies (AGA; 4.11 ± 1.36 vs. 6.39 ± 2.99, p = 0.020), no robust clinical profile differentiates between positive and negative antibody groups. Thus, identifying people in schizophrenia who may benefit from a Gluten-free diet remains possible by blood test only.

  • Gluten Sensitivity: Real or Not (People Shall Not Live by Bread Alone..)
    2013
    Co-Authors: Alessio Fasano
    Abstract:

    Recently, the increasing number of patients worldwide who are sensitive to dietary Gluten without evidence of celiac disease or wheat allergy has contributed to the identification of a new Gluten-related syndrome defined as non-celiac Gluten Sensitivity. Our knowledge regarding this syndrome is still lacking, and many aspects of this syndrome remain unknown. Its pathogenesis is heterogeneous, with a recognized pivotal role for innate immunity; many other factors also contribute, including low-grade intestinal inflammation, increased intestinal barrier function and changes in the intestinal microbiota. Gluten and other wheat proteins, such as amylase trypsin inhibitors, are the primary triggers of this syndrome, but it has also been hypothesized that a diet rich in fermentable monosaccharides and polyols may elicit its functional gastrointestinal symptoms. The epidemiology of this condition is far from established; its prevalence in the general population is highly variable, ranging from 0.63% to 6%. From a clinical point of view, non-celiac Gluten Sensitivity is characterized by a wide array of gastrointestinal and extraintestinal symptoms that occur shortly after the ingestion of Gluten and improve or disappear when Gluten is withdrawn from the diet. These symptoms recur when Gluten is reintroduced. Because diagnostic biomarkers have not yet been identified, a double-blind placebo-controlled Gluten challenge is currently the diagnostic method with the highest accuracy. Future research is needed to generate more knowledge regarding non-celiac Gluten Sensitivity, a condition that has global acceptance but has only a few certainties and many unresolved issues. Cellular & Molecular Immunology advance online publication, 12 August 2013; doi:10.1038/cmi.2013.28.

Maria Peltola - One of the best experts on this subject based on the ideXlab platform.

  • Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with Gluten Sensitivity
    Journal of Neurology Neurosurgery and Psychiatry, 2009
    Co-Authors: Maria Peltola, Markku Mäki, Katri Kaukinen, Prasun Dastidar, Katri Haimila, Jukka Partanen, Anna-maija Haapala, Tapani Keränen, Jukka Peltola
    Abstract:

    Previously coeliac disease (CD) and Gluten Sensitivity (defined as the presence of anti-gliadin antibodies and positive immunogenetics) has been associated with cerebellar degeneration and epilepsy with occipital calcifications. Hippocampal sclerosis (HS) in temporal lobe epilepsy (TLE) is a potentially progressive disorder with unknown aetiology, and autoimmunity has been implicated in TLE+HS as one of the possible mechanism leading to HS.The purpose of this study is to analyze CD associated antibodies and Gluten Sensitivity in well characterized group of patients with refractory focal epilepsy.

  • Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with Gluten Sensitivity
    Journal of neurology neurosurgery and psychiatry, 2009
    Co-Authors: Maria Peltola, Markku Mäki, Katri Kaukinen, Prasun Dastidar, Katri Haimila, Jukka Partanen, Anna-maija Haapala, Tapani Keränen, Jukka Peltola
    Abstract:

    Background: Previous studies have associated coeliac disease (CD) and Gluten Sensitivity (defined as the presence of anti-gliadin antibodies and positive immunogenetics) with cerebellar degeneration and epilepsy with occipital calcifications. Hippocampal sclerosis (HS) in temporal lobe epilepsy (TLE) is a potentially progressive disorder with unknown aetiology; however, autoimmunity has been implicated as one of the possible mechanisms leading to HS. The purpose of this study is to analyze CD-associated antibodies and Gluten Sensitivity in a well-characterised group of patients with refractory focal epilepsy. Methods: We measured anti-gliadin, anti-tissue-transglutaminase and anti-endomysium antibodies, and coeliac-type human leukocyte antigen (DQ2 and DQ8), in 48 consecutive patients with therapy-resistant, localisation-related epilepsy. The patients were categorised into the following three groups on the basis of ictal electro–clinical characteristics and the findings of high resolution MRI: TLE with HS (n = 16), TLE without HS (n = 16) and extratemporal epilepsy (n = 16). Patients with suspected CD or Gluten Sensitivity underwent duodenal biopsies. Results: Seven patients in total were Gluten sensitive; all of these patients fell in the TLE with HS group. On the other hand, none of the TLE without HS patients or those with extratemporal epilepsy were Gluten sensitive (p Conclusions: The present study demonstrates a previously unrecognised link between Gluten Sensitivity and TLE with HS. This association was very robust in this well-characterised group of patients; thus Gluten Sensitivity should be added to the list of potential mechanisms leading to intractable epilepsy and HS.

