1
|
Spencer PS, Valdes Angues R, Palmer VS. Nodding syndrome: A role for environmental biotoxins that dysregulate MECP2 expression? J Neurol Sci 2024; 462:123077. [PMID: 38850769 DOI: 10.1016/j.jns.2024.123077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 05/15/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
Nodding syndrome is an epileptic encephalopathy associated with neuroinflammation and tauopathy. This initially pediatric brain disease, which has some clinical overlap with Methyl-CpG-binding protein 2 (MECP2) Duplication Syndrome, has impacted certain impoverished East African communities coincident with local civil conflict and internal displacement, conditions that forced dependence on contaminated food and water. A potential role in Nodding syndrome for certain biotoxins (freshwater cyanotoxins plus/minus mycotoxins) with neuroinflammatory, excitotoxic, tauopathic, and MECP2-dysregulating properties, is considered here for the first time.
Collapse
Affiliation(s)
- Peter S Spencer
- Department of Neurology, School of Medicine and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA; Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA; Gulu University School of Medicine, Gulu, Uganda.
| | - Raquel Valdes Angues
- Department of Neurology, School of Medicine and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Valerie S Palmer
- Department of Neurology, School of Medicine and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA; Gulu University School of Medicine, Gulu, Uganda
| |
Collapse
|
2
|
Kegele J, Wagner T, Kowenski T, Wiesmayr M, Gatterer C, Alber M, Matuja W, Schmutzhard E, Lerche H, Winkler AS. Long-term clinical course and treatment outcomes of individuals with Nodding Syndrome. J Neurol Sci 2024; 457:122893. [PMID: 38278097 DOI: 10.1016/j.jns.2024.122893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/28/2024]
Abstract
Nodding Syndrome is a poorly understood epilepsy disorder in sub-Saharan Africa. The cause(s) of the disease, risk factors and long-term outcomes are unknown or controversial. The objectives of this study were to describe the long-term clinical course and treatment outcomes of individuals suffering from Nodding Syndrome. In addition, we aimed to provide a comprehensive characterization of the epileptological and social features of patients with Nodding Syndrome. From 11/2014 to 4/2015, we conducted a hospital-based, cross-sectional and observational study in Mahenge, Tanzania. Seventy-eight individuals (female:male ratio: 40:38, age at examination: 21.1 ± 6.39 (SD) years) have been enrolled, of whom 38 (49%) had also been examined in 2005 and in 2009. The 10-year clinical course analysis of this revisited subgroup revealed a calculated case fatality of 0.8-2.3%. Progressive physical or cognitive deterioration has not been observed in any of the 78 individuals and more than half of the people studied (38/69; 55%) managed to live and work independently. 14/78 individuals (18%) were seizure-free, (no head nodding, no other seizure types), 13 of whom were taking antiseizure medication. Phenytoin was more effective against head nodding seizures (14/19 (74%)) than monotherapy with other available antiseizure medication (phenobarbitone 12/25 (48%) and carbamazepine 7/22 (32%), p = 0.02, chi-square test). Our ten-year clinical outcome data show that Nodding Syndrome is not a fatal disease, however, the response to treatment is worse than in epilepsy patients in general. Phenytoin may be more effective than carbamazepine and phenobarbitone, but further studies are needed to confirm this observation.
Collapse
Affiliation(s)
- Josua Kegele
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler Straße 3, 72076 Tuebingen, Germany.
| | - Thomas Wagner
- Centre for Pediatric and Adolescent Medicine, University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Teresa Kowenski
- Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Matthias Wiesmayr
- Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | | | - Michael Alber
- Pediatric Neurology and Developmental Medicine, University of Tübingen, Hoppe-Seyler Straße 3, 72076 Tuebingen, Germany.
| | - Wiliam Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Erich Schmutzhard
- Department of Neurology, Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria.
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler Straße 3, 72076 Tuebingen, Germany.
