Gluten sensitivity based on HLA genotyping in patients with epilepsy in a tertiary hospital in Malaysia

• Published in: NEUROLOGY AND CLINICAL NEUROSCIENCE
• Main Authors: Bhaskar, Shalini; Reffien, Nur Malina Mat; Teh, Lay Kek; Raymond, Azman Ali; Salleh, Mohd Zaki
• Format: Article; Early Access
• Language: English
• Published: WILEY 2024
• Subjects: Neurosciences & Neurology
• Online Access: https://www-webofscience-com.uitm.idm.oclc.org/wos/woscc/full-record/WOS:001188121200001

Introduction: Gluten sensitivity (GS) is present in approximately 1% of the Malaysian population (Yap et al., PLoS One, 10, 2015, e0121908). GS is associated with several neurological conditions including epilepsy. Individuals with GS often exhibit a genetic predisposition associated with human leukocyte antigens (HLA) (Cecilio & Bonatto, Arq Bras Cir Dig, 28, 2015, 183). The purpose of this study was to investigate the prevalence of GS based on HLA genotyping in patients with epilepsy (PWE). Method: In total, 50 PWE and 50 controls were recruited. DNA was extracted from the venous blood samples and genotyped for HLA-DQ2.2, DQ2.5, DQ7 and DQ 8. In this study, GS was diagnosed if any subject showed positive for one or more of the HLA-DQ alleles. The type of epilepsy and number of antiseizure medication (ASM) used were recorded. Results: Only 2 alleles (HLA-DQ 2.2 & HLA-DQ8) were detected among 46 out of 100 subjects. 18 PWE and 19 controls were positive for HLA-DQ8 (p = 0.836). 9 of the PWE, but no controls were positive for HLA-DQ 2.2 (p = 0.003). 8 of these 9 PWE who were positive for HLA-DQ 2.2 were also positive for HLA-DQ8 (double positive), and these patients required multiple ASM for seizure control (p = 0.006). Conclusion: HLA-DQ2.2 was seen highly prevalent in PWE. The double positives required more than one ASM for seizure control postulating malabsorption of ASM in these individuals. These findings suggest that HLA-DQ genotyping may be a valuable additional test in PWE especially in those needing more than one ASM. Prescribing gluten-free diet (GFD) to PWE with GS may potentially be an additional measure to achieve seizure control.