Two adult case reports of improved neurological status with the removal of gluten from diet

Author: Sue Wood Co-author Beth Zupec-Kania
1.Dietitian, Matthews Friends Clinics 2.Nutrition Consultant

Key words: 1. Gluten-free 2. Gluten sensitivity 3. Epilepsy 4. Neurological dysfunction

Introduction: Gluten sensitivity is a systemic autoimmune or immune mediated disease with diverse manifestations 1. Coeliac disease (CD) is the most commonly recognized of these and estimated to occur in at least 1% of the population. There has been conflicting data provided by studies of the association between epilepsy and coeliac disease. However, a recent review concluded with the recommendation that routine screening for CD be performed on all patients with intractable epilepsy, particularly those with temporal lobe epilepsy and hippocampal sclerosis2, 3.
We present two adult cases of intractable epilepsy where gluten exclusion has led to an improvement in seizures and/ or neurological symptoms. Ketogenic diet regimes are readily gluten free and this may carry more significance, particularly in the management of adult cases of intractable epilepsy, than previously thought.

Case 1: A 62 year old female with a long standing history of gastro-intestinal disturbance and a 7 year history of intractable temporal lobe epilepsy with hippocampal sclerosis (negative TTG and jejunal biopsy) was started on a strict gluten free diet trial prior to consideration of ketogenic therapy. Within three months, the absence seizures resolved and this has now been maintained for sixteen months. Infrequent seizure incidences have been traced back to accidental exposure to gluten and generally occur within one to two hours of eating.

Case 2: A 47 year old female with medication resistant epilepsy was initiated on a modified ketogenic diet restricted to 30 grams of carbohydrate daily resulting in strong ketosis. Her tonic-clonic seizures reduced to greater than 50% after 3 months and she was able to return to activities of daily living. In attempts to improve the selection of carbohydrate in her diet, gluten-containing foods were removed (breads and cereals) and were replaced with equivalent carbohydrate from vegetables. Her husband noticed a dramatic improvement in her cognition and balance however no change in seizure-control. The gluten-free diet restriction was maintained due to these neurological benefits.

1. Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with gluten sensitivity J Neurol Neurosurg Psychiatry 2009 80: 626-630.
M Peltola, K Kaukinen, P Dastidar, et al.
2.Gluten sensitivity: from gut to brain Lancet Neurol 2010; 9: 318?30

M Hadjivassiliou, D Sanders, R Gru?newald, et al.