Abstract
The aim of this review was to assess the effects of a gluten free diet (GFD) in the management of epilepsy in people with coeliac disease (CD) or gluten sensitivity (GS). A systematic approach was used to undertake a literature review. Five electronic databases (PubMed; Scopus; Google Scholar; Cochrane Epilepsy Group specialised register; Cochrane Register of Controlled Trails (CENTRAL) via the Cochrane Register of Online Trials) were searched using predetermined relevant search terms. In total, 668 articles were identified. Duplicates were removed and predefined inclusion and exclusion criteria were applied, and a PRISMA flow chart was produced. Data was extracted using Covidence software. Twelve studies on Epilepsy and CD involving a total of 70 participants were selected for analysis; narrative synthesis was used owing to the small sample sizes in the selected studies. None of the 12 studies meeting inclusion criteria investigated gluten sensitivity and epilepsy. All the included studies support a link between epilepsy and CD. GFD was effective in 44 out of 70 participants across the studies in terms of a reduction of seizures, reduction of antiepileptic drugs (AEDs) or normalisation of EEG pattern. A total of 44 participants showed a reduction in seizures (across eight studies) and complete cessation of seizures was reported in 22 participants. In general, the earlier the GFD is implemented after the onset of seizures, the better the likelihood of the GFD being successful in supporting control of seizures. Mechanisms linking gluten with epilepsy are not fully understood; possible hypotheses include gluten mediated toxicity, immune-induced cortical damage and malabsorption. Evidence suggests the effectiveness of a GFD in supporting the management of epilepsy in patients with CD, although the quality of evidence is low. There appears to be a growing number of neurologists who are prepared to advocate the use of a GFD. A multidisciplinary approaches and further research are recommended. It could be argued that when balancing potential treatments such as AEDs or surgery, a GFD has a low likelihood of harm.
Highlights
Epilepsy is a neurological disorder that affects around 70 million people worldwide [1]
Mechanisms linking gluten with epilepsy are not fully understood but possible hypotheses include gluten mediated toxicity, gluten involved immune-induced cortical damage and coeliac disease (CD) related malabsorption of dietary nutrients or antiepileptic drugs (AEDs)
Evidence suggests the effectiveness of a gluten free diet (GFD) in supporting management of epilepsy when co-morbid with CD, due to inherent low quality and limitations in methodology, a cautious approach is necessary
Summary
Epilepsy is a neurological disorder that affects around 70 million people worldwide [1]. It can have a significant effect on the quality of life of those affected and their families [2]. There are over 40 different types of seizure [5] and the seizure type and appearance vary depending on which area of the brain is affected. Some people may lose consciousness, collapse and jerk or twitch (tonic-clonic seizure). Seizures are classified into two main categories: generalised seizures which affect large areas on both sides of the brain (tonic-clonic, absence or atonic) and focal seizures that affect a specific region of the brain [6]
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