Celiac disease (CD) long has been associated with neurologic and
psychiatric disorders including
cerebellar ataxia,
peripheral neuropathy,
epilepsy,
dementia, and depression. Earlier reports mainly have documented the involvement of the nervous system as a complication of prediagnosed CD. However, more recent studies have emphasized that a wider spectrum of neurologic syndromes may be the presenting extraintestinal manifestation of
gluten sensitivity with or without intestinal pathology. These include
migraine,
encephalopathy,
chorea, brain stem dysfunction,
myelopathy,
mononeuritis multiplex, Guillain-Barre-like syndrome, and neuropathy with positive antiganglioside
antibodies. The association between most neurologic syndromes described and
gluten sensitivity remains to be confirmed by larger epidemiologic studies. It further has been suggested that
gluten sensitivity (as evidenced by high antigliadin
antibodies) is a common cause of neurologic syndromes (notably
cerebellar ataxia) of otherwise unknown cause. Additional studies showed high prevalence of
gluten sensitivity in genetic
neurodegenerative disorders such as hereditary
spinocerebellar ataxia and
Huntington's disease. It remains unclear whether
gluten sensitivity contributes to the pathogenesis of these disorders or whether it represents an epiphenomenon. Studies of
gluten-free diet in patients with
gluten sensitivity and neurologic syndromes have shown variable results. Diet trials also have been inconclusive in
autism and
schizophrenia, 2 diseases in which sensitivity to dietary
gluten has been implicated. Further studies clearly are needed to assess the efficacy of
gluten-free diet and to address the underlying mechanisms of nervous system pathology in
gluten sensitivity.