Pediatric Neurology 50 (2014) 479e481
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Pediatric Neurology journal homepage: www.elsevier.com/locate/pnu
Original Article
Prevalence of Celiac Disease in Children With Idiopathic Epilepsy in Southeast Turkey Sedat Is¸ıkay MD a, *, Halil Kocamaz MD b a b
Division of Pediatric Neurology, Gaziantep Children’s Hospital, Gaziantep, Turkey Division of Pediatric Gastroenterology, Gaziantep Children’s Hospital, Gaziantep, Turkey
abstract BACKGROUND: We examined the prevalence of celiac disease in children with idiopathic epilepsy. METHODS: Pa-
tients were screened for celiac disease using the immunoglobulin A anti-tissue transglutaminase antibody. Upper gastrointestinal endoscopy and small intestinal biopsy were offered to all antibody-positive patients. The control group consisted of 400 healthy children. RESULTS: A total of 600 patients (332 boys, 268 girls; 8 months-15 years; 9.40 4.09 years) were studied. In 38 patients, the diagnosis was childhood partial epilepsy with occipital paroxysms. Six of the 38 patients with childhood partial epilepsy with occipital paroxysms (15.7%) had positive immunoglobulin A anti-tissue transglutaminase antibody. The frequency of biopsy-proven celiac disease was 15.7% (6/38) among children with childhood partial epilepsy with occipital paroxysms. None of the control patients had positive immunoglobulin A anti-tissue transglutaminase antibody results. CONCLUSIONS: These findings suggest that the prevalence of celiac disease in children with partial epilepsy with occipital paroxysms may be higher than with other types of epilepsies. It may be reasonable to screen individuals with this type of epilepsy for celiac disease. Keywords: celiac disease, epilepsy, childhood partial epilepsy with occipital paroxysm, children
Pediatr Neurol 2014; 50: 479-481 Ó 2014 Elsevier Inc. All rights reserved.
Introduction
Materials and Methods
Celiac disease (CD) is a chronic autoimmune disease seen in genetically predisposed individuals that is associated with wheat, rye, and barley, which are gluten-containing cereals. Celiac disease has been associated with neurological disorders such as cerebellar ataxia, polyneuropathy, headache, and epilepsy.1-3 The prevalence of CD among epileptic patients has been reported as 0.5-9.1% in different studies; this range may be due to the differences in epilepsy definitions or regional variations of CD prevalence.4-10 In this study, we investigated the prevalence of celiac disease in Turkish children with idiopathic epilepsy.
Patients
Article History: Received October 29, 2013; Accepted in final form January 5, 2014 * Communications should be addressed to: Dr. Is¸ıkay; Department of Pediatric Neurology; Gaziantep Children’s Hospital; 27500; S¸ehitkamil; Gaziantep, Turkey. E-mail address:
[email protected] 0887-8994/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pediatrneurol.2014.01.021
A total of 600 children with idiopathic epilepsy (425 children with generalized, 175 with partial epilepsy) were studied over a period of 1 year (2012-2013). Neurological examination and intellectual level were normal in all patients. The 1989 classification of epilepsy by the International League Against Epilepsy was used for diagnostic classification of study patients.10 Children with secondary epilepsy (involving cerebral malformations, metabolic disorders, infections, head injury, tumors, or cerebral palsy) were excluded. A control group comprised 400 gender- and age-matched children who were evaluated at pediatric clinics for mild upper respiratory tract infection. None of the control subjects had a history of seizures. Demographic characteristics, medication histories, and clinical findings of all of participants were recorded. None of the patients had other medical disorders. All patients were screened with immunoglobulin (Ig)A anti-tissue transglutaminase (tTG) antibody. Patients with confirmed positive IgA tTG antibody were offered an endoscopic small intestinal biopsy. Biopsy specimens were assessed according to a modified Marsh classification.11
S. Is¸ıkay, H. Kocamaz / Pediatric Neurology 50 (2014) 479e481
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Discussion
Laboratory methods
A commercially available microplate enzyme-linked immune sorbent assay (Euroimmune, GmbH, Lübeck, Germany) was used to test for IgA tTG. The threshold for a positive assay result was set at 20 RU/mL. The diagnosis of CD was based on the ESPGHAN guideline.12 To confirm the diagnosis of CD, mucosal biopsy was performed endoscopically from the second part of the duodenum (Olympus GIF P230 videogastroscope, Olympus Optical Corporation, Tokyo, Japan). The ethics committee of Gaziantep University Faculty of Medicine approved the study, which was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Additionally, informed consent was obtained from the parents of all children. Statistical analysis
Statistical analyses were performed with SPSS for Windows version 16.0 (SPSS, Inc, Chicago, IL). c2 and Student t test were used for group comparisons. A P value of
