Title Gluten ataxia in older adult patients. case report and literature review /
Translation of Title Gluten Ataxia in Older Adult Patients. Case Report and Literature Review.
Authors Luoranen, Miia Maria
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Pages 26
Keywords [eng] gluten ataxia, cerebellar ataxia, celiac disease, autoimmune ataxia, late-onset ataxia, anti-gliadin antibody, glutamic acid decarboxylase antibody
Abstract [eng] Late onset cerebellar ataxias have many possible aetiologies, immune mediated gluten ataxia being one of them. Gluten ataxia is autoimmune disorder characterised by cerebellar injury caused by exposure to gluten in sensitive and genetically susceptible individuals. Celiac disease is a gluten-induced autoimmune disorder causing intestinal and extraintestinal symptoms. Gluten ataxia is one of the extraintestinal manifestations. Gluten ataxia manifests with progressive neurological symptoms, like gait ataxia, dysarthria, and nystagmus without autonomic dysfunction. Most patients deteriorate gradually but in rare cases onset is rapid with devastating outcomes. Pathophysiology of gluten ataxia is the damage of mainly Purkinje cells due to inflammatory and immunological processes. Also, anti-gliadin antibodies can have a clinically significant direct or indirect neurotoxic effect. Malabsorption of vitamin E due to villous atrophy is shown to cause spinocerebellar degeneration and damage to the serotonin-containing neurons in the cerebellum and brainstem. Comorbidity with multiple autoimmune diseases is often associated in immune-mediated cerebellar ataxia. Gluten sensitivity relates to glutamic-acid decarboxylase antibody associated disease. There are also other specific antigenic triggers and pathogenic antibodies that are still unidentified. Diagnostic approach to gluten ataxia includes serum serology testing for anti-gliadin antibodies and other antineuronal antibodies, possible biopsy aiming to confirm celiac disease, and head magnetic resonance imaging study. Treatment for gluten ataxia is strict gluten free diet, which can lead to clinical improvement of the symptoms. In rapid-onset course patients can benefit from immunosuppressive medication and immunoglobulin therapy. Sometimes the damage for neuronal cells is irreversible.
Dissertation Institution Vilniaus universitetas.
Type Master thesis
Language English
Publication date 2023