Thursday, 5 February 2015

Tics, OCD and non-coeliac gluten sensitivity: a case report

A curious case report is documented in the paper by Luis Rodrigo and colleagues [1] (open-access) discussing the diagnosis of non-coeliac gluten sensitivity (NCGS) in a young lady "with a long history of 10 years of tics and obsessive compulsive disorder [OCD]." Further, quite a remarkable turn-around in her clinical symptoms was observed following institution of a gluten-free diet (GFD); as the authors note: "One week after the beginning of this diet, the tics diminished notably and the OCD progressively disappeared." They continue: "Within a few months, the tics had entirely stopped and the OCD had almost completely disappeared."

The Rodrigo paper is open-access so no need for me to regurgitate the entire contents to you. I will draw your attention to a few important points though:

  • Both her parents were diagnosed with coeliac disease (CD). She carried the 'genetics' of CD - "HLA-DQ8 was positive" - but not the serology of CD - "the anti-transglutaminase tissue antibodies were negative". She was however positive for anti-gliadin antibodies which dissipated as a consequence of gluten removal.
  • She was not 'cured' of her tics and OCD. Although rather generalised in their account, the authors talk about "occasional flares" which in some cases correlated with "involuntary transgressions with gluten or periods of exhaustion or illness."
  • "She has exhibited a maize intolerance for a year, leading to this having to be excluded from her diet". Although not a large amount of research has been done in this area, there have been previous peer-reviewed rumblings that maize prolamins (specifically zein) might also have pharmcological 'effects' for some with CD [2]. Note the words 'some' and 'CD' in that last sentence.

Of course this is only a case report and whilst interesting and relevant from the N=1 point of view does not necessarily generalise to everyone presenting with tics (or Tourette's syndrome) or OCD. Quite a bit more study is required before this can be determined to be anything but a fluke finding.

I am however interested in this report providing yet another example of the potential extra-intestinal effects of gluten and the promotion of the concept of NCGS. Indeed, the recent paper by Fasano and colleagues [3] perhaps said it best: "Although there is clearly a fad component to the popularity of the GFD, there is also undisputable and increasing evidence for NCGS." One wonders whether this case report might further add to that evidence for the reality of NCGS and indeed, whether labels such as PANS (Pediatric acute-onset neuropsychiatric syndrome) characterised by "rapid onset Obsessive-compulsive disorder (OCD) and/or tics in children and adolescents" may reflect areas ripe for further examination of CD and NCGS related parameters?

So then... Oasis - Stop Crying Your Heart Out.

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[1] Rodrigo L. et al. Tourette Syndrome and Non-Coeliac Gluten Sensitivity. Clinical Remission with
a Gluten-Free Diet: A Description Case. J Sleep Disord Ther 2015, 4:1

[2] Cabrera-Chávez F. et al. Maize prolamins resistant to peptic-tryptic digestion maintain immune-recognition by IgA from some celiac disease patients. Plant Foods Hum Nutr. 2012 Mar;67(1):24, 30.

[3] Fasano A. et al. Non-celiac Gluten Sensitivity. Gastroenterology. 2015 Jan 9. pii: S0016-5085(15)00029-3.

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ResearchBlogging.org Huerta M, R. (2015). Tourette Syndrome and Non-Coeliac Gluten Sensitivity. Clinical Remission with a Gluten-Free Diet: A Description Case Journal of Sleep Disorders & Therapy, 04 (01) DOI: 10.4172/2167-0277.1000183