{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:46:46Z","timestamp":1791866806662,"version":"4.3.4"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify any MR spectroscopy differences amongst patients with gluten ataxia and patients with gluten encephalopathy and interpret what this tells us about cerebellar functionality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective review of MR spectroscopy baseline data from 40 patients with gluten ataxia (GA), 40 patients with gluten encephalopathy (GE) and a group of 55 healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean age at development of ataxia in the GA group was 50\u00a0years. In the GE group, the mean age at development of neurological symptoms was 37\u00a0years. The mean age of the healthy control group at the time of scanning was 41\u00a0years. Patients with GA showed highly significant reduction in the NAA\/Cr (N-acetyl-aspartate\/creatine) ratio from the vermis NAA\/Cr 0.85 vs 0.99 in healthy controls (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0000105, Welch\u2019s\n                      <jats:italic>t<\/jats:italic>\n                      -test). Within this same group, the right hemisphere NAA\/Cr area ratio was 0.969 vs 1.01 in healthy controls (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.058). By contrast, patients with GE showed significant reduction of NAA\/Cr area ratio in the right hemisphere 0.926 vs 1.01 in healthy controls (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.00053, Welch\u2019s\n                      <jats:italic>t<\/jats:italic>\n                      -test) but no difference from control subjects when comparing vermis NAA\/Cr.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MR spectroscopy of the cerebellum demonstrates dysfunction in the vermis in patients with GA, whereas patients with GE have abnormal spectroscopy in the right cerebellar hemisphere in the absence of ataxia. The right cerebellar hemisphere may be implicated in cerebellar cognitive affective syndrome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14200-6","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:11:56Z","timestamp":1791864716000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["MR spectroscopy of the cerebellum in gluten ataxia and gluten encephalopathy"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2542-8954","authenticated-orcid":false,"given":"M.","family":"Hadjivassiliou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RA.","family":"Grunewald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Croal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Hoggard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"14200_CR1","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/S1474-4422(09)70290-X","volume":"9","author":"M Hadjivassiliou","year":"2010","unstructured":"Hadjivassiliou M, Sanders DS, Grunewald RA, Woodroofe N, Boscolo S, Aeschlimann D (2010) Gluten sensitivity: from gut to brain. Lancet Neurol 9:318\u2013330","journal-title":"Lancet Neurol"},{"key":"14200_CR2","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1212\/WNL.56.3.385","volume":"56","author":"M Hadjivassiliou","year":"2001","unstructured":"Hadjivassiliou M, Gr\u00fcnewald RAG, Lawden M, Davies-Jones GAB, Powell T, Smith CML (2001) Headache and CNS white matter abnormalities associated with gluten sensitivity. Neurology 56:385\u2013388","journal-title":"Neurology"},{"key":"14200_CR3","doi-asserted-by":"publisher","DOI":"10.3390\/nu16081209","author":"M Hadjivassiliou","year":"2024","unstructured":"Hadjivassiliou M, Trott N, Hoggard N, Sanders DS (2024) Sensory symptoms without structural pathology in patients with gluten sensitivity. Nutrients. https:\/\/doi.org\/10.3390\/nu16081209","journal-title":"Nutrients"},{"key":"14200_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1212\/WNL.0000000000004237","volume":"89","author":"M Hadjivassiliou","year":"2017","unstructured":"Hadjivassiliou M, Grunewald RA, Sanders DS, Shanmugarajah P, Hoggard N (2017) Effect of gluten-free diet on MR spectroscopy in gluten ataxia. Neurology 89:1\u20135","journal-title":"Neurology"},{"key":"14200_CR5","doi-asserted-by":"publisher","DOI":"10.1007\/s12311-020-01132-8","author":"M Hadjivassiliou","year":"2020","unstructured":"Hadjivassiliou M, Graus F, Honnorat J, Jarius S, Titulaer M, Manto M, Hoggard N, Sarrigiannis PG, Mitoma H (2020) Diagnsotic criteria for primary autoimmune cerebellar ataxia-guidelines from an international task force on immune-mediated cerebellar ataxias. Cerebellum. https:\/\/doi.org\/10.1007\/s12311-020-01132-8","journal-title":"Cerebellum"},{"key":"14200_CR6","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1093\/brain\/121.4.561","volume":"121","author":"JD Schmahmann","year":"1998","unstructured":"Schmahmann JD, Sherman JC (1998) The cerebellar cognitive affective syndrome. Brain 121:561\u2013579","journal-title":"Brain"},{"key":"14200_CR7","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s12311-012-0415-1","volume":"12","author":"S Currie","year":"2013","unstructured":"Currie S, Hadjivassiliou M, Wilkinson ID, Griffiths PD, Hoggard N (2013) Magnetic resonance spectroscopy of the normal cerebellum: what degree of variability can be expected? Cerebellum 12:205\u2013211","journal-title":"Cerebellum"},{"issue":"8","key":"14200_CR8","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1080\/02699050701504273","volume":"21","author":"S Maeshima","year":"2007","unstructured":"Maeshima S, Osawa A (2007) Stroke rehabilitation in a patient with cerebellar cognitive affective syndrome. Brain Inj 21(8):877\u2013883","journal-title":"Brain Inj"},{"key":"14200_CR9","doi-asserted-by":"publisher","DOI":"10.1136\/posgradmedj-2011-130471","author":"S Currie","year":"2011","unstructured":"Currie S, Hadjivassiliou M, Craven IJ, Wilkinson ID, Griffiths PD, Hoggard N (2011) Magnetic resonance spectroscopy of the brain. Postgrad Med J. https:\/\/doi.org\/10.1136\/posgradmedj-2011-130471","journal-title":"Postgrad Med J"},{"key":"14200_CR10","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1093\/brain\/awx317","volume":"141","author":"F Hoche","year":"2018","unstructured":"Hoche F, Guell X, Vangel MG, Sherman JC, Schmahmann JD (2018) The cerebellar cognitive affective\/Schmahmann syndrome scale. Brain 141:248\u2013270","journal-title":"Brain"},{"key":"14200_CR11","doi-asserted-by":"publisher","DOI":"10.1002\/ana.78020","author":"I Croall","year":"2025","unstructured":"Croall I, Hadjivassiliou M, Sanders DS, The K, Biancardi AM, Trott N, Hoggard N (2025) Persisting transglutaminase 6 antibodies in neurological gluten-related disorders. Ann Neurol. https:\/\/doi.org\/10.1002\/ana.78020","journal-title":"Ann Neurol"},{"key":"14200_CR12","doi-asserted-by":"publisher","DOI":"10.1007\/s12311-020-01152-4","author":"M Hadjivassiliou","year":"2020","unstructured":"Hadjivassiliou M, Grunewald RA, Shanmugarajah PD, Sarrigiannis PG, Zis P, Skarlatou V, Hoggard N (2020) Treatment of primary autoimmune cerebellar ataxia with mycophenolate. Cerebellum. https:\/\/doi.org\/10.1007\/s12311-020-01152-4","journal-title":"Cerebellum"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-14200-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-026-14200-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-14200-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:11:56Z","timestamp":1791864716000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-026-14200-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":12,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["14200"],"URL":"https:\/\/doi.org\/10.1007\/s00415-026-14200-6","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]},"assertion":[{"value":"12 July 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 October 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no conflict of interest.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This retrospective data analysis was given ethical approval via the East Midlands REC (IRAS 327729). Informed consent was waived because the study was retrospective and reported on outcomes based on standard clinical care.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"658"}}