In this presentation Dr. David Perlmutter highlights the massive burden of epilepsy in the United States—about 3 million Americans—most of which is idiopathic and treated with anticonvulsant drugs. He reviews several case reports where patients with refractory seizures and elevated anti‑gliadin antibodies (a marker of gluten sensitivity) became seizure‑free after adopting a gluten‑free diet, with concurrent normalization of blood work and improvement in other symptoms (headaches, constipation, rash). He then contrasts these findings with a Neurology journal study that recommends temporal lobectomy for patients who fail two antiepileptic medications, noting that such surgery is under‑utilized. Citing Dr. Marios Hadjivassiliou’s work on “Gluten Sensitivity from Gut to Brain,” he stresses that neurological manifestations of gluten sensitivity often occur without gastrointestinal complaints, urging clinicians to maintain a high index of suspicion. The core argument is that before proceeding to invasive brain surgery, physicians should first trial a gluten‑free diet, which may reduce inflammation, improve cognition, and potentially resolve seizures with minimal risk.
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Epilepsy. It affects 3 million Americans, and generally we as treating physicians, as neurologists, don't know the cause. Certainly in some cases the cause is readily identifiable, but most cases of epilepsy are what we call idiopathic, meaning we don't understand the cause. And again, that's 3 million Americans. Now, the go-to treatment for epilepsy is obviously using medication. What we call anticonvulsant medications. But let's have a look at kind of another perspective on what we should be thinking about in terms of this sometimes devastating situation. This is a study published in the journal Neurology, a very well-respected peer-reviewed journal, that describes the case of an individual, 30-year-old man, who has a headache history for 2 years and also what are called refractory seizures, meaning that despite giving this gentleman seizure medications, his seizures continued. But in addition, he has other issues with chronic constipation. He has a rash on his elbows and his knees. And interestingly, the researchers found that his anti-gliadin levels, antibodies against gliadin, which is something found in gluten, in wheat and barley and rye, were elevated, meaning he was reacting to gluten-containing foods. And what they did for this gentleman was really quite interesting. They went ahead and put him on a gluten-free diet. And what they found when they did that was that his seizures completely went away. So not only did his seizures go away, but his blood work actually normalized as well. Very interesting. Giving a gentleman with a seizure disorder a gluten-free diet and his seizures went away. And here's another case of a 23-year-old woman who has seizures for 11 years, also called refractory seizures, meaning that nothing could help her in terms of pharmaceuticals. They put her also on a gluten-free diet and her epilepsy went away. Well, the reason we're having this discussion today is because of this recent article that appeared in the journal Neurology calling for us to look at treatment of epilepsy in a different way. The study is called Epilepsy Surgery Trends in the United States, 1990 to 2008, again published in the journal Neurology, stating, and I quote, temporal lobectomy— and that means taking out the temporal lobe of the brain— continues to be heavily underutilized as a treatment for epilepsy. Patients who are medically refractory after failing 2 antiepileptic medications should be referred to a comprehensive epilepsy center for surgical evaluation. And this is a picture of what it looks like when you've had your temporal lobe of your brain removed. So what this study is saying is that if you are refractory, meaning that you're still having seizures after 2 medications have been tried, then you should be referred to a center to have your temporal lobe of your brain removed. Now, I opened this video showing you cases of patients who had gluten sensitivity whose epilepsy resolved when they simply went gluten-free. Let's take a look at another study. This is a report called Gluten Sensitivity from Gut to Brain, written by a British researcher named Dr. Marios Hadjivassiliou, published in the journal Lancet Neurology, and he tells us that most patients who present With neurological manifestations of gluten sensitivity may have no gastrointestinal symptoms. And what that means is basically that we should always have a high index of suspicion for gluten sensitivity even if there are no gastrointestinal issues. My point is this, that prior to taking out somebody's temporal lobe, what would be the harm of trying that epilepsy patient on a gluten-free diet. At the very least, you'll reduce inflammation, they'll feel better, they may lose a little weight, their headaches may improve, their cognitive function may very well improve as well, and as we've now learned, it may actually help their seizure disorder. Why not give it a try? I'm Dr. David Perlmutter.
