To provide an updated appraisal of neuropsychiatric conditions associated with celiac disease (CeD), discussing underlying mechanisms, clinical implications, and therapeutic perspectives, particularly focusing on differences between pediatric and adult populations.
Key Findings:
Neurological features include cerebellar ataxia, peripheral neuropathy, epilepsy, headache, cognitive dysfunction, and sleep disorders.
Underlying mechanisms involve autoimmune responses, blood-brain barrier dysfunction, gut dysbiosis, neuroinflammation, micronutrient deficiencies, serotonergic dysregulation, and cerebral perfusion abnormalities.
Clinical outcomes vary; some patients improve on a gluten-free diet, while others have persistent symptoms, highlighting the variability in clinical presentation.
Paediatric patients typically show lower prevalence and milder neurological involvement.
Interpretation:
Neuropsychiatric manifestations are significant yet often underrecognized in CeD, with gluten exposure potentially triggering neuroimmune cascades that have important clinical implications.
Limitations:
The pathophysiological mechanisms remain incompletely understood.
Variability in clinical presentation complicates diagnosis and treatment, and underdiagnosis may impact patient outcomes.
Conclusion:
Early identification and multidisciplinary management are essential to prevent irreversible neurological damage and optimize long-term outcomes, emphasizing the need for awareness of neuropsychiatric symptoms in CeD.
by Valentina Pucinischi, Martina Piersanti, Giovanni Di Nardo, Matteo Guarino, Umberto Volta, Roberto De Giorgio, Renata Auricchio, Alessandro Ferretti, Pasquale Parisi, Maurizio Mennini
