“EEG abnormalities” may represent a confounding factor in celiac disease: A 4-year follow-up family report

OBJECTIVE: The occurrence of celiac disease (CD), electroencephalographic (EEG) abnormalities (with “subtle” seizures or even without any clinical seizures), and neurological disorders has been reported since the 1980s, though there has been no definitive consensus about the possible causal relationship. This topic is further complicated by the occurrence in infancy of ‘clinical–EEG pictures’ called ‘benign epilepsy of infancy’. METHODS AND RESULTS: Here, we report a 4-year follow-up on two siblings with newly diagnosed biopsy-proven celiac disease showing EEG abnormalities not responsive to a gluten-free diet. CONCLUSIONS: This family report indicates that in patients with neurologically asymptomatic CD and EEG abnormalities, it is advisable to make a differential diagnosis between EEG abnormalities associated with CD and an incidental association with cortical hyperexcitability, with “subtle” seizures or even without any clinical seizures. PRACTICE IMPLICATIONS: A long follow-up may sometimes be required, as it was in the family described here, to clarify the etiopathogenetic and therapeutic relationships between clinical and EEG features in CD.