Nodding syndrome and epilepsy in onchocerciasis endemic regions

Comparing preliminary observations from South Sudan and the Democratic Republic of the Congo with data from Uganda

Robert Colebunders, Adam Hendy, John L. Mokili, Joseph Francis Wamala, Joice Kaducu, Lucia Kur, Floribert Tepage, Michel Mandro, Gisele Mucinya, Germain Mambandu, Michel Yendema Komba, Jean Louis Lumaliza, Marieke Van Oijen, Anne Laudisoit

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Nodding syndrome (NS) is an epilepsy disorder occurring in children in South Sudan, northern Uganda and Tanzania. The etiology of NS is unknown, but epidemiological studies demonstrate an association between NS and onchocerciasis. Methods: Between November 2013 and July 2015 we visited onchocerciasis endemic regions in South Sudan, Uganda, and the Democratic Republic of the Congo (DRC) to assess the epilepsy situation. In South Sudan we interviewed patients and affected families, health officials, colleagues and healthcare workers, and performed a small household survey to estimate the epilepsy prevalence in the village of Mvolo, Western Equatoria State. Most information from Uganda was collected through discussions with colleagues and a review of published literature and reports. In the Bas-Uélé district of the DRC, we visited the villages of Liguga, Titule and Dingila, interviewed patients with epilepsy and family members and conducted a preliminary entomological assessment. Results: In South Sudan there is an ongoing NS and epilepsy epidemic in the Western Equatoria state that started around 1990. A survey of 22 households in Mvolo revealed that 28 out of 168 (16.7 %) children suffered from NS or another form of epilepsy. Thirteen (59 %) households had at least one child, and nine (41 %) households at least two children with NS or another form of epilepsy. In northern Uganda, an NS and epilepsy epidemic started around 2000. The occurrence of new NS cases has been in decline since 2008 and no new NS cases were officially reported in 2013. The decline in NS cases coincided with the bi-annual distribution of ivermectin and the treatment of blackfly-breeding rivers with larvicides. In Bas-Uélé district in the DRC, epilepsy appears to be endemic with cases clustered in villages close to blackfly-infested, rapid-flowing rivers. The majority of epilepsy cases in Liguga, Dingila and Titule presented with generalized (tonic-clonic) seizures without nodding, but with mental retardation. In Titule, an epilepsy prevalence of 2.3 % was documented. The only anthropophilic species of blackfly collected in the region belonged to the Simulium damnosum complex. Conclusion: Blackflies may play a key role in the transmission of an etiological agent that either directly or indirectly cause, not only NS, but also other forms of epilepsy in onchocerciasis endemic regions.

Original languageEnglish (US)
Article number182
JournalBMC Research Notes
Volume9
Issue number1
DOIs
StatePublished - Mar 22 2016
Externally publishedYes

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Nodding Syndrome
Onchocerciasis
Democratic Republic of the Congo
Uganda
Epilepsy
Rivers
Ivermectin
Simuliidae
Health
South Sudan

Keywords

  • Africa
  • Blackflies
  • Epilepsy
  • Nodding syndrome
  • Onchocerca
  • Simulium

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Nodding syndrome and epilepsy in onchocerciasis endemic regions : Comparing preliminary observations from South Sudan and the Democratic Republic of the Congo with data from Uganda. / Colebunders, Robert; Hendy, Adam; Mokili, John L.; Wamala, Joseph Francis; Kaducu, Joice; Kur, Lucia; Tepage, Floribert; Mandro, Michel; Mucinya, Gisele; Mambandu, Germain; Komba, Michel Yendema; Lumaliza, Jean Louis; Van Oijen, Marieke; Laudisoit, Anne.

In: BMC Research Notes, Vol. 9, No. 1, 182, 22.03.2016.

