Abstract
IntroductionCeliac disease (CD) may initially present as a neurological disorder or may be complicated by neurological changes. To date, neurophysiological studies aiming to an objective evaluation of the potential central nervous system involvement in CD are lacking.ObjectiveTo assess the profile of cortical excitability to Transcranial Magnetic Stimulation (TMS) in a group of de novo CD patients.Materials and methodsTwenty CD patients underwent a screening for cognitive and neuropsychiatric symptoms by means of the Mini Mental State Examination and the Structured Clinical Interview for DSM-IV Axis I Disorders, respectively. Instrumental exams, including electroencephalography and brain computed tomography, were also performed. Cortico-spinal excitability was assessed by means of single and paired-pulse TMS using the first dorsal interosseus muscle of the dominant hand. TMS measures consisted of resting motor threshold, motor evoked potentials, cortical silent period (CSP), intracortical inhibition (ICI) and facilitation (ICF). None of the CD was on gluten-free diet. A group of 20 age-matched healthy controls was used for comparisons.ResultsCD showed a significantly shorter CSP (78.0 vs 125.0 ms, p<0.025), a reduced ICI (0.3 vs 0.2, p<0.045) and an enhanced ICF (1.1 vs 0.7, p<0.042) compared to controls. A dysthymic disorder was identified in five patients. The effect size between dysthymic and non-dysthymic CD patients indicated a low probability of interference with the CSP (Cohen's d -0.414), ICI (-0.278) and ICF (-0.292) measurements.ConclusionA pattern of cortical excitability characterized by “disinhibition” and “hyperfacilitation” was found in CD patients. Immune system dysregulation might play a central role in triggering changes of the motor cortex excitability.
Highlights
Celiac disease (CD) may initially present as a neurological disorder or may be complicated by neurological changes
The effect size between dysthymic and non-dysthymic CD patients indicated a low probability of interference with the cortical silent period (CSP) (Cohen’s d 0.414), intracortical inhibition (ICI) (-0.278) and Intracortical facilitation (ICF) (-0.292) measurements
Immune system dysregulation might play a central role in triggering changes of the motor cortex excitability
Summary
Celiac disease (CD) may initially present as a neurological disorder or may be complicated by neurological changes. The main target in CD is the proximal small bowel, the clinical presentation is highly heterogeneous, ranging from asymptomatic to dramatically symptomatic forms and affecting several organs, such as skin, joints, bones, blood cells, endocrine glands, the reproductive system and the nervous system. In this context, approximately 50% of CD patients manifest extraintestinal dysfunctions and up to 22.5% have otherwise unexplained neurological symptoms [6]. A possible association between CD and progressive cognitive impairment can be observed, at neuropsychological tests evaluating verbal memory and executive functions [8,9] Different neuropsychiatric disorders, such as schizophrenia, depression, and anxiety, have been reported to be associated with CD [10]. CD should be considered in patients with unexplained neurological
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