Neurological Manifestations of the Celiac Disease in Children

Gluten-related disorders (GRDs) represent a spectrum of diverse clinical manifestations triggered by the ingestion of gluten in genetically susceptible individuals. The most common and widely recognized diseases within this spectrum are celiac disease and non-celiac gluten sensitivity. The clinical manifestations are intestinal, but extraintestinal manifestations may also appear, such as neurological or psychiatric. This work will specifically review the neurological or psychiatric manifestations that are more frequently associated with GRD in children. Gluten ataxia, celiac disease, neuropathy, and celiac disease-epilepsy-brain calcifications syndrome are key entities that appear silently or oligosymptomatically on many occasions. However, they are more typical disorders in adult patients. The treatment with a gluten-free diet can usually alleviate the symptoms and, in some cases, even the neurological condition is cured. Other conditions, such as headache, behavioral disorders, or generalized developmental disorders, are more typical in children. The pathophysiological basis of these conditions is not completely well-defined, although it is probably triggered by autoimmune mechanisms. The effective treatment approach is a gluten-free diet, although drugs such as antiepileptics, anti-migraine, immunomodulators, analgesics, or psychotropic drugs can control the clinical symptoms. The diagnosis of GRD should be made in the presence of neurological and psychiatric signs and symptoms, especially if they are of an unclear etiology. Also, the diagnosis should be made early, since their early correction can substantially improve the prognosis in some of these disorders.