PREVALENCE OF CELIAC DISEASE IN CHILDREN WITH EPILEPSY

VIEIRA, Camilo; JATOBÁ, Izabele; MATOS, Marília; DINIZ-SANTOS, Daniel; SILVA, Luciana R.

doi:10.1590/S0004-28032013000400010

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Sumário

Pediatric Gastroenterology • Arq. Gastroenterol. 50 (4) • Oct-Dec 2013 • https://doi.org/10.1590/S0004-28032013000400010 copy

PREVALENCE OF CELIAC DISEASE IN CHILDREN WITH EPILEPSY

Prevalência de doença celíaca em crianças com epilepsia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Context

Neurological symptoms have been well-documented in patients with celiac disease, nevertheless, the presumption of a greater prevalence of epilepsy in celiac patients remains controversial.

Objectives

To determine the frequency of celiac disease in children and adolescents with idiopathic or cryptogenic epilepsy.

Methods

A cross-sectional study. One hundred pediatric patients with non-symptomatic epilepsy were followed-up at two public pediatric neurology clinics in Salvador, Bahia, Brazil. Screening for celiac disease was performed by serial measurements of IgA anti-transglutaminase and IgA anti-endomysium antibodies, followed by bowel biopsy in positive cases. HLA DQ02 and DQ08 were investigated in seropositive individuals, assessing the type of seizures, the number of antiepileptic drugs used and the presence gastrointestinal symptoms.

Results

Three (3.0%) patients tested anti-tTG-positive, two with normal duodenal mucosa (Marsh 0) and one with intraepithelial infiltrate (Marsh I). No villous atrophy of the duodenal mucosa (Marsh III) celiac disease was found. Two patients tested positive for HLA DQ02; none were DQ08 positive.

Conclusion

The present study failed to prove the association between celiac disease and epilepsy.

Celiac disease; Epilepsy; Disabled children

Reference	Age (years) Mean or Range	Type of epilepsy	Type of screening (% positive)	N (positive cases)	Prevalence
Fois et al.(¹⁶16. Fois A, Vascotto M, Di Bartolo RM, Di Marco V. Celiac disease and epilepsy in pediatric patients. Childs Nerv Syst. 1994;10:450-4.)	0.8 - 18	No restrictions	IgA-AGA and IgG-AGA (0.89%)	781 (7)	0.89%
Cronin et al.(⁷7. Cronin CC, Jackson LM, Feighery C, Shanahan F, Abuzakouk M, Ryder DQ, Whelton M, Callaghan N. Coeliac disease and epilepsy. QJM. 1998;91:303-8.)	14 - 80	No restrictions	EmA (2.3%)	177 (4)	2.26%
Labate et al.(³⁰30. Labate A,Gambardella A, Messina D, Tammaro S, Le Piane E, Pirritano D, Cosco C, Doldo P, Mazzei R, Oliveri RL, Bosco D, Zappia M, Valentino P, Aguglia U, Quattrone A. Silent celiac disease in patients with childhood localization-related epilepsies. Epilepsia. 2001;42:1153-5.)	12.6 ±4.28	Partial idiopathic epilepsy	EmA (2.7%)	72 (2)	2.78%
Pratesi et al.(⁴³43. Pratesi R, Gandolfi L, Martins RC, Tauil PL, Nobrega YK, Teixeira WA. Is the prevalence of celiac disease increased among epileptic patients? Arq Neuropsiquiatr. 2003;61:330-4.)	1 - 65	No restrictions	EmA (0.78%)	255 (2)	0.78%
Essid et al.(¹³13. Essid M, Trabelsi K, Jerbi E, Boubaker S, Gorgi Y, Ayed K, Azzouz MM. [Villous atrophy and idiopathic epilepsy]. Tunis Med. 2003;81:270-2.)	13 - 69	Idiopathic or cryptogenic	EGD (5.5%)	49 (4)	8.16%
Ranua et al.(⁴⁴44. Ranua J, Luoma K, Auvinen A, Mäki M, Haapala AM, Peltola J, Raitanen J, Isojärvi J.Celiac disease-related antibodies in an epilepsy cohort and matched reference population. Epilepsy Behav. 2005;6:388-92.) ^* * Duodenal biopsy was not performed.	46.4 ±15.7	No restrictions	IgA-AGA (12.5%)	968 ( - )	-
			IgG-AGA (5.5%)	964 ( - )	-
			IgA-tTG (2.3%)	853 ( - )	-
			EmA (1.8%)	823 ( - )	-
Dalgiç et al.(⁸8. Dalgiç B, Dursun I, SerdaroĞlu A, Dursun A. Latent and potential celiac disease in epileptic Turkish children. J Child Neurol. 2006;21:6-7.)	1 - 17	Idiopathic or cryptogenic	IgA-tTG (4.7%)	170 (2)	1.18%
Mavroudi et al.(³⁵35. Mavroudi A, Xinias I, Papastavrou T, Karatza E, Fotoulaki M, Panteliadis C, Spiroglou K. Increased prevalence of silent celiac disease among Greek epileptic children. Pediatr Neurol. 2007;36:165-9.)	2 - 14	Idiopathic or cryptogenic	IgA-AGA (1.96%)	255 (5)	1.96%
Emami et al.(¹¹11. Emami MH, Taheri H, Kohestani S, Chitsaz A, Etemadifar M, Karimi S, Eshagi MA, Hashemi M. How frequent is celiac disease among epileptic patients? J Gastrointestin Liver Dis. 2008;17:379-82.)	2-64	Idiopathic or cryptogenic	IgA-tTG (3.7%)	108 (3)	2.78%
Giordiano et al.(¹⁷17. Giordano L, Valotti M, Bosetti A, Accorsi P, Caimi L, Imberti L. Celiac disease-related antibodies in Italian children with epilepsy. Pediatr Neurol. 2009;41:34-6.) ^* * Duodenal biopsy was not performed.	0 – 16	No restrictions	IgA-AGA (15.9%)	272 ( - )	-
			IgG-AGA (27.2%)	272 ( - )	-
			IgA-tTG (1.8%)	272 ( - )	-
			IgG-tTG (2.6%)	272 ( - )	-
			EmA (1.8%)	272 ( - )	-
Ertekin et al.(¹²12. Ertekin V, SelimoĞlu MA, Tan H, Konak M. Prevalence of celiac disease in a sample of Turkish children with epilepsy. Pediatr Neurol. 2010;42:380.)	2 – 16	Idiophatic	IgA-tTG (15.6%)	77 (7)	9.1%
Madrid et al.((³²32. Madrid S AM, Díaz SM, Hurtado HC, Aguilera OL, Mena UB. Silent celiac disease among 21 patients with cryptogenic epilepsy. Rev Med Chil. 2011;139:587-91.)	18 – 65	Cryptogenic	IgA-tTG (4.7%)	21 (1)	4.7%
Djuric et al.(⁹9. Djurić Z, Nagorni A, Jocić-Jakubi B, Dimić M, Novak M, Milićević R, Radenković G. Celiac disease prevalence in epileptic children from Serbia. Turk J Pediatr. 2012;54:247-50.)	2 – 18	Idiophatic	IgA-tTG (2.4%)	125 (1)	0.8%

