Environmental, dietary and case-control study of Nodding Syndrome in Uganda: A post-measles brain disorder triggered by malnutrition?

other Members of the Oregon-Uganda Nodding Syndrome Research Team

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Nodding Syndrome (NS) is an epileptic encephalopathy characterized by involuntary vertical head nodding, other types of seizures, and progressive neurological deficits. The etiology of the east African NS epidemic is unknown. In March 2014, we conducted a case-control study of medical, nutritional and other risk factors associated with NS among children (aged 5–18 years) of Kitgum District, northern Uganda (Acholiland). Data on food availability, rainfall, and prevalent disease temporally related to the NS epidemic were also analyzed. In NS Cases, the mean age of reported head nodding onset was 7.6 years (range 1–17 years). The epidemiologic curve of NS incidence spanned 2000–2013, with peaks in 2003 and 2008. Month of onset of head nodding was non-uniform, with all-year-aggregated peaks in April and June when food availability was low. Families with one or more NS Cases had been significantly more dependent on emergency food and, immediately prior to head nodding onset in the child, subsistence on moldy plant materials, specifically moldy maize. Medical history revealed a single significant association with NS, namely prior measles infection. NS is compared with the post-measles disorder subacute sclerosing panencephalitis, with clinical expression triggered by factors associated with poor nutrition.

Original languageEnglish (US)
Pages (from-to)191-203
Number of pages13
JournalJournal of the Neurological Sciences
Volume369
DOIs
StatePublished - Oct 15 2016

Keywords

  • Abnormal sleep
  • Cognitive deficits
  • Epilepsy
  • Infection
  • Internment
  • Moldy food
  • Sub-acute sclerosing panencephalitis (SSPE)
  • Tropical neurology

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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