Abstract
ObjectiveThe aim of this systematic review was to establish the prevalence of epilepsy in patients with coeliac disease (CD) or gluten sensitivity (GS) and vice versa and to characterise the phenomenology of the epileptic syndromes that these patients present with.MethodologyA systematic computer-based literature search was conducted on the PubMed database. Information regarding prevalence, demographics and epilepsy phenomenology was extracted.ResultsEpilepsy is 1.8 times more prevalent in patients with CD, compared to the general population. CD is over 2 times more prevalent in patients with epilepsy compared to the general population. Further studies are necessary to assess the prevalence of GS in epilepsy. The data indicate that the prevalence of CD or GS is higher amongst particular epileptic presentations including in childhood partial epilepsy with occipital paroxysms, in adult patients with fixation off sensitivity (FOS) and in those with temporal lobe epilepsy (TLE) with hippocampal sclerosis. A particularly interesting presentation of epilepsy in the context of gluten-related disorders is a syndrome of coeliac disease, epilepsy and cerebral calcification (CEC syndrome) which is frequently described in the literature. Gluten-free diet (GFD) is effective in the management of epilepsy in 53% of cases, either reducing seizure frequency, enabling reduced doses of antiepileptic drugs or even stopping antiepileptic drugs.ConclusionPatients with epilepsy of unknown aetiology should be investigated for serological markers of gluten sensitivity as such patients may benefit from a GFD.
Highlights
Gluten-related disorders (GRDs) represent a spectrum of diverse clinical manifestations triggered by the ingestion of gluten
Non-coeliac gluten sensitivity (NCGS) refers to patients with primarily gastrointestinal symptoms related to the ingestion of wheat, barley and rye who do not have enteropathy but who symptomatically benefit from a gluten-free diet (GFD) [3]
For neurological purposes we refer to patients as being gluten sensitive (GS), which is defined by positive serology in the form of anti- gliadin IgG and IgA (AGA), transglutaminase or endomysial antibodies (EMA) and the presence of a range of extra-intestinal symptoms, but without an abnormal bowel biopsy which is diagnostic of coeliac disease
Summary
Gluten-related disorders (GRDs) represent a spectrum of diverse clinical manifestations triggered by the ingestion of gluten. Coeliac disease (CD) is the best recognised amongst these disorders, affecting around 1% of the population [1]. CD describes patients with primarily small bowel enteropathy in genetically susceptible individuals after exposure to the protein gliadin [2]. Non-coeliac gluten sensitivity (NCGS) refers to patients with primarily gastrointestinal symptoms related to the ingestion of wheat, barley and rye who do not have enteropathy but who symptomatically benefit from a gluten-free diet (GFD) [3]. For neurological purposes we refer to patients as being gluten sensitive (GS), which is defined by positive serology in the form of anti- gliadin IgG and IgA (AGA), transglutaminase (tTG) or endomysial antibodies (EMA) and the presence of a range of extra-intestinal symptoms, but without an abnormal bowel biopsy which is diagnostic of coeliac disease
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