Multiple Sclerosis and other Neurological Conditions
Yesha Dave, MS
OMS-III, Medical Student
Rowan-Virtua SOM
Jersey City, New Jersey, United States
Altamash Raja, DO, RMSK, CSCS
Physician
Rowan-Virtua SOM
Sewell, New Jersey, United States
Yesha Dave, MS
Rowan-Virtua SOM
Jersey City, New Jersey, United States
Significant improvement of spasticity symptoms related to MS after testing for, diagnosing, and treating Celiac disease with a gluten-free diet.
Case Description:
A 45 year old female with a history of relapsing-remitting MS, chronic bilateral sacroiliac joint (SIJ) pain, and chronic left leg pain due to spasticity presented to the outpatient clinic for scheduled SIJ ketorolac injections. The previous visit revealed a recent history of GI upset and worsening spasticity with ingestion of gluten and a family history of Celiac disease in the patient’s mother. Celiac antibodies, including tTG IgA and DGP IgA, were ordered and confirmed a diagnosis of Celiac disease. As such, the patient was advised to remove gluten from her diet. By the next visit, which was one month later, the patient noted significant improvement in spasticity.
Discussions:
The severity of spasticity in MS can vary due to a number of different factors, both environmental and physical. Injections of ketorolac, corticosteroids, and botulinum toxin can help to improve pain and spasticity for 1-3 months for most patients, but factors that aggravate the immune system can negatively affect the disease process and the relief that injections provide. In this case, a unique connection was established between an environmental immune system trigger, gluten, and the patient’s long-standing symptoms related to MS.
Conclusions:
This is an interesting case in which the immune system’s role in many different body systems and functions is highly involved. As is evidenced by many different studies, the likelihood of developing multiple autoimmune diseases increases with the diagnosis of just one, but the connection between immune system triggers is highlighted in this case. Future research on the relationship between the presence of antibodies and development of autoimmune conditions that are seemingly unrelated may help to shed more light on the complex connections between MS and immune system triggers.
