Source:Labate A, Gambardella A, Messina D, et al. Silent celiac disease in patients with childhood localization-related epilepsies.

Because celiac disease (CD) can present with neurological disturbances in adults, these authors from Italy investigated whether testing for silent CD was indicated in patients with all forms of idiopathic childhood partial epilepsy (CPE). Seventy-two children (31 girls) with a mean age of 12.6 years ± 4.28 years (age at onset of epilepsy was 6.4 years ± 3.7 years) were evaluated. CD was diagnosed using ELISA in 8% of the 25 children with occipital spikes (CPEO, baseline prevalence 3.3/1000 in the general population), but none of the 47 children with centrotemporal spikes (CPEC) tested positive for antibodies. The authors recommend that CD screening should be routine in children with CPEO.

The numbers in this study are quite small to draw any definitive conclusions. However, the possible identification of a subgroup of children with a specific neurological complaint that may benefit from CD screening deserves attention. Despite much debate over the prevalence of CD in the general population (1 in 200 is a not unreasonable estimate1), it is well recognized that 85% of the time CD presents in adults with nongastrointestinal symptoms. Among these, neurological presentations represent about 10%.1 Adults with CD can demonstrate epilepsy, neuropathy, and cerebellar disorders. One study of children presenting to a child neurology clinic discounted the contribution of CD with such presentations.2 Recently, reversible microcephaly has been identified as one possible infantile presentation,3 so it seems that some degree of consideration should be given to the possible association of CD and neurological disease.

Because celiac disease may present in childhood without gastrointestinal signs and symptoms, eg, Down syndrome (see

AAP Grand Rounds
, December
) and now seizures, relying on “gut level hunches” to prompt testing may no longer be sufficient. We will need to absorb far more studies on these less common presentations before we can define a testing strategy.

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