Abstract
Objective: Describe a case of medically refractory epilepsy associated with celiac disease
Background: Epilepsy has been reported extensively in association with celiac disease (CD) in the pediatric population but there have been very few documented cases in adults.
Design/Methods: A sixty-four-year-old man with a history of depression was evaluated for episodes of inappropriate laughing and crying associated with facial grimacing and impaired awareness occurring twice a week. He does not have a history of head trauma, intracerebral infection or family history of epilepsy.
Results: Physical and neurologic exam were within normal limits. An ambulatory EEG revealed a symmetric, well organized and reactive background with occasional left temporal sharp waves maximal at F7 and T7 and several left temporal electrographic seizures. An MRI was performed that showed subtle enlargement of the medial left temporal lobe in the region of the amygdala with increased signal on T2 FLAIR. The patient was put on Levetiracetam and Lamotrigine but continued to have frequent seizures. Extensive blood and CSF metabolic, autoimmune and encephalitis tests were normal except vitamin B12, which was borderline low at 346 pg/mL. After a routine visit to his gastroenterologist he was found to test positive for celiac disease by anti-transglutaminase antibodies. Once he started a gluten free diet his seizures stopped and the patient was titrated off Levetiracetam. He remains on Lamotrigine monotherapy, without breakthrough. Repeat EEG showed no epileptiform discharges.
Conclusions: CD has been extensively documented as a cause of epilepsy in children. In children with CD but without epilepsy epileptogenic potentials can be seen on EEG. However, CD is a rarely diagnosed cause of epilepsy in adults. This case illustrates the importance of considering CD in new onset refractory epilepsy when the typical causative factors have been ruled out.
Disclosure: Dr. Postelnik has nothing to disclose. Dr. Fields has nothing to disclose.
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