Under the section of MEDICAL PROGRESS the NEJM is publishing a good review on this condition in its last issue of this week:
NEJM Volume 357: 1731-1743 October 25, 2007 Number 17.
This is the initial:
“Celiac disease is a unique autoimmune disorder, unique because the environmental precipitant is known. The disorder was previously called celiac sprue, based on the Dutch word sprue, which was used to describe a disease similar to tropical sprue that is characterized by diarrhea, emaciation, aphthous stomatitis, and malabsorption.1,2 Celiac disease is precipitated, in genetically predisposed persons, by the ingestion of gluten, the major storage protein of wheat and similar grains.3 Originally considered a rare malabsorption syndrome of childhood, celiac disease is now recognized as a common condition that may be diagnosed at any age and that affects many organ systems. . . .”
I got my personal copy for furthur reading. This condition is diffuse and it was considered an important pediatric condition but now we know it interests many other organs. I am interested in the neurological implications of this disease and have collected a couple of reviews to read about.
Is the neurological involvement related to the autoimmune mechanism?
This is one of the review articles that consider the neurologic complications of Celiac disease:
http://www.nature.com/ncpneuro/journal/v3/n10/full/ncpneuro0631.html
at Nature clinical practice neurology, it discusses a new manifestation (ALS), that had not been described until now in this contest.
A 44-year-old male presented to a general neurology clinic with a 6-month history of progressive right-sided spastic hemiparesis without sensory symptoms or signs. The thigh muscle in the affected leg showed signs of wasting. The patient had a remote family history of celiac disease.
Investigations Neurological examination, neurophysiological studies, brain MRI scan, routine blood tests, duodenal biopsy, cerebrospinal fluid analysis including polymerase chain reaction test for JC virus DNA, serological testing for HIV and for the presence of serum antibodies to endomysium, gliadin and tissue transglutaminase.
Diagnosis Celiac disease with neurological involvement, mimicking amyotrophic lateral sclerosis.
The second review article is this, at the:
Postgraduate Medical Journal 2002;78:393-398.
It has a comprehensive and detailed descritption of all the neurological complication in Celiac disease.
AGAPE 