Gastrointestinal symptoms	Frequency
Gastrointestinal symptoms	N	%
Recurrent abdominal pain	44	44.4
Nausea/vomiting	31	31.1
Abdominal distention	27	27.3
Constipation	24	24.2
Recurrent aphthae	19	19.2
Chronic diarrhea	10	10.1

	Patient 1	Patient 2	Patient 3
Age	12.0 years	2.4 years	5.9 years
Gender	Female	Female	Female
Type of seizure	Focal with motor symptoms	Focal with motor symptoms	Focal with motor symptoms
Type of therapy	Monotherapy	Monotherapy	Monotherapy
Medication used	Oxcarbazepine	Carbamazepine	Carbamazepine
Control of the seizures	Yes	Yes	No
Brain computed tomography	Normal	Normal	Normal
Gastrointestinal symptoms	None	Abdominal pain and distention and chronic diarrhea	Abdominal pain
Z score for weight	-0.92	1.31	1.63
Z score for height	-0.38	-0.44	2.20
Anti-tTG titers	47.5	56.4	21.6
Anti-EmA	Negativ	Negative	Negative
Vitamin B12	408 ng/dL	660ng/dL	770ng/dL
Marsh	0	I	0
HLA DQ2	Positive	Positive	Negative
HLA DQ8	Negative	Negative	Negative

Type of epilepsy in the study	N (positive cases)^* * Only individuals with Marsh III duodenal biopsy;P-value = 0.69 with 95% confidence interval.	Prevalence (%)^* * Only individuals with Marsh III duodenal biopsy;P-value = 0.69 with 95% confidence interval.
Idiopathic or cryptogenic	976 (16)	1,64%
No restrictions	1213 (13)	1.07%
Total	2189 (29)	1.32%

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[1] Dr. Camilo Vieira. Rua Clara Nunes 32, ap. 1304, Pituba - 41810-425 - Salvador, BA, Brasil. E-mail: camilovieira@uol.com.br