{"id":630,"date":"2013-04-24T21:59:09","date_gmt":"2013-04-24T21:59:09","guid":{"rendered":"http:\/\/www.mynutriguide.com\/?p=630"},"modified":"2019-12-26T12:44:43","modified_gmt":"2019-12-26T17:44:43","slug":"chorea-3","status":"publish","type":"post","link":"https:\/\/glutenfreeworks.com\/health\/chorea-3\/","title":{"rendered":"Chorea"},"content":{"rendered":"<div id=\"attachment_7053\" style=\"width: 210px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/chorea.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-7053\" class=\"size-full wp-image-7053\" src=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/chorea.jpg\" alt=\"Child with Chorea, Courtesy anatomy.yonsei.ac.kr\" width=\"200\" height=\"128\" \/><\/a><p id=\"caption-attachment-7053\" class=\"wp-caption-text\">Child with Chorea. <em>Courtesy<\/em> anatomy.yonsei.ac.kr<\/p><\/div>\n<h2>What Is Chorea?<\/h2>\n<p style=\"text-align: justify\"><span class=\"dropcap\">C<\/span>horea is a movement disorder characterized by brief, jerky, purposeless or writhing involuntary movements of the distal limbs, head, and face that may occur during voluntary movement or at rest.<\/p>\n<p style=\"text-align: justify\">Chorea has a large number of causes, including metabolic, structural, pharmacologic, genetic, and autoimmune factors. Despite extensive investigations, many patients remain undiagnosed.<a href=\"#footnote_1_630\" id=\"identifier_1_630\" class=\"footnote-link footnote-identifier-link\" title=\"Walker RH. Further Evidence for Celiac Disease-associated Chorea. Tremor Other Hyperkinet Mov (N Y). 2011;1. pii: tre-01-32-96-3.\">1<\/a><\/p>\n<h2>What Is Chorea In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<p><!--more--><\/p>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify\">Chorea is a rare associated neurologic disorder in celiac disease.<\/li>\n<li style=\"text-align: justify\">Chorea has been described as a paraneoplastic phenomenon in patients with non-Hodgkin&#8217;s lymphoma and has been described as associated with lymphoma arising from a background of celiac disease. The finding of chorea in association with celiac disease should prompt a search for possible underlying intestinal T-cell lymphoma.<a href=\"#footnote_2_630\" id=\"identifier_2_630\" class=\"footnote-link footnote-identifier-link\" title=\"Kitiyakara T, Jackson M, Gorard DA. Refractory coeliac disease, small-bowel lymphoma and chorea.&nbsp;J R Soc Med. 2002 Mar;95(3):133-4.\">2<\/a><\/li>\n<\/ul>\n<h2>How Prevalent Is Chorea In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<p style=\"text-align: justify\">The prevalence of chorea associated with celiac disease is not known but has been described in case reports.<a href=\"#footnote_3_630\" id=\"identifier_3_630\" class=\"footnote-link footnote-identifier-link\" title=\"Pereira AC, Edwards MJ, Buttery PC, et al. Choreic syndrome and coeliac disease: a hitherto unrecognized association. Movement Disorders: Official Journal of the Movement Disorder Society. Apr 2004;19(4):478-82.\">3<\/a><\/p>\n<h2>What Are The Symptoms Of Chorea?<\/h2>\n<ul class=\"cp_bullet red\">\n<li>Chorea is marked by rapid, unpredicable, jerky movements of the limb, head or facial muscles.<\/li>\n<li>Movements my be writhing.<\/li>\n<li>Bone fractures and briuses may develop from uncontrolled movements.<\/li>\n<li>Increased risk of falls.<\/li>\n<li>Impaired ability to care for self such as eating, dressing and bathing.<\/li>\n<\/ul>\n<h2>How Does Chorea Develop In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify\">Chorea results from exposure to gluten, but the mechanism is unclear as yet.<\/li>\n<li style=\"text-align: justify\">Neurological complications of celiac disease are believed to be due to autoantibodies, possibly anti-gliadin antibodies, cross-reacting with a neuronal target. The reason for the variability in neurological complications between patients is not known. Lack of benefit of a gluten-free diet in some patients may be due to permanent neuronal damage.<a href=\"#footnote_4_630\" id=\"identifier_4_630\" class=\"footnote-link footnote-identifier-link\" title=\"Walker RH. Further Evidence for Celiac Disease-associated Chorea.&nbsp;Tremor Other Hyperkinet Mov (N Y). 2011;1. pii: tre-01-32-96-3.\">4<\/a><\/li>\n<li style=\"text-align: justify\">Chorea has been described as a paraneoplastic phenomenon in patients with non-Hodgkin&#8217;s lymphoma and has been described as associated with lymphoma arising from a background of celiac disease.<a href=\"#footnote_2_630\" id=\"identifier_5_630\" class=\"footnote-link footnote-identifier-link\" title=\"Kitiyakara T, Jackson M, Gorard DA. Refractory coeliac disease, small-bowel lymphoma and chorea.&nbsp;J R Soc Med. 2002 Mar;95(3):133-4.\">2<\/a><\/li>\n<\/ul>\n<h2 style=\"text-align: justify\">Does Chorea Respond To Gluten-Free Diet?<\/h2>\n<p style=\"text-align: justify\">Yes. Celiac disease-related chorea improves on gluten free diet.<a href=\"#footnote_3_630\" id=\"identifier_6_630\" class=\"footnote-link footnote-identifier-link\" title=\"Pereira AC, Edwards MJ, Buttery PC, et al. Choreic syndrome and coeliac disease: a hitherto unrecognized association. Movement Disorders: Official Journal of the Movement Disorder Society. Apr 2004;19(4):478-82.