Abstract
Background Celiac disease is the inflammatory entropy caused by hypersensitivity to gluten, which occurs in susceptible individuals. Some studies have suggested a link between celiac disease and epilepsy in children. Our aim was to screen for clinical and paraclinical features of celiac disease in children with intractable epilepsy. Methods This was a cross-sectional study. Children aged 2 to 18 years with refractory epilepsy that referred to the pediatric neurology clinic within one year (2018–2019) were enrolled. Demographic and clinical characteristics of patients, especially clinical manifestations of celiac disease, were recorded in a questionnaire. A venous blood sample was sent to determine the total IgA, anti-tTG (IgA), and anti-endomysial antibody (IgA). Endoscopy was performed in cases where the celiac serological test was positive. Results Seventy children with idiopathic drug-resistant epilepsy (44 boys) were evaluated. The height-for-age index was 49.2% and the weight-for-age index was 38.2% less than normal. Constipation (48.6%), anorexia (25.7%), and abdominal pain (21.4%) were the most common gastrointestinal symptoms. Celiac serological tests were negative in all children. Therefore, endoscopy and bowel biopsy were not performed in any case. Conclusion Celiac disease was not found in any patient with intractable epilepsy. Gastrointestinal symptoms and growth disorders in this group may be related to the underlying disease or medications and not to celiac disease.
Highlights
Celiac disease (CD) is a chronic autoimmune disease that affects the small intestine [1]. e disease is caused by a reaction to gluten in those who are genetically predisposed [1]
Some reports have suggested a link between celiac disease and neuropathy, ataxia, seizures, and dementia. e possibility of a connection between celiac disease and epilepsy in adolescence is discussed in some articles [3,4,5,6,7,8]. erefore, screening of CD may be necessary in patients with the neurological disorders [9]. e screening panel of CD is usually based on serological testing especially tissue transglutaminase antibody and anti-endomysial antibody (EMA), and the definitive diagnosis is made by pathological findings on the small bowel biopsy [2]
The use of antiepileptic drugs reduces appetite and induces vitamin deficiency especially vitamin D, which itself plays an important role in bone growth [19, 20]. ere was no evidence of celiac disease in our patients, so their growth disorders were mostly due to underlying disease. e most common gastrointestinal symptoms in our patients were abdominal pain, anorexia, constipation, and abdominal distention
Summary
Celiac disease (CD) is a chronic autoimmune disease that affects the small intestine [1]. e disease is caused by a reaction to gluten in those who are genetically predisposed [1]. CD may initially present with neurological manifestations; seizures and epilepsy with bilateral occipital calcifications could be one of the clinical manifestations of the silent disease [1, 2]. Our aim was to screen for celiac disease in terms of clinical manifestations and paraclinical findings in children with intractable epilepsy. If CD was proven and treated by a gluten-free diet, seizure control could be better in patients with intractable epilepsy. Some studies have suggested a link between celiac disease and epilepsy in children. Our aim was to screen for clinical and paraclinical features of celiac disease in children with intractable epilepsy. Celiac disease was not found in any patient with intractable epilepsy. Gastrointestinal symptoms and growth disorders in this group may be related to the underlying disease or medications and not to celiac disease
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