Nanri Kazunori, Mitoma Hiroshi, Ihara Masafumi, Tanaka Nobuyuki, Taguchi Takeshi, Takeguchi Masafumi, Ishiko Tomoko, Mizusawa Hidehiro
Department of Neurology, Hachioji Medical Center, Tokyo Medical University, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan,
Cerebellum. 2014 Oct;13(5):623-7. doi: 10.1007/s12311-014-0582-3.
Gluten ataxia, a type of cerebellar ataxia caused by exposure to gluten in sensitive patients, has been considered common in the USA and Europe, and rare in Asia. We measured anti-deamidated gliadin peptide (DGP) antibody levels in 49 patients with cerebellar ataxia, excluding those with multiple system atrophy, hereditary spinocerebellar ataxia, or cancer, as well as those who were receiving oral administration of phenytoin. Anti-DGP antibody was positive in eight (16.3 %) patients, five of these patients were positive only for IgA, one was positive for both IgG and IgA, and two were positive only for IgG antibody. Intravenous immunoglobulin was administered to five of the eight patients, and was markedly effective in one, moderately effective in two, and ineffective in two. Steroid therapy was administered to four patients, but none had an apparent response. Ataxia symptoms improved in one patient treated with a gluten-free diet only. Although it had been thought to be extremely rare in Asia, we speculate that more than 10 % of cerebellar ataxia patients in Japan currently have gluten ataxia; therefore, measuring anti-DGP antibody or anti-gliadin antibody in cerebellar ataxia patients in Asia is important.
麸质共济失调是一种由敏感患者接触麸质引起的小脑性共济失调，在美国和欧洲被认为较为常见，而在亚洲则较为罕见。我们检测了49例小脑性共济失调患者的抗脱酰胺麦醇溶蛋白肽（DGP）抗体水平，这些患者排除了患有多系统萎缩、遗传性脊髓小脑共济失调或癌症的患者，以及正在接受苯妥英口服治疗的患者。8例（16.3%）患者抗DGP抗体呈阳性，其中5例仅IgA呈阳性，1例IgG和IgA均呈阳性，2例仅IgG抗体呈阳性。8例患者中有5例接受了静脉注射免疫球蛋白治疗，其中1例显效，2例中度有效，2例无效。4例患者接受了类固醇治疗，但均无明显反应。仅1例采用无麸质饮食治疗的患者共济失调症状有所改善。尽管一直认为麸质共济失调在亚洲极为罕见，但我们推测目前日本超过10%的小脑性共济失调患者患有麸质共济失调；因此，检测亚洲小脑性共济失调患者的抗DGP抗体或抗麦醇溶蛋白抗体很重要。