\">3<\/a><\/p>\n<p style=\"text-align: justify\">However, chorea associated with\u00a0non-Hodgkin&#8217;s lymphoma in a reported patient with refractory celiac disease did not improve.<\/p>\n<h2 style=\"text-align: justify\">6 Steps To Improve Chorea In Celiac Disease and\/or Gluten Sensitivity:<\/h2>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><span class=\"dropcap\"><strong>1<\/strong><\/span><\/span><strong><span style=\"color: #800000\">Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<b>Treatment<\/b>. This condition responds to the complete elimination of gluten, which is the required treatment that improves both chorea and gut health.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.<\/li>\n<li>A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.<\/li>\n<li>Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1\/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Correct Your Individual Nutritional Needs.<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Eat foods that can replenish missing nutrients. Find them under\u00a0NUTRIENT DEFICIENCIES.<\/li>\n<li>Take nutritional supplements as needed.\u00a0Find them under\u00a0NUTRIENT DEFICIENCIES.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Recovery<\/strong>. You should begin to feel better within a week and notice more energy as inflammation subsides and the \u00a0absorbing cells that make up the surface lining of your small intestine are better able to function.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.<\/li>\n<li>Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.<a href=\"#footnote_5_630\" id=\"identifier_7_630\" class=\"footnote-link footnote-identifier-link\" title=\"Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.&nbsp;Clinical Science. Apr 2001;100(4):379-86.\">5<\/a><\/li>\n<li>The intestinal lining may take up to a year to heal.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><span class=\"dropcap\"><strong>2<\/strong><\/span><\/span><strong><span style=\"color: #800000\">\u00a0Reduce Inflammation. Foods to Eat and Foods Not to Eat:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\">Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).<\/p>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Here Are Major Inflammatory Food Types That Reduce Healing<\/strong>:<\/p>\n<ul class=\"cp_bullet red\" style=\"text-align: justify\">\n<li><strong>Damaging Foods<\/strong>. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.<a href=\"#footnote_6_630\" id=\"identifier_8_630\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">6<\/a><\/li>\n<li><strong>Allergenic Foods<\/strong>. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.<\/li>\n<li><strong>Shelf Stable Processed Foods.\u00a0<\/strong>Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_6_630\" id=\"identifier_9_630\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">6<\/a><\/li>\n<li><strong>Fats.<\/strong>\u00a0Limit deep fried foods, trans-fats, saturated fats (animal fat\/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.<a href=\"#footnote_6_630\" id=\"identifier_10_630\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">6<\/a>.<\/li>\n<li><strong>Excessive Refined White Flours\u00a0<\/strong>(bran layer removed)<strong>.\u00a0<\/strong>Includes\u00a0products made from them such as cookies, bread, cakes, pies.\u00a0Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream.\u00a0Also disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_6_630\" id=\"identifier_11_630\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">6<\/a><\/li>\n<li><strong>Refined Sugars.\u00a0<\/strong>\u00a0Includes white sugar, corn fructose and high fructose corn syrup.<\/li>\n<li><strong>Certain Spices<\/strong>. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_6_630\" id=\"identifier_12_630\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">6<\/a><\/li>\n<li><strong>Alcohol and Caffeine<\/strong>. Disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_6_630\" id=\"identifier_13_630\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">6<\/a>\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Here Are Important Anti-Inflammatory Food Types to Promote Health<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li><strong>Fruits<\/strong>.\u00a0Contain ample amounts of vitamins, minerals and phytochemicals which are\u00a0naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.<\/li>\n<li><strong>Non-Starchy Vegetables.<\/strong>\u00a0Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.<\/li>\n<li><strong>High Quality Complex Carbohydrates<\/strong>. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.<\/li>\n<li><strong>Antioxidants<\/strong>. Protect the body from inflammatory oxidant molecules that continually occur and\u00a0help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as\u00a0nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.<\/li>\n<li><strong>Omega-3 Fatty Acids<\/strong>. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.<\/li>\n<li><strong>Probiotics.\u00a0<\/strong>Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.<\/li>\n<li><strong>Prebiotics\/ High Fiber Foods<\/strong>. \u00a0Food with fiber keeps our population of colonic microbes healthy.