Jukka Partanen - One of the best experts on this subject based on the ideXlab platform.

  • Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with Gluten Sensitivity
    Journal of Neurology Neurosurgery and Psychiatry, 2009
    Co-Authors: Maria Peltola, Markku Mäki, Katri Kaukinen, Prasun Dastidar, Katri Haimila, Jukka Partanen, Anna-maija Haapala, Tapani Keränen, Jukka Peltola
    Abstract:

    Previously coeliac disease (CD) and Gluten Sensitivity (defined as the presence of anti-gliadin antibodies and positive immunogenetics) has been associated with cerebellar degeneration and epilepsy with occipital calcifications. Hippocampal sclerosis (HS) in temporal lobe epilepsy (TLE) is a potentially progressive disorder with unknown aetiology, and autoimmunity has been implicated in TLE+HS as one of the possible mechanism leading to HS.The purpose of this study is to analyze CD associated antibodies and Gluten Sensitivity in well characterized group of patients with refractory focal epilepsy.

  • Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with Gluten Sensitivity
    Journal of neurology neurosurgery and psychiatry, 2009
    Co-Authors: Maria Peltola, Markku Mäki, Katri Kaukinen, Prasun Dastidar, Katri Haimila, Jukka Partanen, Anna-maija Haapala, Tapani Keränen, Jukka Peltola
    Abstract:

    Background: Previous studies have associated coeliac disease (CD) and Gluten Sensitivity (defined as the presence of anti-gliadin antibodies and positive immunogenetics) with cerebellar degeneration and epilepsy with occipital calcifications. Hippocampal sclerosis (HS) in temporal lobe epilepsy (TLE) is a potentially progressive disorder with unknown aetiology; however, autoimmunity has been implicated as one of the possible mechanisms leading to HS. The purpose of this study is to analyze CD-associated antibodies and Gluten Sensitivity in a well-characterised group of patients with refractory focal epilepsy. Methods: We measured anti-gliadin, anti-tissue-transglutaminase and anti-endomysium antibodies, and coeliac-type human leukocyte antigen (DQ2 and DQ8), in 48 consecutive patients with therapy-resistant, localisation-related epilepsy. The patients were categorised into the following three groups on the basis of ictal electro–clinical characteristics and the findings of high resolution MRI: TLE with HS (n = 16), TLE without HS (n = 16) and extratemporal epilepsy (n = 16). Patients with suspected CD or Gluten Sensitivity underwent duodenal biopsies. Results: Seven patients in total were Gluten sensitive; all of these patients fell in the TLE with HS group. On the other hand, none of the TLE without HS patients or those with extratemporal epilepsy were Gluten sensitive (p Conclusions: The present study demonstrates a previously unrecognised link between Gluten Sensitivity and TLE with HS. This association was very robust in this well-characterised group of patients; thus Gluten Sensitivity should be added to the list of potential mechanisms leading to intractable epilepsy and HS.

  • Candidate gene regions and genetic heterogeneity in Gluten Sensitivity
    Gut, 2001
    Co-Authors: P. Holopainen, Markku Mäki, K. Mustalahti, Pekka Uimari, Pekka Collin, Jukka Partanen
    Abstract:

    Background—Gluten Sensitivity is a common multifactorial disorder, manifested in the small intestine or on the skin as typical coeliac disease or dermatitis herpetiformis, respectively. The only established genetic risk factor is HLA DQ2. Aims—We tested genetic linkage of previously reported chromosomal loci 5q and 11q in Finnish families with Gluten Sensitivity. We also tested if genetic linkage to candidate loci on 5q, 11q, 2q33, and HLA DQ diVered with respect to clinical manifestations or sex. Subjects—We studied 102 Finnish families with aVected sibpairs. For heterogeneity analysis, families were divided into subgroups according to sex and the presence of dermatitis herpetiformis, the skin manifestation of Gluten Sensitivity. Methods—Non-parametric linkage between microsatellite markers and disease was tested. Linkage heterogeneity between subgroups was tested using the M test. The transmission/disequilibrium test and association analysis were performed. Results—Evidence of linkage to 11q (MLS 1.37), but not to 5q, was found in the entire dataset of 102 families. Heterogeneity between subgroups was suggested: families with only the intestinal disease showed linkage mainly to 2q33 whereas families with dermatitis herpetiformis showed linkage to 11q and 5q, but not to 2q33. Linkage in all three non-HLA loci was strongest in families with predominantly male patients. HLA DQ2 conferred much stronger susceptibility to females than males. Conclusions—Independent evidence for the suggested genetic linkage between 11q and Gluten Sensitivity was obtained. The possible linkage heterogeneity suggests genetic diVerences between intestinal and skin manifestations, and the gender dependent eVect of HLA DQ2. (Gut 2001;48:696‐701)