Gut to brain: Celiac disease beyond the Intestine — A neurological case series

Abstract

Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion in genetically predisposed individuals, leading to small intestinal damage and malabsorption. While gastrointestinal symptoms like diarrhoea are commonly associated with CD, more than 50% of adults with the condition experience significant extraintestinal involvement, including neurological and psychiatric manifestation. The mechanisms underlying these neurological manifestations remain incompletely understood, with potential causes including gluten-mediated neurotoxicity, immune complex deposition, and associated nutritional deficiencies. In this article, we present the Indian case series highlighting immunological CNS involvement with celiac disease, where three patients, initially presenting with neurological symptoms ranging from isolated cerebellar ataxia to acute encephalopathy with psychiatric features, were diagnosed with CD. Patients showed clinical improvement following multimodal management including gluten-free diet and, in selected cases, immunotherapy. Additionally, all three patients showed substantial improvement with long-term follow-up, suggesting the importance of sustained monitoring and management in cases of neurological CD. This is a small case series from India highlighting varied neurological phenotypes associated with CD, contributing to a broader understanding of its complex presentation and management.