title: Nodding syndrome.
abstract: An epidemic illness characterized by head nodding associated with onchocerciasis has been described in eastern Africa since the early 1960s; we summarize published reports and recent studies. Onset of nodding occurs in previously healthy 5-15-year-old children and is often triggered by eating or cold temperatures and accompanied by cognitive impairment. Its incidence has increased in Uganda and South Sudan over the past 10 years. Four case-control studies identified modest and inconsistent associations. There were nonspecific lesions seen by magnetic resonance imaging, no cerebrospinal fluid inflammation, and markedly abnormal electroencephalography results. Nodding episodes are atonic seizures. Testing has failed to demonstrate associations with trypanosomiasis, cysticercosis, loiasis, lymphatic filariasis, cerebral malaria, measles, prion disease, or novel pathogens; or deficiencies of folate, cobalamin, pyridoxine, retinol, or zinc; or toxicity from mercury, copper, or homocysteine. There is a consistent enigmatic association with onchocerciasis detected by skin snip or serologic analysis. Nodding syndrome is an unexplained epidemic epilepsy.
authors: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. sfd2@cdc.gov
authors: Scott F
authors: SF
authors: Dowell
authors: James J
authors: JJ
authors: Sejvar
authors: Lul
authors: L
authors: Riek
authors: Katelijn A H
authors: KA
authors: Vandemaele
authors: Margaret
authors: M
authors: Lamunu
authors: Annette C
authors: AC
authors: Kuesel
authors: Erich
authors: E
authors: Schmutzhard
authors: William
authors: W
authors: Matuja
authors: Sudhir
authors: S
authors: Bunga
authors: Jennifer
authors: J
authors: Foltz
authors: Thomas B
authors: TB
authors: Nutman
authors: Andrea S
authors: AS
authors: Winkler
authors: Anthony K
authors: AK
authors: Mbonye
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D062306:Geography, Medical; D006801:Humans; D015994:Incidence; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D064128:Nodding Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult
keywords: Africa; Nodding syndrome; South Sudan; Uganda; epidemic; epilepsy; head nodding; idiopathic; onchocerciasis; parasites; seizures
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