Clinical characteristics of people with head nodding in southern Tanzania

Winkler, Andrea Sylvia; Friedrich, Katrin; Meindl, Michael; Kidunda, Aslam; Nassri, Amir; Jilek-Aall, Louise; Matuja, William; Schmutzhard, Erich

doi:10.1258/td.2010.090373

Cited by 39 publications

(45 citation statements)

References 4 publications

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“…A similar experience with treatment with PHB was reported from southern Tanzania where a significant reduction in seizure frequency has been observed in most patients but full control was achieved only in a few. 24,25 In Tanzania, besides PHB patients also received treatment with other AEDs (phenytoine or carbamazepine) as monotherapy or in combination. No clear difference was noted between the varying regimens, although this was not systematically studied.…”

Section: Discussionmentioning

confidence: 99%

Nodding Syndrome, Western Uganda, 1994

Kaiser¹,

Rubaale²,

Tukesiga³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Nodding syndrome (NS) is a poorly understood condition, which was delineated in 2008 as a new epilepsy syndrome. So far, confirmed cases of NS have been observed in three circumscribed African areas: southern Tanzania, southern Sudan, and northern Uganda. Case-control studies have provided evidence of an association between NS and infection with Onchocerca volvulus, but the causation of NS is still not fully clarified. We report a case of a 15-year old boy with head nodding seizures and other characteristic features of NS from an onchocerciasis endemic area in western Uganda, with no contiguity to the hitherto known areas. We suggest that the existence of NS should be systematically investigated in other areas.

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Section: Discussionmentioning

confidence: 99%

Nodding Syndrome, Western Uganda, 1994

Kaiser¹,

Rubaale²,

Tukesiga³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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“…[1][2][3][4] Human onchocerciasis is caused by the filarial nematode Onchocerca volvulus (O. volvulus), which mainly manifests on skin and eyes. 5,6 The blackfly (Simulium species) transmits the microfilariae (mf) during a blood meal.…”

Section: Introductionmentioning

confidence: 99%

MRI findings in people with epilepsy and nodding syndrome in an area endemic for onchocerciasis: An observational study

Winkler

Friedrich

Velicheti³

et al. 2013

Afr H. Sci.

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Background: Onchocerciasis has been implicated in the pathogenesis of epilepsy. The debate on a potential causal relationship between Onchocerca volvulus and epilepsy has taken a new direction in the light of the most recent epidemic of nodding syndrome. Objective: To document MRI changes in people with different types of epilepsy and investigate whether there is an association with O. volvulus infection. Methods: In a prospective study in southern Tanzania, an area endemic for O. volvulus with a high prevalence of epilepsy and nodding syndrome, we performed MRI on 32 people with epilepsy, 12 of which suffered from nodding syndrome. Polymerase chain reaction (PCR) of O. volvulus was performed in skin and CSF. Results: The most frequent abnormalities seen on MRI was atrophy (twelve patients (37.5%)) followed by intraparenchymal pathologies such as changes in the hippocampus (nine patients (28.1%)), gliotic lesions (six patients (18.8%)) and subcortical signal abnormalities (three patients (9.4%)). There was an overall trend towards an association of intraparenchymal cerebral pathologies and infection with O. volvulus based on skin PCR (Fisher's Exact Test p=0.067) which was most pronounced in children and adolescents with nodding syndrome compared to those with other types of epilepsy (Fisher's Exact Test, p=0.083). Contrary to skin PCR results, PCR of CSF was negative in all patients. Conclusion: The observed trend towards an association of intraparenchymal cerebral pathological results on MRI and a positive skin PCR for O. volvulus despite negative PCR of CSF is intriguing and deserves further attention.

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“…J-A.) observed repetitive head nodding (amesinzia kichwa, Swahili) among members of the rural Wapogoro community of the Mahenge highlands of Tanganyika (now the United Republic of Tanzania), 5 where malnutrition, infectious disease (notably onchocerciasis) and grand mal convulsions (kifafa, Swahili) are highly prevalent [5][6][7] . While the clinical features, treatment and course of epilepsy among patients seen at the Mahenge Epilepsy Clinic have been extensively documented elsewhere, including a 30-year follow-up in 1992 of the available caseload 8 , there has been no systematic examination of clinical notes from the early years (1959 onwards).…”

Section: Introductionmentioning

confidence: 99%

Nodding syndrome: origins and natural history of a longstanding epileptic disorder in sub-Saharan Africa

Spencer¹,

Palmer²,

Jilek-Aall³

2013

Afr H. Sci.

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Background: Repetitive involuntary head nodding was first reported in the 1960s in the Wapogoro tribe of Tanzania. Objectives: We describe the natural history of head nodding in the Wapogoro tribe, with special reference to the earliest reported dates of onset. Methods: We analyzed clinical data from 150 historical patients seen between 1960 and 1971. Results: Head nodding with or without grand mal convulsions was present in 33/150 (~20%) cases, was mostly familial and equally distributed by gender. Age at onset of head nodding ranged from 2-22 years (mean: ~10 years) in the period . Head nodding preceded onset of grand mal convulsions by up to 12 months, and motor and psychomotor deficits indicative of brain damage developed with time. Fourteen of the 33 cases died at 13-39 years of age (mean: ~20 years) while nineteen aged 16-28 years (mean: ~16 years) were still alive. Conclusion: Historical accounts of head nodding (amesinzia kichwa, Swahili) among the Wapogoro tribe fit the August 2012 World Health Organization (WHO) case definition of probable Nodding Syndrome. Reported to have existed in this population for at least 80 years, Nodding Syndrome is a progressive seizure disorder that leads to generalized convulsions (kifafa), brain damage and death.

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Clinical characteristics of people with head nodding in southern Tanzania

Cited by 39 publications

References 4 publications

Nodding Syndrome, Western Uganda, 1994

Nodding Syndrome, Western Uganda, 1994

MRI findings in people with epilepsy and nodding syndrome in an area endemic for onchocerciasis: An observational study

Nodding syndrome: origins and natural history of a longstanding epileptic disorder in sub-Saharan Africa

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