Dramatic improvement of parkinsonian symptoms after gluten-free diet introduction in a patient with silent celiac disease

Dear Sirs, Celiac disease (CD) may manifest only with neurological symptoms [5], even in advanced age [3]. No clear association has been reported to date between CD and Parkinson’s disease (PD). A 75-year-old man presented with a 1-year history of difficulty with walking, instability, and fatigability. Neurological examination showed facial hypomimia, bradykinesia, rigidity, and postural instability with a UPDRS/Part II score of 8 and a UPDRS/part III motor score of 19 (Table 1). The remaining neurological examination was unremarkable. The patient had never been treated with drugs acting on the central nervous system; in particular he had never received drugs causing parkinsonism such as neuroleptics. Brain MR revealed several nonspecific foci of hyperintensity in the frontal and parietal subcortical white matter but not in the basal ganglia. Few punctate calcifications were present in the globus pallidus bilaterally, a finding that is quite common in elderly subjects [6]. Single-photon ...