Cerebellar ataxia, peripheral neuropathy, gluten sensitivity and anti-neuronal

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Clin Lab. 2006;52(11-12):589-92.

Cerebellar ataxia, peripheral neuropathy, " gluten sensitivity " and

anti-neuronal autoantibodies.

Lock RJ, Tengah DP, AJ, Ward JJ, Bingley PJ, Wills AJ,

Unsworth DJ.

Immunology and Immunogenetics, North Bristol NHS Trust, Southmead

Hospital, Bristol, UK.

" Gluten sensitive " neurological syndromes (ataxia, peripheral

neuropathy, and other conditions) have been hypothesised in patients

with various idiopathic neuropathologies, detectable anti-gliadin

antibodies and HLA-DQ2 or DQ7. Further investigation of these cases

has suggested a high incidence of anti-neuronal antibodies (anti-

Purkinje, anti- neuronal nuclear, anti-GAD). This study investigates

this contentious area.

Over a two-year period, from a local UK population base of two

million, seeing over 5000 general neurology referrals per year, we

collected 20 cases with idiopathic ataxia, and 32 with idiopathic

peripheral neuropathy, and referred them all for blinded antibody

testing. 30 adult healthy blood donors, and 7 cases of hereditary

ataxia were used as control subjects.

Anti-gliadin antibodies (IgG and or IgA) were found in 40% of cases

with idiopathic ataxia, 34% with idiopathic peripheral neuropathy,

17% healthy blood donors and 43% with hereditary ataxia. None was

positive for antiPurkinje cell or anti-neuronal nuclear antibodies.

Only two patients with idiopathic ataxia were positive for antiGAD

antibodies (one also being anti-gliadin positive). We were unable to

confirm the findings of other groups.

First, cases of so-called " gluten sensitive " neurological syndromes

were extremely rare in our centre. Second, our idiopathic cases,

whether they be gliadin antibody seropositive or not (i.e. " gluten

sensitive " or not) were rarely neuronal autoantibody positive.