**4. Neuropsychiatric complications of CD**

There is an established association of CD with different neuropsychiatric symptoms including headache, peripheral neuropathy, ataxia, depression, dysthymia, anxiety and epilepsy [40]. Peripheral neuropathies, characterized by burning, tingling, and numbness in hands and feet is quiet common among CD patients and sometimes the initial presentation as well. These neuropathies are associated with deficiencies of different vitamins including B1(thiamine), B2(riboflavin), B3(niacin), B6(pyridoxine), B12(cobalamin) and E, and mineral including copper. However, these deficiencies occurred when there is severe and extensive bowel involvement. Neuropathies may also be associated with lymphoma as well. Patients presenting with neurological manifestation has significant structural and functional brain deficits on MRI as compared to controls. The exact mechanism in relation to depression and epilepsy is not clear yet [41]. Patients with peripheral neuropathies do not responded on gluten free diet as compared to other neurological manifestations.
