Cognitive impairment and celiac disease: Is transcranial magnetic stimulation a Trait d’Union between gut and brain?

Giuseppe Lanza, Rita Bella, Mariagiovanna Cantone, Giovanni Pennisi, Raffaele Ferri, Manuela Pennisi

Research output: Contribution to journalReview articlepeer-review


Celiac disease is a systemic disorder with multifactorial pathogenesis and multifaceted symptomatology. In response to gluten exposure, a significant part of the general population produces antibodies that have been hypothesized to be deleterious to the brain. Among the well-known neurological manifestations, adult celiac patients often complain cognitive symptoms, ranging from the so-called “brain fog” till an overt dementia. Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that can contribute to the assessment and monitoring of celiac patients, even in those without a clear neurological involvement. The studies here reviewed seem to converge on an impaired central motor conductivity and a “hyperexcitable celiac brain” to TMS, which partially reverts back after a long-term gluten restriction. Notably, a clear hyperexcitability is a stably reported feature of both degenerative and vascular dementia. Therefore, given its potential neuroprotective effect, the gluten-free diet should be introduced as early as possible, although the overall response of neurological symptoms (and cognition in particular) is still controversial. Identifying new and possibly modifiable risk factors may be of crucial importance for patients, clinicians, and researchers.

Original languageEnglish
Article number2243
JournalInternational Journal of Molecular Sciences
Issue number8
Publication statusPublished - Aug 1 2018


  • Celiac disease
  • Cortical excitability
  • Gut-brain axis
  • Motor evoked potentials
  • Neuroplasticity

ASJC Scopus subject areas

  • Catalysis
  • Molecular Biology
  • Spectroscopy
  • Computer Science Applications
  • Physical and Theoretical Chemistry
  • Organic Chemistry
  • Inorganic Chemistry


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