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Nodding Syndrome-A Mysterious Disease Affecting Children

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Nodding Syndrome-A Mysterious Disease Affecting Children International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Review Article Nodding Syndrome - A Mysterious Disease Affecting Children Arun Kumar VN Assistant Professor, Rama Nursing College, Kanpur, UP. Received: 19/07/2016 Revised: 14/08/2016 Accepted: 16/08/2016 ABSTRACT Nodding Syndrome is a disorder of brain that affects children and adolescents in African countries. It is characterized by episodes of repetitive dropping forward of the head, often accompanied by other seizure-like activity, such as convulsions or staring spells. Studies have suggested that the head nods are due to atonic seizures. Since the cause is not known cause, symptomatic treatment was given. The objective is to relieve symptoms, and to provide primary and secondary prevention for disability and to improve function. The most important aspect of treatment was seizure control, management of behavioral and psychiatric difficulties, nursing care, nutritional and physical and cognitive rehabilitation. Key words: Nodding Syndrome, Seizure, Convulsions. INTRODUCTION are investigating to find out the exact cause Nodding Syndrome is a neurologic and pathophysiology for nodding disease. disorder of unknown etiology that affects The cause for the nodding is a children and adolescents in some parts of special seizure called an atonic seizure. Africa. There are probably between 5000 - Associations of the disease with 10,000 affected children in East Africa. This malnutrition and with onchocerciasis was first reported in Tanzania in 1960’s and (parasitic infection) later from Liberia, South Sudan and Signs and symptoms Northern Uganda where there are several Head Nodding is defined as thousand affected individuals. The repeated, involuntary drooping of the head syndrome is characterized by head nodding on two or more occasions. Frequency of with variable presence of seizure types, nodding 5 to 20 per minute. It is usually cognitive and motor decline, wasting, accompanied by following minor criteria: stunting, behaviour and psychiatric neurological abnormalities (cognitive difficulties. decline, school dropout due to cognitive or Definition behavioral problems, seizures or Nodding syndrome is a neurologic neurological abnormalities), Clustering in condition characterized by episodes of space or time with similar cases, Triggered repetitive dropping forwards of the head, by food or cold weather, Stunting or accompanied with seizure-like activity, such wasting, Delayed sexual or physical as convulsions or staring spells. The development. Psychiatric symptoms such as condition commonly affects children aged impulsivity, emotional and mood disorders 5-15 years. and cognitive decline. Causes Depression and anxiety, including World Health Organization (WHO) post-traumatic stress disorder are associated and the Centers of Disease Control (CDC) with this syndrome. International Journal of Health Sciences & Research (www.ijhsr.org) 467 Vol.6; Issue: 9; September 2016 Arun Kumar VN. Nodding Syndrome-A Mysterious Disease Affecting Children Investigations 5mL/kg/hr for the first 2 hours, then 5- Investigations such as blood test for 10mL/kg ReSoMal. malaria parasites, blood glucose, complete Severely anemic patients blood count, ESR, liver and renal function, (haemoglobin <5g/dl) with under nutrition electrolytes and creatine kinase. are given blood transfusion at 5 -7 mL/kg. chest x ray to detect chest infection 4. Microfilaria and helminthic and x-rays of the wrist to determine bone treatment. age Electroencephalogram recording for Sometimes Nodding Syndrome is seizure activity lumbar puncture for associated with infestation with Onchocerca cerebrospinal fluid analysis to detect volvulus. Interventions for this include meningitis brain imaging with brain MRI or aerial spraying against the parasite and mass CT scan to detect structural & functional treatment of all people living in the affected abnormalities. areas with antifilarial drug e.g.: ivermectin. Management Because of high prevalence of 1. Seizure control. intestinal helminthes in these rural setting, a 2. Management of behavioral, social single dose of Albendazole 400mg is and psychiatric difficulties. recommended. It is repeated every 6 3. Management of malnutrition. months. 