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Celiac Disease in Children: An Association With Drug-Resistant Epilepsy
Shanna Swartwood1, Jacob Wilkes2, Joshua L Bonkowsky3
1Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Insights
Pediatric epilepsy patients with celiac disease (CD) often have drug-resistant epilepsy (DRE). A gluten-free diet (GFD) can help reduce seizure frequency and medication needs in these children.
Area of Science:
- Neurology
- Pediatrics
- Gastroenterology
Background:
- Neurological symptoms are frequently observed in individuals diagnosed with celiac disease (CD).
- Epilepsy is a significant neurological manifestation associated with CD.
- Understanding the interplay between CD and epilepsy in children is crucial for effective management.
Purpose of the Study:
- To investigate the specific characteristics of epilepsy in pediatric patients with celiac disease.
- To evaluate the impact of a gluten-free diet (GFD) on seizure frequency and severity in this population.
Main Methods:
- A retrospective chart review was conducted on pediatric patients diagnosed with both epilepsy and CD.
- Patients were compared to a control group of children with epilepsy but without CD.
- Diagnostic criteria included biopsy-confirmed CD or elevated tissue transglutaminase antibodies (tTG-Ab).
Main Results:
- 56 pediatric patients with epilepsy and CD were identified.
- A higher prevalence of drug-resistant epilepsy (DRE) was observed in patients with CD compared to controls.
- Seizure onset often preceded CD diagnosis, particularly in DRE cases.
- A majority of patients with DRE experienced reduced seizure frequency or medication reduction on a GFD.
Conclusions:
- Drug-resistant epilepsy (DRE) is more common in pediatric patients with celiac disease (CD) than previously recognized.
- Adherence to a gluten-free diet (GFD), alongside antiseizure medications, shows promise in mitigating seizure burden for children with CD and DRE.
Background:
Neurological manifestations are commonly reported in patients with celiac disease (CD). We aimed to characterize epilepsy features in a pediatric population with CD and the effect of a gluten-free diet (GFD) on seizure burden.
Methods:
A retrospective chart review was performed on pediatric patients treated at the University of Utah and Primary Children's Hospital in Salt Lake City, Utah, with both epilepsy and CD and compared with a control group with epilepsy only.
Results:
We identified 56 patients with epilepsy and biopsy-confirmed CD (n = 36, 64%) or elevated tissue transglutaminase antibodies (tTG-Ab) without biopsy-confirmed CD (n = 20, 36%). Age- and gender-matched controls were selected from patients with epilepsy only (n = 168). Patients with biopsy-proven CD or positive tTG-Ab had high percentage of drug-resistant epilepsy (DRE) compared with the control group (P < 0.05). Age at seizure onset preceded the diagnosis of CD on average by 5.9 years for patients with DRE (P < 0.01) compared with 2.2 years for those with drug-responsive epilepsy. Adhering to a GFD reduced seizure frequency or resulted in weaning dosage or weaning off of one or more antiseizure medications in a majority of patients with DRE.
Conclusions:
DRE was more prevalent in pediatric patients with biopsy-confirmed CD and positive tTG-Ab compared with the control group (which included childhood epilepsy syndromes), but comparable with the prevalence of DRE in the general population. Adherence to a GFD in combination with antiseizure medications appears to reduce seizure burden for those with CD and DRE.
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