Lathyrism: has the scenario changed in 2013?

Abstract

Lathyrism is now rarely seen as a clinical disease in general, medical or neurology outpatient departments, throughout the world. Eating patterns of seeds of Lathyrus sativus are still prevalent focal points in parts of the world. Question arises, why are we not seeing cases of lathyrism? Is it that the disease has changed its profile, with the changing socioeconomic status of the poor or underdeveloped or moderately developed countries? Is it that the seeds of lathyrus are less toxic now? Is it that the body defence against toxins of lathyrus has genetically modified? To find out answers to these interesting questions, an extensive questionnaire-based sampling was done among 1000 subjects from northern India to identify the human behaviour regarding the knowledge, attitude, and practices (KAPs) for L. sativus. Four clinically suspected cases of Lathyrism were also fully worked up. It was concluded that many areas of India are still being fed with lathyrus seeds, but not many cases have appeared. Many questions have to be answered, as to what has reduced the incidence of lathyrism.

Metabolic and Toxic Causes of Myelopathy

“…24 Cyanide detoxification is mediated by the enzyme rhodanese, which requires sulfur (provided by sulfur-containing amino acids) and is responsible for the conversion of cyanide into thiocyanate, which is excreted in the urine. 26 Similar to konzo, outbreaks of neurolathyrism typically occur during times of drought, flooding, or wars, with the rural poor being most vulnerable. The World Health Organization recommends a varied diet and immediate multivitamin therapy to prevent or treat other potential complications related to vitamin deficiencies.…”

Study of Knowledge, Attitude, and Practice in Participants with Regular Intake of Lathyrus, But No Spastic Paraparesis

“…[1] A causal relationship between the excessive consumption of L. sativus and neurolathyrism (an upper motor neuron disorder characterized by a spastic paraparesis of the lower limbs) is well known for several decades. [2] It has been discussed that neurolathyrism has been only reported in the extreme conditions of drought or famine [3] but not in normal conditions and afflicts predominantly the lower socioeconomic class. The last recorded episode of the disease was from Ethiopia during the 1995-1997 famine, and in India, it has virtually disappeared during the past three decades despite the continued cultivation and consumption in several states.…”

El Niño-southern oscillations and lathyrism epidemics

“…Reference had been made by Hippocrates and Galen to the impotentia crurum of those who fed on what was called ervum, ..." (Buchanan, 1904). While lathyrism epidemics occurred during droughts in France, Germany, Spain, India, and Algeria from early nineteenth century to early twentieth century, and in Bangladesh (Haque et al, 1994), Afghanistan (Arya et al, 1988), India (Khandare et al, 2014;Mishra et al, 2014), Nepal (Hamilton, 1978), and Ethiopia (Fikre et al, 2011) from the late twentieth century to early twenty-first century, the most systematic studies were carried out in India during the Colonial rule from 1833 to 1920. It was shown that lathyrism epidemics occurred during droughts when the population depended on Lathyrus sativus (grasspea), a drought resistant crop, for supply of calories (Buchanan, 1904).…”