--about the extragastric neurological consequences of gluten intolerance:

http://www.medfinds.com/healthnotes....10_04_08_3.cfm

Granted this is only a "pop" communication channel, but given the blind spot a lot of doctors have regarding this, any communication is welcome.

Thanks!

I believe this is the report referenced:


The article gives a nice review of the various neurological manifestations of gluten sensitivity and some of his more recent findings.

Of particular note is a diagnostic flowchart for a patient with possible neurological manifestion of gluten sensitivity (ataxia, peripheral neuropathy, seizures).

The blood tests to be included are:
antigliadin (AGA IgA and IgG antibodies)
anti-deamidated gliadin (DGP IgA and IgG antibodies)
anti-TG2 (TG2 IgA and IgG antibodies)

If the above are all negative, then additionally test for:
anti-TG6 (TG6 IgA and IgG antibodies... not widely available yet)
HLA DQ2 or DQ8 varients.

If any of the tests for gliadin, deamidated gliadin, TG2, or TG6 are positive (IgA or IgG antibodies), or HLA DQ2 or HLA DQ8 are present, then the recommendation is to proceed to biopsy.

If there is enteropathy then a strict gluten free diet is warranted. If there is no enteropathy, testing for IgA deposits against TG on the biopsy should be performed (limited availability). If deposits are found then a strict gluten free diet is warranted.

In the case of an uncertain diagnosis, consideration should be given to offering strict gluten free diet particularly if there is no other aetiology and the disease is on a progressive course. Of note, improvement or stabilization does not occur until after a year of strict gluten free diet with serological elimination of antibodies.

SO... Hadjviassiliou's team recommends BOTH the original antigliadin antibody AND the newer anti-deamidated antibody (both IgG and IgA classes). I am happy to have this clarification and direction!

More specifically, they say this:
They also note that IgG class antibodies to TG2 or TG6 are more common than IgA class antibodies in patients with gluten related neurological disease, in contrast to celiac disease where IgA class antbodies are more common.

I bought the full text of this report last week. It's absolutely fascinating.

I've been looking for a lab that tests TG6 IgA & IgG antibodies, but have only been successful in finding one in Germany. Are there any labs in the US that do this test?

In the flowchart, I don't understand what "test for IgA deposits against TG on the biopsy" means. What is that?

I don't really know the answers.... I have just heard/read that anti-tTG6 blood test is being used in research only and not yet available commercially... so if you know the test is available in Germany you know more than I do!

As for the IgA deposits that can be seen in tissue samples, the best I can do is point you to another article. I don't have any medical or lab background to know the exact method. Sorry I can't be more helpful.

I was wrong in saying the lab in Germany was doing testing. They're actually producing the ELISA test kits for testing TG6 antibody presence. The name of the company Zedira. If you look under "products for celiac disease diagnosis" then click ELISA kits, you'll see two new entries for TG6 kits, one for IgA and one for IgG.

I believe Dr. H's research has connected the presence of TG6 antibodies with gluten ataxia, but I don't know if the same is true for gluten neuropathy.

Regarding the IgA deposits, I'm reminded of the line from Ghostbusters: "We'd like to get a sample of your brain tissue." Um.... I think maybe I'll hold off on this particular test.

I'm also not sure I've seen specific mention of anti-tTG6 in peripheral neuropathy, although I've seen other articles reference it more generally.

Gluten sensitivity:an emerging issue behind neurological impairment?
http://www.ncbi.nlm.nih.gov/pubmed/20170835

Course, the reference points back to Hadjivasilliou 2008.

In Dr. H's paper, there are some generalized references of anti-tTG6 to neurological dysfunction or neurological manifestation but when I look for specific references I only see anti-tTG6 in reference to gluten ataxia.

I have seen (I'm sure you have, too) reference to anti-Purkinje cell in patients with cerebellar ataxia and anti-ganglioside antibodies in patients with peripheral neuropathy.