<\/li>\n<li><strong>Protective Herbs and Spices<\/strong>. \u00a0See below #6 below for examples.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><strong><span class=\"dropcap\">3<\/span>\u00a0Information Sheet You Can Take to Your Doctor or Other Health Professional:<\/strong><\/span><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\">Click here.<\/p>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><span style=\"color: #800000\"><strong><em><span class=\"dropcap\">4<\/span>\u00a0Manage Your Medications\u00a0Safely<\/em>:<\/strong><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p style=\"text-align: justify\">Certain medications used to treat chorea deplete nutrients which complicate celiac disease. \u00a0Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below.\u00a0<strong>Do not stop prescribed medications without supervision.<\/strong><\/p>\n<p style=\"text-align: justify\">This is not a complete list.<\/p>\n<p style=\"text-align: justify\"><strong>MAJOR TRANQUILIZERS<\/strong>\u00a0<strong>\u00a0<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Neuroleptics (Haloperidol and Fluphenazine) deplete\u00a0Coenzyme Q10.<\/li>\n<li>Atypical neuroleptics (Clozapine) deplete L-tryptophan, Selenium.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">\n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><strong><span class=\"dropcap\">5<\/span>Nutritional Supplements To Help Correct Deficiencies:<\/strong><\/span><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p style=\"text-align: justify\">The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.<\/p>\n<ul class=\"cp_bullet orange\" style=\"text-align: justify\">\n<li>Multivitamin\/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.<\/li>\n<li>Coenzyme Q10 as prescribed following blood test for status.<\/li>\n<li>Selenium\u00a0as prescribed following blood test for status.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Storage Note<\/strong>:\u00a0<em>Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet &#8211; not in the bathroom or on the kitchen table<\/em>.\n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><span style=\"color: #800000\"><em><strong><span class=\"dropcap\">6<\/span>Manage Natural Remedies:\u00a0<\/strong><\/em><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Hydration<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.<\/li>\n<li>If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.<\/li>\n<li>Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.<\/li>\n<li>What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Carminatives.\u00a0<\/strong>The following \u00a0anti-inflammatory\u00a0plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.<\/p>\n<p style=\"text-align: justify\"><strong>Carminative Food Remedies<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Raspberry.<\/li>\n<li>Carrot is also a cleansing digestive tonic.<\/li>\n<li>Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.<\/li>\n<li>Redbeets also stimulate and improve digestion and are easily digested.<\/li>\n<li>Cabbage also stimulates and improves digestion and is also a liver decongestant.<\/li>\n<li>Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.<\/li>\n<li>Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Carminative Herb Remedies:<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. \u00a0Drink as tea or use in cooking.<\/li>\n<li>Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.<\/li>\n<li>Parsley also relieves indigestion.<\/li>\n<li>Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.<\/li>\n<li>Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Carminative Spice Remedies:<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Cloves are also antispasmodic.<\/li>\n<li>Nutmeg is also useful for indigestion.<\/li>\n<li>Ginger.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Exercise Helps<\/strong>:<\/p>\n<p style=\"text-align: justify\">Exercise improves circulation and rids the body of toxins.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Walking is aerobic exercise that reconditions the whole body to improve stamina.\u00a0Read more about<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">\u00a0Exercise and Fitness<\/a>.<\/li>\n<li>Weight training builds muscle.\u00a0Read more about\u00a0<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">Exercise and Fitness<\/a>.<\/li>\n<li>Stretching improves flexibilty.\u00a0Read more about\u00a0<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">Exercise and Fitness<\/a>.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Note<\/strong>: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. \n\t\t\t<\/div><\/div>\n<h2 style=\"text-align: justify\">What Do Medical Research Studies Tell About Chorea In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<h4><strong>CASE REPORT SUMMARIES<\/strong><\/h4>\n<p style=\"text-align: justify\"><strong>&#8220;Further Evidence for Celiac Disease-associated Chorea.