Questions and answers about the neurology of gluten sensitivity

Abstract

In recent years there has been a plethora of articles claiming that various neurological syndromes are associated with or are caused by gluten sensitivity. However, the busy clinical neurologist needs to know the answers to just two main questions – does gluten sensitivity predispose patients to the development of various neurological complications, and should a patient with a cryptogenic neurological illness be investigated for occult gluten sensitivity (and if so how)? WHAT IS GLUTEN SENSITIVITY? Coeliac disease is a classic gluten sensitive enteropathy, typically presenting in childhood. It is common with a prevalence of between 1 : 80 and 1 : 300. There is characteristic small bowel villous atrophy (Fig. 1a) associated with abdominal pain, malabsorption and weight loss. A gluten-free diet rapidly reverses this atrophy (within weeks) (Fig. 1b), corrects malabsorption and leads to symptomatic improvement. In addition, patients may sometimes present with non-specific or trivial complaints and the diagnosis