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www.neurologyreviews.com/aug04/nr_aug04_gluten.html

GLUTEN SENSITIVITY IS PREVALENT IN PATIENTS WITH PERIPHERAL
NEUROPATHY

Gluten sensitivity in patients with neuropathy was more frequent than
in a control group and much greater than in the general population,
according to Lieutenant Colonel Eleanor E. Avery, MD. She advised that
a gluten-free diet may be appropriate in patients with antigliadin
antibodies, even in the absence of gastrointestinal symptoms.

"The results of our small pilot study are provocative and consistent
with previous reports showing enhanced prevalence of gluten
sensitivity in neuropathy patients as compared with the general
population," reported Lt. Col. Avery, of the Wilford Hall Medical
Center at Lackland Air Force Base, Texas. She presented her findings
at the 56th Annual Meeting of the American Academy of Neurology.

Peripheral neuropathy is a common diagnosis among patients with
neuropathy, noted Lt. Col. Avery. "Most patients would like an
ideology for their diagnosis as well as a specific treatment and
prognosis," she said. "Too often, the neuropathy is labeled as
cryptogenic or idiopathic when no answer is found." Neurologic
complications generally occur in up to 10% of patients with
established celiac disease; however, gluten sensitivity has been
reported to cause neurologic complications even when enteric disease
is not present. The prevalence of gluten-sensitive enteropathy is
estimated to be between 0.4% and 1% in the United States. "So any
prevalence in the neuropathy population that exceeds that might
indicate an independent cause/effect relationship," theorized Lt. Col.
Avery.

SCREENING FOR NEUROPATHY

Patients who were examined by a neurologist and believed to have
peripheral neuropathy symptoms were sent for standard laboratory
screening. The patients' blood was also sent for an antigliadin
antibody panel and any other special tests that the neurologist deemed
necessary. Serum was obtained from controls, who were patients
hospitalized for other reasons and had no peripheral neuropathy signs
or symptoms. The patients were not matched for age, sex, or race.

A total of 70 patients were screened for antigliadin antibodies. Of 45
patients with neuropathy who were tested, Lt. Col. Avery found that 15
patients (33%) had serum immunoglobulin G (IgG) or IgA antigliadin
positivity or both IgA and IgG positivity. For controls, four of 25
subjects (16%) had antigliadin positivity. The odds ratio for patients
versus controls was 2.58.

GLUTEN SENSITIVITY AND NEUROPATHY

Lt. Col. Avery believes that her findings are important because
peripheral neuropathy can lead to significant morbidity. She
emphasized that the disorder is typically a distal, symmetric axonal
sensory neuropathy and was previously believed to be secondary to fat-
soluble vitamin deficiency. "However," she commented, "recent studies
suggest that the neuropathy can occur in the absence of vitamin
deficiency and in response to a gluten-free diet. This may indicate
that isolated gluten sensitivity can precipitate an autoimmune disease
directed at the peripheral nervous system even in the absence of
celiac sprue.

"It is not known whether these patients have concomitant celiac
disease," Lt. Col. Avery added. "It has been postulated that gliadin
itself is the inciting cause of disease and that neurologic
manifestations occur secondary to direct toxicity of gluten without
concomitant gastrointestinal disease. These observations may offer
alternative treatment modalities, including dietary modification to
the usual symptomatic therapies for idiopathic peripheral neuropathy."

Lt. Col. Avery also said that testing antigliadin antibodies may be a
reasonable addition to a standard neuropathy panel. Further studies
are now under way to determine the prevalence of gluten sensitivity in
a larger population of patients with peripheral neuropathy.
.

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