Ataxia with gluten sensitivity (gluten ataxia) is increasingly recognised in adults but the age range of 68 patients in North Trent and London (

) was 14–81 years. Patients presented with ataxia of gait, upper and lower limb ataxia, eye signs (nystagmus or abnormal eye movements), and dysarthria, and had cerebellar atrophy and white matter intensities on MRI. Almost half had a sensorimotor axonal neuropathy on neurophysiological testing and almost a quarter had coeliac disease. Testing for antigliadin antibodies is suggested for patients with sporadic (non-familial) ataxia but data on children seem sparse. There is some evidence that a gluten free diet may be beneficial.

An environment containing tobacco smoke is not good for children. More evidence of this has come from a study in Puerto Rico (

). This study included 512 children aged 2–12 years 243 of whom were exposed to tobacco smoke in the home because of parental smoking. Mean plasma vitamin C concentrations were significantly lower in the exposed group (48.9 v 52.1 μmol/l) even though dietary intake of vitamin C was similar in the two groups and urinary cotinine measurements suggested only mild exposure to tobacco smoke. The practical importance of this reduction in vitamin C concentrations is unknown but these authors maintain that it could be important in vulnerable …