4. Microfilaria and helminthic 5. Nursing management treatment. Nursing Management include 5. Nursing care. parental education on epilepsy and seizure 6. Assessment and rehabilitation of management, Use of & common side effects functional difficulties and of anti epileptic drugs and treatment disabilities. adherence, nutrition, hygiene, injury 7. Follow up care Surveillance, prevention and wound care. Children with documentation, community frequent seizures should be supervised to education and engagement. prevent injury. Encourage, teach and 1. Seizure control supervise self care, feeding, toileting, The initial management for seizure hygiene and monitor growth. Make sure that control include intravenous benzodiazepine vaccinations are up to date & promote use (Diazepam 0.3mg/kg, Midazolam 0.3mg/kg of insecticide for malaria prevention. /Lorazepam0.1mg/kg). Parents should be discouraged from 2. Management of behavioral, social and restraining children with ropes. psychiatric difficulties Wounds should be cleaned dressed Some of behavioral changes can be regularly and parents should be taught to modified positively or, rarely, negatively by keep the wounds dry and clean. Parents sodium valproate. Other Management should be advised on food preparation and includes counseling for patients and their children should perform mild daily caretakers about the illness, talking about exercises to prevent muscle atrophy, and finding solutions to the emotional, storytelling, and play therapy to help with social and behavioral problems, and follow concentration, memory and stimulation up care and referral to a mental health 6. Functional difficulties and disabilities agency for drug therapy (E.g. Treatment for Assessment depression and anti psychotic drugs) and Difficulties include behavior, motor, other interventions. psychiatric difficulties, declining cognitive 3. Management of malnutrition function and difficulties with personal care. Children, who are under nutrition The speech may not be clear and patients and dehydration, are given rehydration may be confused and disoriented especially solution for malnutrition e.g. (ReSoMal) at during and up to 24 hours following a seizure. Speech difficulties may arise from International Journal of Health Sciences & Research (www.ijhsr.org) 468 Vol.6; Issue: 9; September 2016 Arun Kumar VN. Nodding Syndrome-A Mysterious Disease Affecting Children impaired cognition, seizures or muscle Lacey M: Nodding disease: mystery of weakness. All should be individually southern Sudan. Lancet Neurol 2003; assessed & repeated Assessment during 2:714. follow up visits to document any Blednov YA, Benavidez JM, Homanics progression or improvements with therapy. GE, Harris RA: Behavioral Document the presence of any of these characterization of knockin mice with difficulties and provide a management plan mutations M287L and Q266I in the glycine receptor alpha1 subunit. J for each. Pharmacol Exp Ther 2012; 340:317- 7. Follow up care 329. For every follow up visit, children Kaiser C, Pion S, Boussinesq M: Head should be assessed for seizure control, nodding syndrome and river blindness: medication side-effects, and nutrition, and a parasitologic perspective. Epilepsia disability, psychological and social issues. 2009; 50:2325-2326. Follow up visits should be conducted every Wasswa H: Ugandan authorities deal 2 weeks until there is seizure control. with a mysterious ailment that leaves people nodding continuously. BMJ CONCLUSION 2012; 344:e349. Nodding Syndrome is a disorder of Sejvar JJ, Kakooza AM, Foltz JL, brain that affects children both physically & Makumbi I, Atai-Omoruto AD, mentally. It is a fatal disorder with duration Malimbo M, Ndyomugyenyi R, Alexander LN, Abang B, Downing RG, of 3 or more years. Since the exact cause is et al: Clinical, neurological, and not known symptomatic treatment is done to electrophysiological features of nodding reduce the severity of disease. Hope soon syndrome in Kitgum, Uganda: an our scientists will find out the root cause of observational case series. Lancet, the disease & exact treatment for this & Neurol 2013; 12:166-174. thereby saving many lives of children’s. Idro R, Opoka R O, Aanyu H T, Kakooza-Mwesige A, Piloya-Were T, REFERENCES Namusoke H, Tumwine JK. Nodding Korevaar DA, Visser BJ: Reviewing the syndrome in Ugandan children-clinical evidence on nodding syndrome, a features, brain imaging and mysterious tropical disorder. Int J Infect complications: a case series. BMJ open, Dis 2013; 17(3):1149-152. 2013; 3(5) e00 2540.doi: 10.1136/ bmj Jilek LA: [Mental Diseases and open-2012-00 2540. Epilepsy in Tropical Africa]. Fortschr Musisi S, Nakimuli-Mpungu E, Akena Neurol Psychiatr Grenzgeb 1964; D, Bangirana P, Kinyanda E. 32:213-259. Psychological Manifestations of Goudsmit J, van der Waals FW: Nodding Syndrome in Northern Endemic epilepsy in an isolated region Uganda: A Case report. African Journal of Liberia. Lancet 1983, 1:528-529. of Traumatic Stress 2011: 2 (1): 56-57. How to cite this article: Kumar VNA. Nodding syndrome - a mysterious disease affecting children. Int J Health Sci Res. 2016; 6(9):467-469. *********** International Journal of Health Sciences & Research (www.ijhsr.org) 469 Vol.6; Issue: 9; September 2016 .
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