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Ugandan Authorities Investigating Nodding Disease

by Gopalan on  December 16, 2009 at 1:22 PM Tropical Disease News   - G J E 4
 Ugandan Authorities Investigating Nodding Disease
Ugandan authorities are investigating the outbreak of the nodding disease in the northern part of the country. The disease attacks children between the ages of 5 to 16 and makes them nod unstoppably for some length of time, as if in a seizure.
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 The nodding seizures could indeed be violent. Some elders in an affected region reported, "We have lost three girls... one drowned in a well during a seizure; the other two went several weeks without eating."  

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  Issa Makumbi, the head of disease surveillance in the Health Ministry told Xinhua, "We know that it affects the brain, the muscles and it affects the whole of the body so that the child does not grow properly," he added.

He also revealed that some parents have started abandoning their children who have fallen victims of the disease.

    "We have established a community counseling program there to tell the parents that this disease can be controlled, they should not lose hope," he said.

    The disease that was first reported in June this year has so far affected at least 300 children, according to reports.  Some believe it could be connected to river blindness noticed in many parts of poverty-stricken Africa, the blindness the neurological effect of a parasitic worm.

    William Mbabazi, an official in charge of disease surveillance and response at the World Health Organization office, told the state owned New Vision daily last week that Uganda was the fourth country to be struck by the strange disease after Sudan, the Democratic Republic of Congo and Tanzania.

The nodding disease had previously been reported from southern Sudan. A medical NGO in the Mundri area of western Equatoria had reported an estimated 300 cases around 2003.

Northern Uganda's Kitgum disctrict, an area recovering from two decades of civil war, appears a new epicentre of the disease.

Prof James Tumwine of Makerere University in Kampala, who participated in a WHO-sponsored investigation into the outbreak in Sudan, described the disease as a form of epilepsy linked to onchocerciasis or river blindness. However he told IRIN he found it "incredible" that such a large number of cases were being reported in Uganda. "The infected children need immediate treatment for seizure and Onchocerciasis."

Five streams - Pager, Lakankodi, Adinga, Lanyalyang, and Anyuka - cut across the affected villages.  Proving the link has not been easy, and research into other possible causes such as toxins have not produced answers. An epidemiological study in 2004 was inconclusive.

A study in December 2008 suggests that the "seizure disorder" had been reported in Tanzania as long ago as the 1960s and should be treated as a "syndrome" whose possible link to Onchocerciasis was "intriguing".

In June 2009, a review of studies in eight African countries, including Uganda, looked at the statistical links between river blindness and epilepsy and found that for every 10 percent increase in the prevalence of Onchocerciasis, epilepsy rates go up 0.4 percent.

The report's authors say they found "a close epidemiological association between the two diseases" in the data of over 70,000 patients. The study, in the PLOS Neglected Tropical Diseases journal goes on to suggest a new terminology: Should a causative relationship be demonstrated, onchocerciasis [...] could thus also be called "river epilepsy".

Epilepsy affects some 50 million people worldwide, according to the WHO.  "Seizures can vary from the briefest lapses of attention or muscle jerks, to severe and prolonged convulsions", according to a WHO fact sheet:

Grace Lanyero, a psychiatrist at Kitgum government hospital, said food seemed to trigger off the attacks among the children she has seen. "This is a seizure which begins when the victim begins to eat," she told IRIN. "The child starts nodding with uncoordinated hand movements that don't reach the mouth."

The affected children, she added, were being treated with anti-convulsive drugs and medicines to relax the muscles and control nodding.

Christine Auma, 62, cannot understand what ails her two grandchildren, who have been bedridden for three weeks. The children nod endlessly whenever food is presented to them, and cannot eat properly. "I tried all means of treatment in Kitgum government hospital, but nothing [worked]," she said. "I even tried a traditional healer who slaughtered a black goat but nothing has worked."

The WHO website cites nodding disease as an example of a disease that is not fully understood.

Source: Medindia
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