Child's Nervous System

, Volume 30, Issue 6, pp 1091–1098 | Cite as

Prevalence of resistant occipital lobe epilepsy associated with celiac disease in children

  • Alper I. Dai
  • Aylin Akcali
  • Celal Varan
  • Abdullah T. Demiryürek
Original Paper



Celiac disease (CD) is a chronic, inflammatory autoimmune disorder caused by intolerance to ingested gluten. Increased frequency of CD has been reported in occipital lobe epilepsy. The aim of the present study is to investigate the frequency of CD among children followed up due to epilepsy and diagnosed with epileptic activity in the occipital lobe in at least one electroencephalography (EEG) test.


For this research, 90 pediatric epilepsy patients with epileptic activity in the occipital lobe were enrolled in the study group, while the control group comprised of 100 healthy children. In addition to the EEG examination, tissue transglutaminase (tTG) antibody was determined on duodenal biopsy.


None of the healthy children in the control group was positive in terms of the tTG antibody test used to scan CD. In the group with epileptic activity in the occipital lobe, two patients out of 90 were tTG antibody positive. The seroprevalence was 1/45 (2.22 %) in this group. These two patients were diagnosed with CD based on the endoscopic duodenal biopsy. In these patients, the seizures were uncontrollable through monotherapy.


Our results showed that the prevalence of CD is observed to be higher than the normal population among the patients with occipital lobe epilepsy. This type of seizure disorder seems to be more resistant to monotherapy, compared with other types of occipital epilepsy. Therefore, screening for CD is recommended in children with resistant epileptic activity in the occipital lobe.