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
3
|
Metanmo S, Dossa D, Ahmat DN, Winkler AS, Boumediene F. Mapping, Associated Factors, and Pathophysiology of Nodding Syndrome in Africa: A Systematic Review. Neuroepidemiology 2024; 58:92-119. [PMID: 38171341 DOI: 10.1159/000536013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Nodding syndrome (NS) remains a poorly understood disorder. For a long time, it has been thought to be restricted to East Africa; however, cases in Central Africa have been increasing over time. The objective of this systematic review (SR) was to provide a summary of the state of knowledge on NS to date. METHODS All original articles published on NS up to November 2021 were searched in four major databases and in the gray literature. Commentaries, editorials, book chapters, books, conference paper, qualitative studies that mentioned NS cases were also included. Data retrieved included study location (with GPS coordinates searched), year of study and publication, population characteristics, definition and diagnosis of NS, associated factors, and treatment if applicable. A meta-analysis of associated factors was performed where possible, and results were presented as odds ratios (ORs) and visualized as forest plots. Geographic information systems were used for cartographic representations. The quality of the articles included was assessed. RESULTS Of the 876 articles initially identified, 67 (corresponding to 59 studies) were included in the SR. NS is only present in Central and East Africa. Interestingly, there were reports of NS in Central Africa prior to 2010, earlier than previously thought. The way NS diagnosis was established varies according to studies, and the 2012 WHO classification was used in only 60% of the studies. Approximately 11% of the articles did not meet the quality requirements set for this review. In our meta-analysis, the main factor associated with NS was onchocerciasis (OR = 8.8 [4.8, 15.9]). However, the pathophysiology of the disease remains poorly understood. The lack of common anti-epileptic drugs is a significant barrier to the management of head nodding and associated epileptic seizures. DISCUSSION/CONCLUSION The lack of an operational definition of NS is an obstacle to its diagnosis and, thus, to its appropriate treatment. Indeed, diagnostic difficulties might have led to false positives and false negatives which could have altered the picture of NS presented in this article. Treatment should take into account nutritional and psychological factors, as well as associated infections. Some risk factors deserve further investigation; therefore, we suggest a multicentric study with an etiological focus using a more operational definition of NS.
Collapse
Affiliation(s)
- Salvatore Metanmo
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Djamirou Dossa
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Djibrine Nassir Ahmat
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Andrea Sylvia Winkler
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Farid Boumediene
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France,
| |
Collapse
|
4
|
Spencer P, Okot C, Palmer V, Valdes Angues R, Mazumder R. Nodding syndrome: A key role for sources of nutrition? eNeurologicalSci 2022; 27:100401. [PMID: 35480298 PMCID: PMC9035392 DOI: 10.1016/j.ensci.2022.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 12/16/2022] Open
Abstract
Nodding Syndrome (NS) has occurred among severely food-stressed communities in northern Uganda and several other East African populations that, with their forced physical displacement, have resorted to nutritional support from available wild plants and fungi, some of which have neurotoxic potential. Among the latter is an agaric mushroom with an unknown content of hydrazine-generating agaritine, namely Agaricus bingensis, the unusually wide consumption of which may relate to the low serum levels of vitamin B6 in Ugandan NS subjects relative to controls. Hydrazine-related compounds induce patterns of DNA damage that promote neuropathological changes (tauopathy) reminiscent of those associated with established NS. While the cause of this childhood brain disease is unknown, we encourage increased attention to the role of malnutrition and B6 hypovitaminosis in the etiology of this devastating brain disease.
Collapse
Affiliation(s)
- P.S. Spencer
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | | | - V.S. Palmer
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - R. Valdes Angues
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - R. Mazumder
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, USA
| |
Collapse
|
5
|
Pollanen MS, Onzivua S, McKeever PM, Robertson J, Mackenzie IR, Kovacs GG, Olwa F, Kitara DL, Fong A. The spectrum of disease and tau pathology of nodding syndrome in Uganda. Brain 2022; 146:954-967. [PMID: 35411378 PMCID: PMC9976958 DOI: 10.1093/brain/awac137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Nodding syndrome is an enigmatic recurrent epidemic neurologic disease that affects children in East Africa. The illness begins with vertical nodding of the head and can progress to grand mal seizures and death after several years. The most recent outbreak of nodding syndrome occurred in northern Uganda. We now describe the clinicopathologic spectrum of nodding syndrome in northern Uganda. The neuropathologic findings of 16 children or young adults with fatal nodding syndrome were correlated with the onset, duration and progression of their neurological illness. The affected individuals ranged in age from 14 to 25 years at the time of death with a duration of illness ranging from 6-15 years. All 16 cases had chronic seizures. In 10 cases, detailed clinical histories were available and showed that three individuals had a clinical course that was predominantly characterized by epilepsy, whereas the other seven individuals had progressive cognitive, behavioural and motor decline, in addition to epilepsy. The main neuropathologic findings included: tau pathology (16/16 cases), cerebellar degeneration (11/16 cases) and white matter degeneration (7/16 cases). The tau pathology was characterized by filamentous tau-positive deposits in the form of neurofibrillary tangles, pre-tangles and dot-like grains and threads in the neuropil. All cases showed some degree of tau pathology in the neocortex and in the locus coeruleus with frequent involvement of the substantia nigra and tegmental nuclei and lesser involvement of other grey matter sites, but there was a lack of glial tau pathology. The tau pathology in the neocortex showed a multifocal superficial laminar pattern. We conclude that nodding syndrome is a clinicopathological entity associated consistently with tau pathology, but our observations did not establish the cause of the disease, or an explanation for the tau pathology.