&#8221;\u00a0<\/strong>This case report\u00a0describes chorea\u00a0in a patient with celiac disease (non-adherent to diet)\u00a0which responded to a gluten-restricted diet. The response of the movement disorder to change in diet strongly suggests a functional role for anti-gliadin antibodies in the generation of\u00a0chorea, probably involving basal ganglia targets. Gluten sensitivity may be a treatable cause of\u00a0chorea.<\/p>\n<p style=\"text-align: justify\">A 59-year-old Caucasian male was referred for evaluation of generalized chorea, present for 1.5 years. All neurologic evaluations were performed by the author at the James J. Peters Veterans Affairs Medical Center. There was no relevant family history. As a child he had been diagnosed with celiac disease and followed a gluten-free diet which controlled his symptoms, but as an adult he returned to a normal diet without problems. In recent months, he reported recurrence of abdominal pain and diarrhea. He has a long history of psychiatric disease with possible schizotypal personality disorder, depression, anxiety, and past alcohol dependence. He had received phenobarbital for \u201cnerves\u201d for a few months, but had never been hospitalized for psychiatric reasons.<\/p>\n<p style=\"text-align: justify\">Twelve years prior to evaluation he was treated with antipsychotic drugs. Five years prior to presentation treatment was started with risperidone (1 mg\/day), for paranoid ideation. For 3 years prior to neurological evaluation he was on stable doses of trazodone (100 mg\/day), venlafaxine (375 mg\/day) and mirtazapine (15 mg\/day). Involuntary movements were first noted by his psychiatrist 1 year prior to referral. Six months prior to the current evaluation risperidone was switched to quetiapine 100 mg\/day with no change in his involuntary movements. Doses of his antidepressants were unchanged. The movements remained unchanged when he was first seen by the author.\u00a0On examination he had generalized chorea with dystonic facial movements and right hand posturing.<\/p>\n<p style=\"text-align: justify\">Anti-gliadin antibodies were IgG = 139 U (normal range 0\u201320 U), IgA = 72 U (normal range 0\u201320 U).\u00a0Three months later his involuntary movements were significantly reduced on a gluten free diet.<a href=\"#footnote_1_630\" id=\"identifier_14_630\" class=\"footnote-link footnote-identifier-link\" title=\"Walker RH. Further Evidence for Celiac Disease-associated Chorea. Tremor Other Hyperkinet Mov (N Y). 2011;1. pii: tre-01-32-96-3.\">1<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cChoreic syndrome and coeliac disease: a hitherto unrecognized association.\u201d<\/strong> This case report describes four patients average age 61 years old with celiac disease and chorea. A gluten free diet produced notable improvement in the motor symptoms of all 4 patients.<a href=\"#footnote_3_630\" id=\"identifier_15_630\" class=\"footnote-link footnote-identifier-link\" title=\"Pereira AC, Edwards MJ, Buttery PC, et al. Choreic syndrome and coeliac disease: a hitherto unrecognized association. Movement Disorders: Official Journal of the Movement Disorder Society. Apr 2004;19(4):478-82.\">3<\/a><\/p>\n<p style=\"text-align: justify\">&#8220;<strong>Refractory celiac disease, small-bowel lymphoma and chorea<\/strong>.&#8221; This case report describes the development of chorea associated with non-Hodgkin&#8217;s T-cell lymphoma in a 58 year old woman who was compliant with a gluten free diet since having been diagnosed with celiac disease eleven years earlier upon being investigated for symptomatic anemia and found to be iron and folate deficient. She had no abdominal symptoms. Distal duodenal biopsies showed subtotal villous atrophy, inflammatory infiltration of the lamina propria and an increase in intraepithelial lymphocytes. Celiac disease was diagnosed and she was started on a gluten-free diet. She gained weight and ceased to be anemic; however, repeat biopsies of her duodenal mucosa showed no improvement in the villous atrophy.<\/p>\n<p style=\"text-align: justify\">Eleven years later she complained of diarrhea, ankle edema and 7 kg weight loss. Endoscopic duodenal biopsies again showed features consistent with untreated celiac disease, and again a dietitian confirmed adherence to a strict gluten-free diet. A barium follow-through showed a rather featureless jejunal mucosa but no obstructive lesion of the small bowel; nothing abnormal was seen on an ultrasound scan of the abdomen. In view of her worsening symptoms despite a gluten-free diet, she was started on prednisolone, initially 30 mg daily, and over the next year her clinical condition improved, with resolution of her diarrhea and a weight gain of 5 kg.<\/p>\n<p style=\"text-align: justify\">At the time of discontinuation of prednisolone a year later she developed involuntary writhing movements of her left limbs. On examination she had choreo-athetoid movements involving the left limbs and persistent dysarthria. At that time she was taking digoxin, aspirin, ferrous sulphate and thyroxin; she had never received any neuroleptic medication. No underlying neurological disease to explain her chorea was found.<br \/>\nHer chorea continued and seven months later she developed acute abdominal pain. At emergency laparotomy she was found to have a perforated jejunal tumour, which was resected. It proved to be a non-Hodgkin&#8217;s T-cell lymphoma. She had intravenous chemotherapy but deteriorated three months postoperatively and died.