TY - JOUR
T1 - Environmental, dietary and case-control study of Nodding Syndrome in Uganda
T2 - A post-measles brain disorder triggered by malnutrition?
AU - other Members of the Oregon-Uganda Nodding Syndrome Research Team
AU - Spencer, Peter S.
AU - Mazumder, Rajarshi
AU - Palmer, Valerie S.
AU - Lasarev, Michael R.
AU - Stadnik, Ryan C.
AU - King, Peter
AU - Kabahenda, Margaret
AU - Kitara, David L.
AU - Stadler, Diane
AU - McArdle, Breanna
AU - Tumwine, James K.
N1 - Publisher Copyright:
© 2016 The Authors
PY - 2016/10/15
Y1 - 2016/10/15
N2 - 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.
AB - 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.
KW - Abnormal sleep
KW - Cognitive deficits
KW - Epilepsy
KW - Infection
KW - Internment
KW - Moldy food
KW - Sub-acute sclerosing panencephalitis (SSPE)
KW - Tropical neurology
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UR - http://www.scopus.com/inward/citedby.url?scp=84982150857&partnerID=8YFLogxK
U2 - 10.1016/j.jns.2016.08.023
DO - 10.1016/j.jns.2016.08.023
M3 - Article
C2 - 27653888
AN - SCOPUS:84982150857
SN - 0022-510X
VL - 369
SP - 191
EP - 203
JO - Journal of the neurological sciences
JF - Journal of the neurological sciences
ER -