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[Ataxia associated with gluten sensitivity, myth or reality?]
M Anheim1, B Degos, A Echaniz-Laguna
1Service des Maladies du Système Nerveux et du Muscle, Clinique Neurologique, Hôpital Civil de Strasbourg, Strasbourg. mathieu.anheim@calixo.net
Revue Neurologique
|March 7, 2006
Summary
Screening for anti-gliadin antibodies (AGA) in patients with unexplained ataxia is recommended. Positive AGA without other causes suggests gluten ataxia, warranting a gluten-free diet discussion.
Area of Science:
- Neurology
- Immunology
- Gastroenterology
Context:
- Gluten ataxia, a controversial concept, links idiopathic ataxia with gluten sensitivity indicated by anti-gliadin antibodies (AGA).
- Investigating the association between AGA and neurological disorders is crucial for understanding potential autoimmune or immune-mediated conditions.
Purpose:
- To screen patients with unexplained ataxia for circulating AGA.
- To analyze the clinical and biological features of AGA-positive patients and determine the prevalence of gluten ataxia.
Summary:
- Thirty-three patients with subacute or chronic ataxia were screened for AGA; twelve tested positive.
- Eight of the twelve AGA-positive patients were diagnosed with gluten ataxia, presenting with varied neurological symptoms including cerebellar ataxia, hemisyndrome, and polyneuropathy.
- Other AGA-positive patients had alternative diagnoses such as multiple sclerosis, Friedreich ataxia, tuberculous meningitis, and type 2 diabetes, highlighting the importance of differential diagnosis.
Impact:
- Systematic screening for AGA in ataxia patients of unknown etiology is advised.
- Positive AGA results without alternative explanations may necessitate a trial of a gluten-free diet.
- The study underscores the debate surrounding AGA's role in neurological pathogenesis, suggesting potential mechanisms like epitope mimicry and recommending further research.
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