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Volume 19, Number 9—September 2013


Nodding Syndrome

Scott F. DowellComments to Author , James J. Sejvar, Lul Riek, Katelijn A.H. Vandemaele, Margaret Lamunu, Annette C. Kuesel, Erich Schmutzhard, William Matuja, Sudhir Bunga, Jennifer Foltz, Thomas B. Nutman, Andrea S. Winkler, and Anthony K. Mbonye
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.F. Dowell, J.J. Sejvar, S. Bunga, J. Foltz); Ministry of Health, Juba, South Sudan (L. Riek); World Health Organization, Geneva, Switzerland (K.A.H. Vandemaele, M. Lamunu, A.C. Kuesel); University of Innsbruck, Innsbruck, Austria (E. Schmutzhard); Muhimbili University, Dar es Salaam, Tanzania (W. Matuja); National Institutes of Health, Bethesda, Maryland, USA (T.B. Nutman); Technical University of Munich, Munich, Germany (A.S. Winkler); Ministry of Health, Kampala, Uganda (A.K. Mbonye); Makerere University, Kampala (A.K. Mbonye)

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Table 1

Studies of nodding syndrome and major findings

Location, author, date (reference) Major finding*
Tanzania, Aall-Jilek, 1965 (4) Reported nodding as symptom in a description of epilepsy
Liberia, Van der Waals et al., 1983 (3) Described seizure disorders as dorsoventral movements of the head
Uganda, Kaiser et al., 2000 (5) Reported head nodding as 1 feature of complex partial seizures
Sudan, Tumwine, et al.2001–2002 (2) Described nodding disease as a progressive epileptic encephalopathy; weak associations with measles, sorghum, and baboon brain consumption; stronger associations with testing for onchocerciasis and Mansonella perstans nematodes
Tanzania, Winkler et al., 2008 (9) Reported clinical description of 62 patients; 48 CSF samples mostly clear, 2/10 EEG interictal changes (no recording of nodding episodes), and 8/12 nonspecific MRI changes
Uganda, Sejvar et al., 2009 (7) Reported neurologic and clinical characterization of the syndrome, EEG documenting atonic seizure as cause for nodding, and negative CSF and MRI findings
Uganda, Foltz et al., 2009 (6) Reported descriptive epidemiology and case–control results, and associations with munitions, crushed roots, and antibodies against Onchocerca spp. nematodes
Uganda, unpub. data, 2010 Reported follow up case–control results; associations with gun raids and antibodies against Onchocerca spp. nematodes; no differences for questions regarding consumption of crushed roots
Tanzania, Winkler et al., 2010 (10) Provided additional detail on 62 aforementioned patients; unsatisfactory seizure control and cognitive impairment
South Sudan, Nyungura et al., 2011 (11) Described features of 96 cases
South Sudan, Riek, 2011 (8) Reported skin snip specimens with microfilaria more common among patients than controls.

*CSF, cerebrospinal fluid; MRI, magnetic resonance imaging; EEG, electroencephalography.

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