Research output: Contribution to journalArticle

Colebunders, R, Hendy, A, Mokili, JL, Wamala, JF, Kaducu, J, Kur, L, Tepage, F, Mandro, M, Mucinya, G, Mambandu, G, Komba, MY, Lumaliza, JL, Van Oijen, M & Laudisoit, A 2016, 'Nodding syndrome and epilepsy in onchocerciasis endemic regions: Comparing preliminary observations from South Sudan and the Democratic Republic of the Congo with data from Uganda', BMC Research Notes, vol. 9, no. 1, 182. https://doi.org/10.1186/s13104-016-1993-7
Colebunders, Robert ; Hendy, Adam ; Mokili, John L. ; Wamala, Joseph Francis ; Kaducu, Joice ; Kur, Lucia ; Tepage, Floribert ; Mandro, Michel ; Mucinya, Gisele ; Mambandu, Germain ; Komba, Michel Yendema ; Lumaliza, Jean Louis ; Van Oijen, Marieke ; Laudisoit, Anne. / Nodding syndrome and epilepsy in onchocerciasis endemic regions : Comparing preliminary observations from South Sudan and the Democratic Republic of the Congo with data from Uganda. In: BMC Research Notes. 2016 ; Vol. 9, No. 1.
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abstract = "Background: Nodding syndrome (NS) is an epilepsy disorder occurring in children in South Sudan, northern Uganda and Tanzania. The etiology of NS is unknown, but epidemiological studies demonstrate an association between NS and onchocerciasis. Methods: Between November 2013 and July 2015 we visited onchocerciasis endemic regions in South Sudan, Uganda, and the Democratic Republic of the Congo (DRC) to assess the epilepsy situation. In South Sudan we interviewed patients and affected families, health officials, colleagues and healthcare workers, and performed a small household survey to estimate the epilepsy prevalence in the village of Mvolo, Western Equatoria State. Most information from Uganda was collected through discussions with colleagues and a review of published literature and reports. In the Bas-U{\'e}l{\'e} district of the DRC, we visited the villages of Liguga, Titule and Dingila, interviewed patients with epilepsy and family members and conducted a preliminary entomological assessment. Results: In South Sudan there is an ongoing NS and epilepsy epidemic in the Western Equatoria state that started around 1990. A survey of 22 households in Mvolo revealed that 28 out of 168 (16.7 {\%}) children suffered from NS or another form of epilepsy. Thirteen (59 {\%}) households had at least one child, and nine (41 {\%}) households at least two children with NS or another form of epilepsy. In northern Uganda, an NS and epilepsy epidemic started around 2000. The occurrence of new NS cases has been in decline since 2008 and no new NS cases were officially reported in 2013. The decline in NS cases coincided with the bi-annual distribution of ivermectin and the treatment of blackfly-breeding rivers with larvicides. In Bas-U{\'e}l{\'e} district in the DRC, epilepsy appears to be endemic with cases clustered in villages close to blackfly-infested, rapid-flowing rivers. The majority of epilepsy cases in Liguga, Dingila and Titule presented with generalized (tonic-clonic) seizures without nodding, but with mental retardation. In Titule, an epilepsy prevalence of 2.3 {\%} was documented. The only anthropophilic species of blackfly collected in the region belonged to the Simulium damnosum complex. Conclusion: Blackflies may play a key role in the transmission of an etiological agent that either directly or indirectly cause, not only NS, but also other forms of epilepsy in onchocerciasis endemic regions.",
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AU - Hendy, Adam

AU - Mokili, John L.

AU - Wamala, Joseph Francis

AU - Kaducu, Joice

AU - Kur, Lucia

AU - Tepage, Floribert

AU - Mandro, Michel

AU - Mucinya, Gisele

AU - Mambandu, Germain

AU - Komba, Michel Yendema

AU - Lumaliza, Jean Louis

AU - Van Oijen, Marieke

AU - Laudisoit, Anne

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N2 - Background: Nodding syndrome (NS) is an epilepsy disorder occurring in children in South Sudan, northern Uganda and Tanzania. The etiology of NS is unknown, but epidemiological studies demonstrate an association between NS and onchocerciasis. Methods: Between November 2013 and July 2015 we visited onchocerciasis endemic regions in South Sudan, Uganda, and the Democratic Republic of the Congo (DRC) to assess the epilepsy situation. In South Sudan we interviewed patients and affected families, health officials, colleagues and healthcare workers, and performed a small household survey to estimate the epilepsy prevalence in the village of Mvolo, Western Equatoria State. Most information from Uganda was collected through discussions with colleagues and a review of published literature and reports. In the Bas-Uélé district of the DRC, we visited the villages of Liguga, Titule and Dingila, interviewed patients with epilepsy and family members and conducted a preliminary entomological assessment. Results: In South Sudan there is an ongoing NS and epilepsy epidemic in the Western Equatoria state that started around 1990. A survey of 22 households in Mvolo revealed that 28 out of 168 (16.7 %) children suffered from NS or another form of epilepsy. Thirteen (59 %) households had at least one child, and nine (41 %) households at least two children with NS or another form of epilepsy. In northern Uganda, an NS and epilepsy epidemic started around 2000. The occurrence of new NS cases has been in decline since 2008 and no new NS cases were officially reported in 2013. The decline in NS cases coincided with the bi-annual distribution of ivermectin and the treatment of blackfly-breeding rivers with larvicides. In Bas-Uélé district in the DRC, epilepsy appears to be endemic with cases clustered in villages close to blackfly-infested, rapid-flowing rivers. The majority of epilepsy cases in Liguga, Dingila and Titule presented with generalized (tonic-clonic) seizures without nodding, but with mental retardation. In Titule, an epilepsy prevalence of 2.3 % was documented. The only anthropophilic species of blackfly collected in the region belonged to the Simulium damnosum complex. Conclusion: Blackflies may play a key role in the transmission of an etiological agent that either directly or indirectly cause, not only NS, but also other forms of epilepsy in onchocerciasis endemic regions.

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