Abstract
ObjectiveTranscranial Magnetic Stimulation in de novo patients with Celiac Disease previously revealed an imbalance in the excitability of cortical facilitatory and inhibitory circuits. After a median period of 16 months of gluten-free diet, a global increase of cortical excitability was reported, suggesting a glutamate-mediated compensation for disease progression. We have now evaluated cross-sectionally the changes of cortical excitability to TMS after a much longer gluten-free diet.MethodsTwenty patients on adequate gluten-free diet for a mean period of 8.35 years were enrolled and compared with 20 de novo patients and 20 healthy controls. Transcranial Magnetic Stimulation measures, recorded from the first dorsal interosseous muscle of the dominant hand, consisted of: resting motor threshold, cortical silent period, motor evoked potentials, central motor conduction time, mean short-latency intracortical inhibition and intracortical facilitation.ResultsThe cortical silent period was shorter in de novo patients, whereas in gluten-free diet participants it was similar to controls. The amplitude of motor responses was significantly smaller in all patients than in controls, regardless of the dietary regimen. Notwithstanding the diet, all patients exhibited a statistically significant decrease of mean short-latency intracortical inhibition and enhancement of intracortical facilitation with respect to controls; more intracortical facilitation in gluten-restricted compared to non-restricted patients was also observed. Neurological examination and celiac disease-related antibodies were negative.ConclusionsIn this new investigation, the length of dietary regimen was able to modulate the electrocortical changes in celiac disease. Nevertheless, an intracortical synaptic dysfunction, mostly involving excitatory and inhibitory interneurons within the motor cortex, may persist. The clinical significance of subtle neurophysiological changes in celiac disease needs to be further investigated.
Highlights
Background and rationaleCeliac disease (CD) is an immune-mediated inflammatory disorder of the small intestine due to gluten sensitivity leading to alteration of the mucosal architecture and impairment in the absorption of nutrients [1]
The cortical silent period was shorter in de novo patients, whereas in gluten-free diet participants it was similar to controls
In a previous study aiming to evaluate the effect of the gluten-mediated immune disorder on cerebral cortex function [17], we investigated the profile of cortical excitability to Transcranial Magnetic Stimulation (TMS) of 20 neurologically asymptomatic de novo CD patients
Summary
Background and rationaleCeliac disease (CD) is an immune-mediated inflammatory disorder of the small intestine due to gluten sensitivity leading to alteration of the mucosal architecture and impairment in the absorption of nutrients [1]. CD is regarded as a complex systemic disorder with highly variable clinical presentation and frequent extraintestinal involvement [4]. There may be a silent neurological involvement during the course of the disease; the opposite case is true, considering that pure central and/or peripheral nervous system diseases and gut histopathological changes can be seen in some CD patients without typical intestinal symptoms [4]. These scenarios highlight the importance of a diagnostic tool suitable for detecting even the silent presence or progression of the disease
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