Volume 19, Number 9—September 2013
|Risk factor||Study (reference)
|Sudan, 2002; 13 case-patients, 19 controls (2)||Uganda, 2009; 49 case-patients, 49 controls (6)||Uganda, 2010; 73 case-patients, 73 controls†||South Sudan, 2011; 38 case-patients, 38 controls (7,8)|
|History of measles||Less common (15% cases vs. 58% controls; p = 0.03)||No difference (24% case-patients vs. 6% controls; p = 0.02‡)||NA||NA|
|History of malaria||NA||ND||NA||NA|
|History of meningitis||No difference (0% vs. 6%; p = 1.0)||NA||NA||NA|
|Prior treatment for onchocerciasis (ivermectin)||No difference 62% cases vs. 37% controls)||No difference (33% case-patients vs. 25% controls)||NA||NA|
|Consumption of animal brain (risk for prion disease)
||Baboon brain consumption (46% vs. 22%; p = 0.25)
||No association with brain consumption
|Exposure to munitions||NA||More common in case-patients (71% vs. 51%; p = 0.06)||Exposure to gun raids more common in case-patients (54% vs. 27%)||ND|
|Exposure to pesticides (on seeds)||No difference||ND||NA||NA|
|Consumption of crushed roots||NA||More common in case-patients (39% vs. 16%; p = 0.02)||No differences in 17 root types before onset of nodding syndrome; root consumption more common after onset of nodding syndrome (22% vs. 0%)||ND|
|Consumption of cassava (thiocyanate toxicity)
||Widely consumed, no acute toxicity reported
||ND (100% consumption)
||Specifically asked about bitter cassava: no difference
|Early malnutrition||NA||NA||NA||Hunger more common for case-patients 2 y of age (24% vs. 8%; p = 0.03)|
|Current wasting||Weight-for-age Z scores lower in case-patients (−1.6 vs. −1.0, p = 0.09)||Low BMI for age (42% vs. 13%; p<0.01)||Low BMI for age (42% vs. 26%; p = 0.03)||Low BMI for age (16% vs. 3%; p = 0.06)|
|Current stunting||Height-for-age Z scores lower in case-patients (−1.5 vs. −0.8, p = 0.29)||Low height for age (60% vs. 29%; p<0.01)||Low height for age (35% vs. 20%; p = 0.05)||Low height for age (24% vs. 3%; p = 0.03)|
|Consumption of red sorghum||54% case-patients vs. 16% controls; p = 0.05||ND||ND||ND|
|Consumption of spoiled relief foods||NA||ND||NA||NA|
|Consumption of river fish||NA||ND||NA||ND|
|Consumption of rodent brain||NA||ND||NA||NA|
|Consumption of river water||NA||ND||NA||NA|
*Selected risk factors, all positive associations and selected negative findings (see original reference for full listings). NA, not assessed; ND, no difference; BMI body mass index.
‡Not significant after age adjustment.
- Lacey M. Nodding disease: mystery of southern Sudan. Lancet Neurol. 2003;2:714 and.
- Tumwine JK, Vandemaele K, Chungong S, Richer M, Anker M, Ayana Y, Clinical and epidemiologic characteristics of nodding syndrome in Mundri County, South Sudan. Afr Health Sci. 2012;12:242–8 .
- van der Waals F, Goudsmit J, Gajdusek DC. See-ee: clinical characteristics of highly prevalent seizure disorders in the Gbawein and Wroughbarh clan region of Grand Bassa County, Liberia. Neuroepidemiology. 1983;2:35–44.
- Aall-Jilek LM. Epilepsy in the Wapogoro tribe in Tanganyika. Acta Psychiatr Scand. 1965;41:57–86.
- Kaiser C, Benninger C, Asaba G, Mugisa C, Kabagambe G, Kipp W, Clinical and electro-clinical classification of epileptic seizure in west Uganda. Bull Soc Pathol Exot. 2000;93:255–9 .
- Foltz J, Makumbi I, Sejvar JJ, Malimbo M, Ndyomugyenyi R, Atai-Omoruto AD, An epidemiologic investigation of potential risk factors for nodding syndrome in Kitgum District, Uganda. PLoS ONE. 2013;8. In press.
- Sejvar JJ, Kakooza AM, Foltz JL, Makumbi I, Atai-Omoruto AD, Malimbo M, Clinical, neurologic, and electrophysiologic features of nodding syndrome, Kitgum, Uganda: an observational case series. Lancet Neurol. 2013;12:166–74 .
- Centers for Disease Control and Prevention. Nodding syndrome—South Sudan, 2011. MMWR Morb Mortal Wkly Rep. 2012;61:52–4 .
- Winkler AS, Friedrich K, Konig R, Meindl M, Helbrok R, Unterberger I, The head nodding syndrome: clinical classification and possible causes. Epilepsia. 2008;49:2008–15 .
- Winkler AS, Friedrich K, Meindl M, Kidunda A, Nassri A, Jilek-Aall L, Clinical characteristics of people with head nodding in southern Tanzania. Trop Doct. 2010;40:173–5.
- Nyungura JL, Lako A, Gordon A, Lejeng L, William G. Investigation into the nodding syndrome in Witto Payam, Western Equatoria State, 2010. Southern Sudan Medical Journal. 2011;4:3–6.
- Donnelly J. CDC planning trial for mysterious nodding syndrome. Lancet. 2012;379:299.
- Williams SC. Nodding syndrome leaves baffled scientists shaking their heads. Nat Med. 2012;18:334 .
- Wasswa H. Ugandan authorities deal with a mysterious ailment that leaves people nodding continuously. BMJ. 2012;344:e349.
