Hippocampal sclerosis is associated with celiac disease type immunity in patients with drug-resistant temporal lobe epilepsy

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background: A prior small-scale single center study suggested an association between celiac disease (CD)-type immunity and refractory temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS). The present study addresses this putative association in a large, well-characterized group of drug-resistant epilepsy (DRE) patients. These patients were grouped based on the spectrum of CD and gluten sensitivity-associated antibodies. Methods: In this cross-sectional study, 253 consecutive adult epilepsy patients (135 females, 118 males; age 16–76 years) were categorized into three groups: (i) CD-positive group with either prior diagnosis of CD or CD-specific TG2/EmA antibodies, (ii) AGA-positive group with antigliadin antibodies (AGA) but without CD, and (iii) CD/AGA-negative group without any gluten sensitivity-associated antibodies or CD. Clinical and immunological findings were then compared among the groups. Results: TLE with HS was more common in the CD-positive group compared to CD/AGA-negative group (31.8% versus 11.9%, P = 0.019). Autoimmune disorders were more common in the AGA-positive group than in the CD/AGA-negative group (P = 0.025). Considering HS lateralization; left lateralization was more common in CD-positive group compared to CD/AGA-negative group (71.4% versus 25%, P = 0.030). TG6 seropositivity did not differ among the groups (P > 0.05). Conclusions: This study provides further evidence linking TLE with HS and CD-type autoimmunity suggesting that CD-type immune response to gluten can be one potential mechanism as a disease modifier leading to DRE and HS. Understanding these immunological factors is imperative for developing immunomodulatory or dietary treatments for DRE potentially preventing HS progression.

Original languageEnglish
Pages (from-to)2596–2604
Number of pages9
JournalJOURNAL OF NEUROLOGY
Volume271
DOIs
Publication statusPublished - 2024
Publication typeA1 Journal article-refereed

Keywords

  • Anti-gliadin antibody
  • Celiac disease
  • Gluten sensitivity
  • Hippocampal sclerosis
  • Refractory epilepsy
  • Systemic immunity

Publication forum classification

  • Publication forum level 2

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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