Timothy C. Hain, MD Page last modified: January 3, 2016
Related page: cerebellar
The cerebellum may be injured by antibodies or other immune system disturbances such as in the paraneoplastic cerebellar degenerations and in celiac disease (Gluten enteropathy).
According to Hadjivassiliou there is some evidence for the existence of gluten related neurological syndromes (Hadjivassiliou, Grunewald et al. 2002; Hadjivassiliou, Grunewald et al. 2003). Hadjivassiliou suggests that gluten intolerance related ataxia is the single most common cause of a sporadic ataxia, accounting for about 41% of cases. Looking at the donut hole rather than the donut, Mittelbronn, claimed that up to 8% of patients with gluten sensitivity (GS) develop neurological symptoms such as ataxia, dementia, seizures or peripheral neuropathy. Of course, these are common symptoms in the general population too, and there may not be a causal relationship.
The underlying immunological mechanisms still remain to be elucidated. Anti gliaden-antibody testing can be used to detect cases with neurological disease who have an abnormal blood test. Whether or not this is useful, remains to be established. Anti-HLA DQ2 testing is also reported to be positive in 70%. Again, this is another blood test finding of uncertain significance.
Others are not so sure that gliaden sensitivity is a significant source of neurological disability. Willis and Unsworth observed that 10% of the otherwise normal population has anti-gliaden antibodies, which would suggest a very high rate of false-positives would be expected. (Willis and Unsworth, 2002).
It seems to us that the more conservative opinion is more likely to be correct, but nevertheless a gluten-free diet should reasonably be tried in persons who have no other cause for ataxia. Hadjivassiliou, in an unblinded trial, but using somewhat objective measures, reported improvement after a year of diet (2003). It seems to us that without a placebo control, which is of course impossible for a diet like this, the value of this observation is unclear.