Discussion
The main evidence suggesting CD as the etiology of this patient’s choreais the none improvement seen with neuroleptic and the large negative exploration. Certitude diagnosiswill be based on the improvement of chorea after strict gluten free diet.
Case reports of the benefit to neurological symptoms of a gluten-free diet are inconsistent, but the only systematic controlled study of the effect of a gluten-free diet did show neurological improvement(4).In that study,43 patients with ataxia attributed to celiac disease were identified and studied between 1996 and 2003.Twenty six patients (treatment group) adhered to the gluten-free diet and had evidence of elimination of antigliadinantibodies by one year. Fourteen patients refused the diet (control group). Three patients had persistently raised antigliadin antibodies despite adherence to the diet and were there for eexcluded from the analysis. After one year there was improvement in ataxia reflected in all of the ataxia tests in the treatmentgroup. This was significant when compared with the control group (4).
Only two publications about chorea attribuated to celiac disease was found in the litterature. The first was a series of four cases published on 2004 from United Kingdom (1). Theywere four women aged between 48–77, with no significant family history of the disease. Chorea was associated with otherneurologic manifestations and had an other wiseun explained neurological disorder. Diagnosis of coeliac disease has been made on serological and/or biopsy grounds and who have an other wiseun explainedneurologicaldisorder. In all cases, there was clear improvement in chorea and ataxia with treatment with a glutenfreediet. They suggest that gluten sensitivity may cause chorea in some patients(1).
Next publicationwas a case from United States of Americareported on 2011(3).
He was a 59-year-old man. As a childhehad been diagnosed with CD. He followed a gluten-free diet as a childbut as an adulthe returned to a normal diet. He reported recurrence of abdominal pain and diarrhea. Involuntary movements were noted. On examination he had generalized chorea with dystonic facial movements and right hand posturing. IgG and IgA anti-gliadinantibodies were positifs. He was advised to adhere to a gluten-free diet.Three months later his involuntary movements weres ignificantly reduced and antigliadinantibodies level decreased. This case provides further evidence supporting celiac disease as a potentially reversible cause of chorea(3).