<\/p>\n<p style=\"text-align: justify\">&#8220;Although her chorea may have been a neurological association of her refractory celiac disease, an alternative explanation is that it was a paraneoplastic complication of her impending T-cell lymphoma. Chorea has been described as a paraneoplastic phenomenon in patients with non-Hodgkin&#8217;s lymphoma, but to our knowledge this is the first case where it has been associated with lymphoma arising from a background of celiac disease. The finding of chorea in association with celiac disease should prompt a search for possible underlying intestinal T-cell lymphoma.&#8221;<a href=\"#footnote_7_630\" id=\"identifier_16_630\" class=\"footnote-link footnote-identifier-link\" title=\"Kitiyakara T, Jackson M, Gorard DA. Refractory coeliac disease, small-bowel lymphoma and chorea. J R Soc Med. 2002 Mar;95(3):133-4.\">7<\/a><\/p>\n<ol class=\"footnotes\"><li id=\"footnote_1_630\" class=\"footnote\">Walker RH. Further Evidence for Celiac Disease-associated Chorea. <em>Tremor Other Hyperkinet Mov (N Y)<\/em>. 2011;1. pii: tre-01-32-96-3.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_1_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_14_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_2_630\" class=\"footnote\">Kitiyakara T, Jackson M, Gorard DA. Refractory coeliac disease, small-bowel lymphoma and chorea.\u00a0<em>J R Soc Med<\/em>. 2002 Mar;95(3):133-4.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_2_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_5_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_3_630\" class=\"footnote\">Pereira AC, Edwards MJ, Buttery PC, et al. Choreic syndrome and coeliac disease: a hitherto unrecognized association. <em>Movement Disorders: Official Journal of the Movement Disorder Society<\/em>. Apr 2004;19(4):478-82.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_3_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_6_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_15_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_4_630\" class=\"footnote\">Walker RH. Further Evidence for Celiac Disease-associated Chorea.\u00a0<em>Tremor Other Hyperkinet Mov<\/em> (N Y). 2011;1. pii: tre-01-32-96-3.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_4_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_5_630\" class=\"footnote\">Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.\u00a0<em>Clinical Science<\/em>. Apr 2001;100(4):379-86.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_7_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_6_630\" class=\"footnote\">Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.\u00a0<em>Journal of Gastroenterology and Hepatology<\/em>. 2003;18:479-91.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_8_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_9_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_10_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_11_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_12_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_13_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_7_630\" class=\"footnote\">Kitiyakara T, Jackson M, Gorard DA. Refractory coeliac disease, small-bowel lymphoma and chorea. <em>J R Soc Med<\/em>. 2002 Mar;95(3):133-4.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_16_630\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>What Is Chorea? Chorea is a movement disorder characterized by brief, jerky, purposeless or writhing involuntary movements of the distal limbs, head, and face that may occur during voluntary movement or at rest. Chorea has a large number of causes, including metabolic, structural, pharmacologic, genetic, and autoimmune factors. Despite extensive investigations, many patients remain undiagnosed.1 &#8230;<\/p>\n","protected":false},"author":29,"featured_media":7053,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[4,779,144,196,49],"tags":[101,1926,1958,878,776,1106,1887,1105],"class_list":["post-630","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-conditions-2","category-associated-disorder","category-brain","category-cerebellum","category-nervous-2","tag-associated-disorders","tag-brain","tag-cerebellum","tag-chorea","tag-health-conditions","tag-involuntary-movements","tag-nervous-2","tag-writhing"],"_links":{"self":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/630","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/users\/29"}],"replies":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/comments?post=630"}],"version-history":[{"count":15,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/630\/revisions"}],"predecessor-version":[{"id":18846,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/630\/revisions\/18846"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media\/7053"}],"wp:attachment":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media?parent=630"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/categories?post=630"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/tags?post=630"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}