Celiac disease with neurologic manifestations in children.

UNLABELLED: Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals and neurologic manifestations may be one of the presentations form. The aim of this study was to report the incidence of neurologic manifestations in children with CD.

MATERIAL AND METHODS: Between 2000-2010, 48 children aged 2-18 years diagnosed with CD have been monitored. The diagnosis of CD was made by serological tests and intestinal biopsy. The study protocol included: measurement of weight and height, biological and immunological tests, histological examination, questionnaires filled out by parents about their child motor development and some neurologic signs, psychological exam, electroencephalogram, and brain CT-scan.

RESULTS: 16 of the 48 children presented one or more neurologic symptoms as the onset manifestation of CD. The neurologic signs in order of frequency were: headache/migraine, attention-deficit/hyperactivity disorder, epileptic seizures, mental retardation, cerebellar ataxia and behavior disorders. Brain CT-scan showed cerebral calcifications in 3 patients with epilepsy, and atrophy in 2 cases with cerebellar ataxia. All children received gluten free diet, but a favorable course was noticed only in the children with migraine and epilepsy, in the other patients this diet having no influence on neurologic symptoms.

CONCLUSIONS: This study proved the variety of neurologic symptoms that can be included in the clinical signs of celiac disease in pediatric patients. That is why in the presence of different neurologic symptoms of unknown etiology and resistant to treatment, celiac disease must be taken into account and laboratory investigations have to include intestinal biopsy and immunological test.