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Celiac Disease and Epilepsy (seizures)

What is Epilepsy? What are Seizures?

Epilepsy is a neurological condition characterized by repeated seizures. Seizures are surges of electrical activity in the brain that temporarily affect the way a person acts, speaks, or moves. Symptoms vary widely, but common ones include:

  • Jerking or twitching limbs
  • Lack of awareness or loss of consciousness
  • Confusion
  • Staring into space
  • Anxiety and fear
  • Stiffness or immobility

There are many types of seizures, but an individual usually has the same or similar symptoms with each seizure. Anyone can develop epilepsy, but it is most common in children and older adults (about 65+).

The reason why someone may have seizures varies from person to person, but head injuries and strokes are common causes. For some people, epilepsy is autoimmune.

What is the Connection Between Celiac Disease and Epilepsy?

In pediatric patients who had epilepsy of an unknown cause, the prevalence of celiac disease was 1.83%. In adult patients who had epilepsy of an unknown cause, the prevalence of celiac disease was 2.27%. (1) Those percentages are higher than the generally accepted 1% of the general population that has celiac disease.

A different study from 2016 found that about 6% of patients with epilepsy tested positive for celiac disease. (2) In these patients, the gluten-free diet was effective for managing seizures.

On the flip side, a Swedish study found that celiac disease patients had a 1.43-fold increased risk of developing epilepsy. (3)

In patients with epilepsy and celiac disease, 40% reported no gastrointestinal symptoms (such as diarrhea, constipation, bloating, etc.). (1) For many of these patients, their only celiac disease symptoms were neurological ones.

In short, if you have epilepsy, you have an increased risk of developing celiac disease, and if you have celiac disease, you have an increased risk of developing epilepsy. (3) In patients with both, neurological issues may be their only celiac disease symptoms.

What Types of Seizures are Associated with Celiac Disease?

Among epilepsy patients who also had celiac disease, 59% presented with focal seizures. (1)

Other types of epilepsy and seizures linked to celiac disease include (1):

  • Childhood partial epilepsy with occipital paroxysms
  • Children with occipital lobe epilepsy
  • Adult patients with fixation off sensitivity (FOS)
  • Progressive myoclonic epilepsy (PME)
  • Temporal lobe epilepsy (TLE) with hippocampal sclerosis

According to the study authors, these associations could indicate that certain areas of the brain may be more susceptible to damage than others in patients with both epilepsy and celiac disease. (1)

There is also CEC syndrome (sometimes called Gobbi syndrome), which refers to patients who have celiac disease, epilepsy and bilateral occipital calcifications. The first description of CEC is from 1970 (4), and subsequent cases from Italy appear to confirm the existence of this unique syndrome. (5, 6), This is a rare condition, but it is a possibility in patients who have celiac disease alongside seizures.

How is Epilepsy Diagnosed?

If you have multiple seizures, let your primary care doctor know. Your primary care doctor will likely refer you to a neurologist, which is a doctor who specializes in the brain and nervous system. The neurologist will then conduct a series of tests, often including blood tests and brain scans, to learn more about your brain functioning and what type of seizures you experience.

How is Epilepsy Treated?

Epilepsy is treated with antiepileptic medications. If medications do not work, doctors may recommend brain surgery to remove the part of the brain causing the seizures.

For those with both celiac disease and epilepsy, a gluten-free diet can alleviate or eliminate seizures (7), (8). A 2019 research review found that in patients who had both epilepsy of an unknown cause and celiac disease, the gluten-free diet helped manage seizures in 53% of the cases; this was evident from a reduction in seizure frequency, a reduction in antiepileptic drugs, and/or ability to stop taking antiepileptic drugs entirely. (1)

However, the gluten-free diet should not be assumed to be a perfect substitution for antiepileptic drugs. Do not go on the gluten-free diet without speaking to your doctor first and getting tested for celiac disease. Do not stop taking medications without speaking with your doctor first.

Where Can I Learn More?

Citations

  1. Julian T, Hadjivassiliou M, Zis P. Gluten sensitivity and epilepsy: a systematic review. J Neurol. 2019 Jul; 266(7):1557-1565. doi: 10.1007/s00415-018-9025-2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586915/
  2. Bashiri H, Afshari D, Babaei N, et al. Celiac Disease and epilepsy: the effect of gluten-free diet on seizure control. Adv Clin Exp Med. 2016;25:751–754. doi: 10.17219/acem/43585. https://advances.umw.edu.pl/en/article/2016/25/4/751/
  3. Ludvigsson JF, Zingone F, Tomson T, et al. Increased risk of epilepsy in biopsy-verified celiac disease: a population-based cohort study. Neurology. 2012;78:1401–1407. doi: 10.1212/WNL.0b013e3182544728. https://pubmed.ncbi.nlm.nih.gov/22517096/
  4. Visakorpi JK, Kuitunen P, Pelkonen P. Intestinal malabsorption: a clinical study of 22 children over 2 years of age. Acta Paediatr Scand. 1970 May;59(3):273-80. doi: 10.1111/j.1651-2227.1970.tb09003.x. PMID: 5444711. https://pubmed.ncbi.nlm.nih.gov/5444711/
  5. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4. PMID: 3414652. https://pubmed.ncbi.nlm.nih.gov/3414652/
  6. Gobbi G, Ambrosetto P, Zaniboni MG, et al. Celiac disease, posterior cerebral calcifications and epilepsy. Brain Dev. 1992;14:23–29. doi: 10.1016/S0387-7604(12)80275-0. https://pubmed.ncbi.nlm.nih.gov/1354781/
  7. Pratesi R, Modelli IC, Martins RC, et al. Celiac disease and epilepsy: favorable outcome in a child with difficult to control seizures. Acta Neurol Scand. 2003;108:290–293. doi: 10.1034/j.1600-0404.2003.00082.x. https://pubmed.ncbi.nlm.nih.gov/12956865/
  8. Postelnik A, Fields M. Medically Refractory Epilepsy Associated with Celiac Disease (P4.5-031) Neurology. Apr 2019, 92 (15 Supplement) P4.5-031. https://n.neurology.org/content/92/15_Supplement/P4.5-031

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