The neurology of gluten sensitivity: science vs. conviction
Marios Hadjivassiliou and Richard Grünewald
The proliferation of publications on the neurological manifestations of gluten sensitivity reflects a surge of interest in this fascinating group of immune-mediated diseases. Thorough knowledge of the literature on the subject is essential to avoid the bias in interpretation of such studies apparent in some recent editorials, in particular the article by Pengiran Tengah and Wills in the December 2003 issue of Practical Neurology.
In 1996 we published a paper entitled ‘Does cryptic gluten sensitivity play a part in neuro- logical illness?’ (Hadjivassiliou et al. 1996). On the basis of a markedly increased prevalence of circulating antigliadin antibodies in a group of patients with otherwise idiopathic neurological dysfunction, weconcludedtheanswerwas‘yes’. A follow-up paper demonstrated that the most common problem was ataxia and we intro- duced the term ‘gluten ataxia’ (Hadjivassiliou et al. 1998). This is no surprise. A review of all published papers from 1964 to 2000 of 83 patients with coeliac disease who then developed a neurological illness showed that the most common were ataxia (29 patients) and peripheral neuropathy (29 patients) (Hadjivassiliou et al. 2002b).