Nodding Syndrome in Uganda: Risk Factors at Disease Onset (P2.321)

OBJECTIVE: To determine environmental factors associated with Nodding Syndrome (NS), a treatable but otherwise progressive form of epilepsy in east Africa. BACKGROUND: Uncontrollable head nodding, often food-associated, was first described in Tanzania in the 1960s, with reports from 1934 (Afr. Health Sci. 13:176-82, 2013). Many develop generalized seizures. Large outbreaks of NS occurred in South Sudan (from 1991) and Uganda (from 1997), the latter affecting thousands of children. Common risk factors include population displacement, food insecurity, and systemic infection with Onchocerca volvulus, transmitted by Simulium (blackfly) in these and other sub-Sahara regions where NS is not reported. DESIGN/METHODS: In March 2014, we conducted a case-control study of NS in Tumangu, Kitgum, Uganda. Subjects included children with probable NS (n=50) and age- and gender-matched community Controls living in epilepsy-free households (n=50). Data included a dietary questionnaire at NS onset (reported here) and urine/plasma analyses (in progress). Cases were identified by local healthcare workers and defined as 5-18 year-old persons with episodes of repetitive head nodding. Logistic regression was used to evaluate association. RESULTS: Reported NS onset was 2000-2013, with peaks in 2003 and 2008. Month of onset was non-uniform, with all-year-aggregated peaks in April and June that were not correlated with rainfall pattern or blackfly peak biting periods. Ten locally harvested staples were limited in January to May, and food insecurity in Internally Displaced Person camps began in March and peaked in June. Eating emergency food [OR=4.0 (1.3-12.4), P=0.0162], moldy maize [OR=4.0 (1.0-16.0), P=0.0496], emergency red sorghum [OR 2.4 (0.9-6.5), P=0.0848], and (pesticide-coated) painted seed [OR 2.3 (0.9-5.8), P=0.0696], was more likely in cases than in controls. CONCLUSIONS: Exposure to plant components with chemical substances of natural origin (mycotoxins) and synthetic origin (pesticide) are possible risk factors for NS in northern Uganda. Study Supported by: Grant R01 NS079276 to P.S.S. Disclosure: Dr. Mazumder has nothing to disclose. Dr. Palmer has nothing to disclose. Dr. Spencer has received personal compensation for activities as a consultant for a chemical company. Dr. King has nothing to disclose. Dr. Stadnik has nothing to disclose. Dr. Lasarev has nothing to disclose. Dr. Kabahenda has nothing to disclose. Dr. Kitara has nothing to disclose. Dr. Stadler has nothing to disclose.