Celiac disease Occipital lobe epilepsy Prevalence Resistant 


  1. 1.
    Alapirtti T, Rinta S, Hulkkonen J, Mäkinen R, Keränen T, Peltola J (2009) Interleukin-6, interleukin-1 receptor antagonist and interleukin-1beta production in patients with focal epilepsy: a video-EEG study. J Neurol Sci 280:94–97PubMedCrossRefGoogle Scholar
  2. 2.
    Bernasconi A, Bernasconi N, Andermann F, Dubeau F, Guberman A, Gobbi G, Olivier A (1998) Celiac disease, bilateral occipital calcifications and intractable epilepsy: mechanisms of seizure origin. Epilepsia 39:300–306PubMedCrossRefGoogle Scholar
  3. 3.
    Bushara KO (2005) Neurologic presentation of celiac disease. Gastroenterology 128(4 Suppl 1):S92–S97PubMedCrossRefGoogle Scholar
  4. 4.
    Celiloğlu C, Karabiber H, Selimoğlu MA (2011) Atypical presentations of celiac disease. Turk J Pediatr 53:241–249PubMedGoogle Scholar
  5. 5.
    Ciclitira PJ, King AL, Fraser JS (2001) AGA technical review on celiac sprue. American gastroenterological association. Gastroenterology 120:1526–1540PubMedCrossRefGoogle Scholar
  6. 6.
    Cogulu O, Ozkinay F, Gunduz C, Cankaya T, Aydogdu S, Ozgenc F, Kutukculer N, Ozkinay C (2003) Celiac disease in children with Down syndrome: importance of follow-up and serologic screening. Pediatr Int 45:395–399PubMedCrossRefGoogle Scholar
  7. 7.
    Dalgic B, Sari S, Basturk B, Ensari A, Egritas O, Bukulmez A, Baris Z (2011) Prevalence of celiac disease in healthy Turkish school children. Am J Gastroenterol 106:1512–1517PubMedCrossRefGoogle Scholar
  8. 8.
    Dewar D, Pereira SP, Ciclitira PJ (2004) The pathogenesis of coeliac disease. Int J Biochem Cell Biol 36:17–24PubMedCrossRefGoogle Scholar
  9. 9.
    Dursun I, Dalgıc B, Elmas C, Serdaroglu A, Dursun A (2005) Silent celiac disease in epileptic children. Turk Klin J Pediatr 14:126–132Google Scholar
  10. 10.
    Ertekin V, Selimoglu MA, Kardas F, Aktas E (2005) Prevalence of celiac disease in Turkish children. J Clin Gastroenterol 39:689–691PubMedCrossRefGoogle Scholar
  11. 11.
    Fois A, Vascotto M, Di Bartolo RM, Di Marco V (1994) Celiac disease and epilepsy in pediatric patients. Childs Nerv Syst 10:450–454PubMedCrossRefGoogle Scholar
  12. 12.
    Grossman G (2008) Neurological complications of coeliac disease: what is the evidence? Pract Neurol 8:77–89PubMedCrossRefGoogle Scholar
  13. 13.
    Gujral N, Freeman HJ, Thomson AB (2012) Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol 18:6036–6059PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Ishikita T, Ishiguro A, Fujisawa K, Tsukimoto I, Shimbo T (1999) Carbamazepine-induced thrombocytopenia defined by a challenge test. Am J Hematol 62:52–55PubMedCrossRefGoogle Scholar
  15. 15.
    Ivarsson A, Hernell O, Stenlund H, Persson LA (2002) Breast-feeding protects against celiac disease. Am J Clin Nutr 75:914–921PubMedGoogle Scholar
  16. 16.
    Kang JY, Kang AH, Green A, Gwee KA, Ho KY (2013) Systematic review: worldwide variation in the frequency of coeliac disease and changes over time. Aliment Pharmacol Ther 38:226–245PubMedCrossRefGoogle Scholar
  17. 17.
    Labate A, Gambardella A, Messina D, Tammaro S, Le Piane E, Pirritano D, Cosco C, Doldo P, Mazzei R, Oliveri RL, Bosco D, Zappia M, Valentino P, Aguglia U, Quattrone A (2001) Silent celiac disease in patients with childhood localization-related epilepsies. Epilepsia 42:1153–1155PubMedCrossRefGoogle Scholar
  18. 18.
    Lionetti E, Francavilla R, Pavone P, Pavone L, Francavilla T, Pulvirenti A, Giugno R, Ruggieri M (2010) The neurology of coeliac disease in childhood: what is the evidence? A systematic review and meta-analysis. Dev Med Child Neurol 52:700–707PubMedCrossRefGoogle Scholar
  19. 19.
    Ludvigsson JF, Zingone F, Tomson T, Ekbom A, Ciacci C (2012) Increased risk of epilepsy in biopsy-verified celiac disease: a population-based cohort study. Neurology 78:1401–1407PubMedCrossRefGoogle Scholar
  20. 20.
    Marild K, Stephansson O, Grahnquist L, Cnattingius S, Söderman G, Ludvigsson JF (2013) Down syndrome is associated with elevated risk of celiac disease: a nationwide case–control study. J Pediatr 163:237–242PubMedCrossRefGoogle Scholar
  21. 21.
    Norris JM, Barriga K, Hoffenberg EJ, Taki I, Miao D, Haas JE, Emery LM, Sokol RJ, Erlich HA, Eisenbarth GS, Rewers M (2005) Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. JAMA 293:2343–2351PubMedCrossRefGoogle Scholar
  22. 22.
    Ozaydin E, Arhan E, Cetinkaya B, Ozdel S, Degerliyurt A, Güven A, Köse G (2012) Differences in iron deficiency anemia and mean platelet volume between children with simple and complex febrile seizures. Seizure 21:211–214PubMedCrossRefGoogle Scholar
  23. 23.
    Pratesi R, Gandolfi L, Friedman H, Farage L, de Castro CA, Catassi C (1998) Serum IgA antibodies from patients with coeliac disease react strongly with human brain blood-vessel structures. Scand J Gastroenterol 33:817–821PubMedCrossRefGoogle Scholar
  24. 24.
    Pratesi R, Gandolfi L, Martins RC, Tauil PL, Nobrega YK, Teixeira WA (2003) Is the prevalence of celiac disease increased among epileptic patients? Arq Neuropsiquiatr 61:330–334PubMedCrossRefGoogle Scholar
  25. 25.
    Purnak T, Efe C, Yuksel O, Beyazit Y, Ozaslan E, Altiparmak E (2011) Mean platelet volume could be a promising biomarker to monitor dietary compliance in celiac disease. Ups J Med Sci 116:208–211PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Ravizza T, Gagliardi B, Noé F, Boer K, Aronica E, Vezzani A (2008) Innate and adaptive immunity during epileptogenesis and spontaneous seizures: evidence from experimental models and human temporal lobe epilepsy. Neurobiol Dis 29:142–160PubMedCrossRefGoogle Scholar
  27. 27.
    Riazi K, Galic MA, Pittman QJ (2010) Contributions of peripheral inflammation to seizure susceptibility: cytokines and brain excitability. Epilepsy Res 89:34–42PubMedCrossRefGoogle Scholar
  28. 28.
    Ribaldone DG, Astegiano M, Fagoonee S, Rizzetto M, Pellicano R (2011) Epilepsy and celiac disease: review of literature. Panminerva Med 53:213–216PubMedGoogle Scholar
  29. 29.
    Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA (2013) ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 108:656–676PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Sammaritano M, Andermann F, Melanason D, Guberman A, Tinuper P, Gastaut H (1988) The syndrome of intractable epilepsy, bilateral calcifications and folic acid deficiency. Neurology 38(Suppl 1):239Google Scholar
  31. 31.
    Tutor-Crespo MJ, Hermida J, Tutor JC (2007) Relation of blood platelet count during carbamazepine and oxcarbazepine treatment with daily dose, and serum concentrations of carbamazepine, carbamazepine-10, 11-epoxide, and 10-hydroxycarbazepine. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 151:91–94PubMedCrossRefGoogle Scholar
  32. 32.
    Vezzani A, Granata T (2005) Brain inflammation in epilepsy: experimental and clinical evidence. Epilepsia 46:1724–1743PubMedCrossRefGoogle Scholar
  33. 33.
    Villalta D, Alessio MG, Tampoia M, Tonutti E, Brusca I, Bagnasco M, Pesce G, Stella S, Bizzaro N (2007) Testing for IgG class antibodies in celiac disease patients with selective IgA deficiency. A comparison of the diagnostic accuracy of 9 IgG anti-tissue transglutaminase, 1 IgG anti-gliadin and 1 IgG anti-deaminated gliadin peptide antibody assays. Clin Chim Acta 382:95–99PubMedCrossRefGoogle Scholar
  34. 34.
    Volta U, De Giorgio R, Granito A, Stanghellini V, Barbara G, Avoni P, Liguori R, Petrolini N, Fiorini E, Montagna P, Corinaldesi R, Bianchi FB (2006) Anti-ganglioside antibodies in coeliac disease with neurological disorders. Dig Liver Dis 38:183–187PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Alper I. Dai
    • 1
  • Aylin Akcali
    • 2
  • Celal Varan
    • 3
  • Abdullah T. Demiryürek
    • 4
  1. 1.Department of Pediatric Neurology, Faculty of MedicineUniversity of GaziantepGaziantepTurkey
  2. 2.Department of Neurology, Faculty of MedicineUniversity of GaziantepGaziantepTurkey
  3. 3.Department of Pediatrics, Faculty of MedicineUniversity of GaziantepGaziantepTurkey
  4. 4.Department of Medical Pharmacology, Faculty of MedicineUniversity of GaziantepGaziantepTurkey

Personalised recommendations