Central and Peripheral Neurological Manifestations of Inflammatory Bowel Disease

Asli Demirtas; Münevver Gokyigit; Canan Alkım; Kemal Barkut; Ender Uysal; Mehmet Sökmen

doi:10.4274/Tnd.40316

Asli Demirtas¹, Münevver Gokyigit¹, Canan Alkım², Kemal Barkut¹, Ender Uysal³, Mehmet Sökmen²

¹Sisli Etfal Research and Training Hospital, Department of Neurology, Istanbul, Turkey
²Sisli Etfal Research and Training Hospital, Department of Gastroenterology, Istanbul, Turkey
³Sisli Etfal Research and Training Hospital, Department of Radiology, Istanbul, Turkey

Keywords: Inflammatory bowel disease, Crohn’s disease, ulcerative colitis, neurological manifestations

Abstract

OBJECTIVE: The aim of this study is to evaluate the spectrum, frequency and coincidence of central and peripheral neurological involvement in a cohort of patients with inflammatory bowel disease (IBD).

METHODS: Thirty consecutive patients, with a biopsy proven diagnosis of IBD (15 Crohn’s Disease, 15 Ulcerative Colitis) were enrolled and were followed for a period of one year. All the patients underwent clinical neurological evaluations, electrodiagnostic examination and neuroimaging. Neuroimaging findings were compared with an age- and sex-matched healthy control group.

RESULTS: Among the 25 patients who completed the study, mild peripheral neuropathy was the most commonly encountered neurologic pathology, and included distal symmetrical sensory and sensorimotor polyneuropathy in 12% and mononeuropathy in 16%. Peripheral neuropathy predominantly affected females (p<0.05). Focal white matter lesions were demonstrated in 20.8% of the patients, which was not significantly different from the control group (p>0.05). Seizure disorder and steroid myopathy occurred once each. Concurrent central and peripheral nervous system pathologies were detected in three cases with longer durations of the disease. Two new neurological incidents were observed during the one year follow-up period and included cranial mononeuropathy in one and cerebral venous thrombosis in another.

CONCLUSION: Our findings suggest higher vulnerability of the peripheral nerves among women throughout the course of this inflammatory disease. Focal white matter lesions appear unlikely to represent another neurological manifestation of IBD. Larger controlled studies should be conducted prospectively in order to study common etiological pathways and identify the nature of neurological involvement in IBD.