Published online December 1, 2004
PEDIATRICS Vol. 114 No. 6 December 2004, pp. 1734 (doi:10.1542/peds.2004-1874)
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Neurologic Disorders in Patients With Celiac Disease: Are They Mediated by Brain Perfusion Changes?: In Reply

Nathanel Zelnik, MD
Carmel Medical Center
Technion–Israel Institute of Technology
Haifa 34362, Israel

In Reply.—

I appreciate the comments of Abenavoli et al regarding our observation that extraintestinal manifestations associated with celiac disease (CD) include "softer" and common neurologic and neurobehavioral disorders such as chronic headache, learning disabilities, and attention-deficit/hyperactivity disorders.1

The recent study of the same group,2 showing regional cerebral blood flow alteration in untreated patients with CD who do not have neurologic problems (other than anxiety or depression), is indeed interesting. In my opinion, this raises the possibility that the whole concept must be considered as an "iceberg" phenomenon; ie, in addition to silent intestinal CD, many patients with CD have also "silent" or subclinical forms of neurologic involvement that are detectable by functional imaging.

Cerebral blood flow alteration has been found frequently in non-CD patients with attention-deficit/hyperactivity disorder,3 migraine,4 and relatively common psychiatric disorders.5 Hence, it seems that cerebral blood flow alteration is a common but nonspecific response of the brain vasculature to diverse mechanisms, stimuli or mediators, including the inflammatory and immune mediators of CD.

REFERENCES

  1. Zelnik N, Pacht A, Obeid R, Lerner A. Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004;113 :1672 –1676[Abstract/Free Full Text]
  2. Addolorato G, Di Giuda D, De Rossi G, et al. Regional cerebral hypoperfusion in patients with celiac disease. Am J Med. 2004;116 :312 –317[Medline]
  3. Lorberboym M, Watemberg N, Nissenkorn A, Nir B, Lerman-Sagie T. Technetium 99m ethylcysteinate dimer single-photon emission computed tomography (SPECT) during intellectual stress test in children and adolescents with pure versus comorbid attention-deficit hyperactivity disorder (ADHD). J Child Neurol. 2004;19 :91 –96[Abstract/Free Full Text]
  4. Calandre EP, Bembibre J, Arnedo ML, Becerra D. Cognitive disturbances and regional cerebral blood flow abnormalities in migraine patients: their relationship with the clinical manifestations of the illness. Cephalalgia. 2002;22 :291 –302[CrossRef][Medline]
  5. Camargo EE. Brain SPECT in neurology and psychiatry. J Nucl Med. 2001;42 :611 –623[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

Related articles in Pediatrics:

Neurologic Disorders in Patients With Celiac Disease: Are They Mediated by Brain Perfusion Changes?
Ludovico Abenavoli, Lorenzo Leggio, Daniela Di Giuda, Giovanni Gasbarrini, and Giovanni Addolorato
Pediatrics 2004 114: 1734. [Extract] [Full Text]  




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