- Fallon A. Hundreds of new nodding disease cases reported. iUganda 2012;Section. Uganda local news story [cited 2013 Jun 4]. http://iuganda.ug/news/local/11793-hundreds-of-new-nodding-cases-reported.html
- World Health Organization. Report of an international conference on nodding syndrome. Bull World Health Organ. 2013;91. In press.
- Sillanpää M, Shinnar S. Long-term mortality in childhood-onset epilepsy. N Engl J Med. 2010;363:2522–9.
- Lin FC, Wei LJ, Shih PY. Effect of levetiracetam on truncal tic in neuroacanthocytosis. Acta Neurol Taiwan. 2006;15:38–42 .
- Noma M, Nwoke BE, Nutall I, Tambala PA, Enyong P, Namsenmo A, Rapid epidemiological mapping of onchocerciasis (REMO): its application by the African Programme for Onchocerciasis Control (APOC). Ann Trop Med Parasitol. 2002;96(Suppl 1):S29–39.
- World Health Organization Economic and Social Council. Onchocerciasis and its control. Geneva: The Organization; 1995.
- Sauerbrey M. The Onchocerciasis Elimination Program for the Americas (OEPA). Ann Trop Med Parasitol. 2008;102(Suppl 1):25–9 .
- Jilek-Aall L, Jilek W, Miller JR. Clinical and genetic aspects of seizure disorders prevalent in an isolated African population. Epilepsia. 1979;20:613–22.
- Demirkaya E, Ozen S, Bilginer Y, Ayaz NA, Makay BB, Unsal E, The distribution of juvenile idiopathic arthritis in the eastern Mediterranean: results from the registry of the Turkish Paediatric Rheumatology Association. Clin Exp Rheumatol. 2011;29:111–6 .
- Demiroren K, Yavuz H, Cam L, Oran B, Karaaslan S, Demiroren S. Sydenham’s chorea: a clinical follow-up of 65 patients. J Child Neurol. 2007;22:550–4.
- Bonmarin I, Nunga M, Perea WA. Konzo outbreak, in the south-west of the Democratic Republic of Congo, 1996. J Trop Pediatr. 2002;48:234–8.
- Getahun H, Mekonnen A. TekleHaimanot R, Lambein F. Epidemic of neurolathyrism in Ethiopia. Lancet. 1999;354:306–7.
- Mutonga DM, Pimentel G, Muindi J, Nzioka C, Mutiso J, Klena JD, Epidemiology and risk factors for serogroup X meningococcal meningitis during an outbreak in western Kenya, 2005–2006. Am J Trop Med Hyg. 2009;80:619–24 .
- Morenikej OA, Idowu BA. Studies on the prevalence of urinary schistosomiasis in Ogun State, south-western Nigeria. West Afr J Med. 2011;30:62–5 .
- Barskey AE, Glasser JW, LeBaron CW. Mumps resurgences in the United States: a historical perspective on unexpected elements. Vaccine. 2009;27:6186–95.
- Collie DA, Summers DM, Sellar RJ, Ironside JW, Cooper S, Zeidler M, Diagnosing variant Creutzfeldt-Jakob disease with the pulvinar sign: MR imaging findings in 86 neuropathologically confirmed cases. AJNR Am J Neuroradiol. 2003;24:1560–9 .
- Geschwind MD, Shu H, Haman A, Sejvar JJ, Miller BL. Rapidly progressive dementia. Ann Neurol. 2008;64:97–108 .
- Basáñez MG, Pion SD, Boakes E, Filipe JA, Churcher TS, Boussinesq M. Effect of single-dose ivermectin on Onchocerca volvulus: a systematic review and meta-analysis. Lancet Infect Dis. 2008;8:310–22 .
- Pion SD, Kaiser C, Boutros-Toni F, Cournil A, Taylor MM, Meredith SE, Epilepsy in onchocerciasis endemic areas: systematic review and meta-analysis of population-based surveys. PLoS Negl Trop Dis. 2009;3:e461 .
- Kaiser C, Rubaale T, Tukesiga E, Kipp W, Kabasambe G, Ojony JO, Association between onchocerciasis and epilepsy in the Itwara hyperendemic focus, West Uganda: controlling for time and intensity of exposure. Am J Trop Med Hyg. 2011;85:225–8.
- Katabarwa M, Lakwo T, Habumogisha P, Richards F, Eberhard M. Could neurocysticercosis be the cause of “onchocerciasis-associated” epileptic seizures? Am J Trop Med Hyg. 2008;78:400–1 .
- König R, Nassri A, Meindl M, Matuja W, Kidunda AR, Siegmund V, The role of Onchocerca volvulus in the development of epilepsy in a rural area of Tanzania. Parasitology. 2010;137:1559–68.
- Stockler S, Plecko B, Gospe SM Jr, Coulter-Mackie M, Connolly M, van Karnebeek C, Pyridoxine dependent epilepsy and antiquitin deficiency: clinical and molecular characteristics and recommendations for diagnosis, treatment and follow-up. Mol Genet Metab. 2011;104:48–60.
- Gospe SM Jr. Neonatal vitamin-responsive epileptic encephalopathies. Chang Gung Med J. 2010;33:1–12 .
- Kirvan CA, Swedo SE, Kurahara D, Cunningham MW. Streptococcal mimicry and antibody-mediated cell signaling in the pathogenesis of Sydenham's chorea. Autoimmunity. 2006;39:21–9.
- Quek AM, Britton JW, McKeon A, So SE, Lennon VA, Shin C, Autoimmune epilepsy: clinical characteristics and response to immunotherapy. Arch Neurol. 2012;69:582–93.
Page created: August 20, 2013
Page updated: August 20, 2013
Page reviewed: August 20, 2013
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.