title: Catatonia in Ugandan children with nodding syndrome and effects of treatment with lorazepam: a pilot study.
abstract: BACKGROUND
  Nodding syndrome (NS) is a severe neuropsychiatric syndrome of an unknown etiology affecting children and adolescents mostly in Eastern Africa. Symptoms of NS and catatonia seem to overlap. We investigated the presence and types of catatonic symptoms in NS and their response to one or two doses of lorazepam, the first-line treatment for catatonia.
  
  
  METHODS
  A cross-sectional descriptive study with systematic assessment of catatonia in 33 patients with NS using a modified version of the Bush Francis Catatonia Rating Scale. Sixteen patients met criteria for catatonia and were observed in an open and uncontrolled study to examine the effects of one or two doses of lorazepam in them.
  
  
  RESULTS
  Sixteen of 33 patients with NS had an average of 5 catatonia symptoms and met criteria for catatonia. The highest scores were found for mutism, staring, poor eating/drinking, stupor, and grimacing. Excitement, rigidity, negativism and impulsivity had lower scores. None of the children had echolalia or echopraxia. In 6 children, there was a reduction of more than 50% in catatonia ratings, representing a positive response to lorazepam. Three out of six children whose catatonia ratings did not change after the first dose, responded after administration of a second double dose. There were no unusual or critical side-effects.
  
  
  CONCLUSIONS
  About half of a selected sample of children with NS met criteria for catatonia. Catatonia scores decreased in most patients after one or two doses of lorazepam. Larger, longer, and controlled studies are warranted to assess the prevalence of catatonia in NS and to assess the use of lorazepam in NS through its effects on catatonia.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02462109 Date of formal registration: June 2, 2015.
authors.affiliation: Department of Pediatrics and Child Health, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. akakooza246@gmail.com.|Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden. akakooza246@gmail.com.
authors.forename: Angelina
authors.initials: A
authors.lastname: Kakooza-Mwesige
authors.affiliation: University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA. dirkdhossche@gmail.com.
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Dhossche
authors.affiliation: Department of Pediatrics and Child Health, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. ridro1@gmail.com.|Nuffield Department of Medicine, Centre for Global Health and Tropical Medicine, University of Oxford, Oxford, UK. ridro1@gmail.com.
authors.forename: Richard
authors.initials: R
authors.lastname: Idro
authors.affiliation: Department of Psychiatry, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. akenadickens@yahoo.co.uk.
authors.forename: Dickens
authors.initials: D
authors.lastname: Akena
authors.affiliation: Department of Psychiatry, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. joycenalugya@yahoo.com.
authors.forename: Joyce
authors.initials: J
authors.lastname: Nalugya
authors.affiliation: Ministry of Health Headquarters, Kampala, Uganda. bopato@gmail.com.
authors.forename: Benard T
authors.initials: BT
authors.lastname: Opar
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002389:Catatonia / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D064128:Nodding Syndrome / Q000150:complications / Q000188:drug therapy*; D010865:Pilot Projects; D016896:Treatment Outcome; D014454:Uganda; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D008140:Lorazepam