Autism Studies and Related Medical Conditions, January 2009 - TACA

169a. Hadjivassiliou M et al. Does cryptic gluten sensitivity play a part in neurological
illness? Lancet. 1996 Feb 10;347(8998):369-71. PMID: 8598704
BACKGROUND: Antigliadin antibodies are a marker of untreated coeliac disease but can
also be found in individuals with normal small-bowel mucosa. Because neurological
dysfunction is a known complication of coeliac disease we have investigated the
frequency of antigliadin antibodies, as a measure of cryptic gluten sensitivity, and
coeliac disease in neurological patients. METHODS: Using ELISA, we estimated serum
IgG and IgA antigliadin antibodies in 147 neurological patients who were divided into
two groups. There were 53 patients with neurological dysfunction of unknown cause
despite full investigation (25 ataxia, 20 peripheral neuropathy, 5 mononeuritis multiplex,
4 myopathy, 3 motor neuropathy, 2 myelopathy). The remaining 94 patients were
found to have a specific neurological diagnosis (16 stroke, 12 multiple sclerosis, 10
Parkinson's disease, 56 other diagnoses) and formed the neurological control group. 50
healthy blood donors formed a third group. FINDINGS: The proportions of individuals
with positive titres for antigliadin antibodies in the three groups were 30/53, 5/94, and
6/50 respectively (57, 5, and 12%). The difference in proportion between group 1 and
the combined control groups was 0.49 (95% CI 0.35-0.63). Distal duodenal biopsies in
26 out of 30 antigliadin-positive patients from group 1 revealed histological evidence of
coeliac disease in nine (35%), non-specific duodenitis in ten (38%), and no lesion in
seven (26%) individuals. INTERPRETATION: Our data suggest that gluten sensitivity is
common in patients with neurological disease of unknown cause and may have
aetiological significance.
169b. Dietary treatment of gluten ataxia. J Neurol Neurosurg Psychiatry. 2003
Sep;74(9):1221-4. PMID: 12933922 m.hadjivassiliou@sheffield.ac.uk
http://jnnp.bmjjournals.com/cgi/reprint/74/9/1221.pdf
BACKGROUND: Gluten ataxia is an immune mediated disease, part of the spectrum of
gluten sensitivity, and accounts for up to 40% of cases of idiopathic sporadic ataxia. No
systematic study of the effect of gluten-free diet on gluten ataxia has ever been
undertaken. OBJECTIVE: To study the effect of gluten-free diet on patients presenting
with ataxia caused by gluten sensitivity. METHODS: 43 patients with gluten ataxia were
studied. All were offered a gluten-free diet and monitored every six months. All patients
underwent a battery of tests to assess their ataxia at baseline and after one year on
diet. Twenty six patients (treatment group) adhered to the gluten-free diet and had
evidence of elimination of antigliadin antibodies by one year. Fourteen patients refused
the diet (control group). Three patients had persistently raised antigliadin antibodies
despite adherence to the diet and were therefore excluded from the analysis. RESULTS:
After one year there was improvement in ataxia reflected in all of the ataxia tests in the
treatment group. This was significant when compared with the control group. The diet
associated improvement was apparent irrespective of the presence of an enteropathy.
CONCLUSIONS: Gluten ataxia responds to a strict gluten-free diet even in the absence
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