Collapse
Affiliation(s)
- Michael S Pollanen
- Correspondence to: Michael S. Pollanen 135 Nassau Street, K6D-448, Toronto Ontario Canada M5T 1M8 E-mail:
| | - Sylvester Onzivua
- Department of Pathology, College of Health Sciences, Makerere University, Kampala PO 7072, East Africa
| | - Paul M McKeever
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario M5G 2C4, Canada
| | - Janice Robertson
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario M5G 2C4, Canada
| | - Ian R Mackenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z7, Canada
| | - Gabor G Kovacs
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario M5G 2C4, Canada,Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Ontario M5G 2C4, Canada
| | - Francis Olwa
- Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda PO 166, East Africa
| | - David L Kitara
- Department of Surgery, Faculty of Medicine, Gulu University, Gulu, Uganda PO 166, East Africa
| | - Amanda Fong
- Ontario Forensic Pathology Service, Toronto, Ontario M3M 0B1, Canada
| |
Collapse
|
6
|
Abd-Elfarag GOE, Edridge AWD, Spijker R, Sebit MB, van Hensbroek MB. Nodding Syndrome: A Scoping Review. Trop Med Infect Dis 2021; 6:tropicalmed6040211. [PMID: 34941667 PMCID: PMC8703395 DOI: 10.3390/tropicalmed6040211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/23/2022] Open
Abstract
Nodding syndrome (NS) is a debilitating yet often neglected neurological disease affecting thousands of children in several sub-Saharan African countries. The cause of NS remains unknown, and effective treatment options are lacking. Moreover, knowledge regarding NS is scarce and is based on a limited number of publications, with no comprehensive overview published to date. Therefore, the aim of this scoping review was to summarise the current evidence and identify existing knowledge gaps in order to help clinicians, scientists, and policymakers develop guidelines for prioritising this severe condition. We searched the Medline (Ovid), Embase (Ovid), Scopus, and Global Health Library databases in accordance with the PRISMA extension for scoping review guidance and in accordance with the Joanna Briggs Institute guidelines and methodology for a scoping review, using keywords describing NS. We then extracted and presented the original data regarding the epidemiology, aetiology, pathophysiology, clinical features, diagnosis, management, and outcomes of NS, as well as community perceptions and the psychosocial and economic impact of NS. Out of 1470 identified articles, a total of 69 were included in this scoping review. Major gaps exist in understanding the aetiology and pathogenesis of NS. Future research is urgently needed not only to address these gaps, but also to study the treatment options, epidemiology, and psychosocial and economic impacts of NS. Innovative interventions and rehabilitation programmes designed to address the psychosocial and economic burdens associated with NS are also urgently needed.
Collapse
Affiliation(s)
- Gasim Omer Elkhalifa Abd-Elfarag
- Amsterdam Center for Global Health, Department of Pediatrics and Department of Global Health, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (A.W.D.E.); (M.B.v.H.)
- Correspondence:
| | - Arthur Wouter Dante Edridge
- Amsterdam Center for Global Health, Department of Pediatrics and Department of Global Health, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (A.W.D.E.); (M.B.v.H.)
- Laboratory of Experimental Virology, Department of Medical Microbiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - René Spijker
- Amsterdam Public Health, Medical Library, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
| | - Mohamed Boy Sebit
- Department of Psychiatry, College of Medicine, University of Juba, Juba P.O. Box 82, Sudan;
| | - Michaël B. van Hensbroek
- Amsterdam Center for Global Health, Department of Pediatrics and Department of Global Health, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (A.W.D.E.); (M.B.v.H.)
| |
Collapse
|
7
|
Human Biomonitoring of T-2 Toxin, T-2 Toxin-3-Glucoside and Their Metabolites in Urine through High-Resolution Mass Spectrometry. Toxins (Basel) 2021; 13:toxins13120869. [PMID: 34941707 PMCID: PMC8703800 DOI: 10.3390/toxins13120869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 01/24/2023] Open
Abstract
The metabolic profile of T-2 toxin (T-2) and its modified form T-2-3-glucoside (T-2-3-Glc) remain unexplored in human samples. Therefore, the present study aimed to investigate the presence of T-2, T-2-3-Glc and their respective major metabolites in human urine samples (n = 300) collected in South Italy through an ultra-high performance liquid chromatography (UHPLC) coupled to Q-Orbitrap-HRMS methodology. T-2 was quantified in 21% of samples at a mean concentration of 1.34 ng/mg Crea (range: 0.22–6.54 ng/mg Crea). Almost all the major T-2 metabolites previously characterized in vitro were tentatively found, remarking the occurrence of 3′-OH-T-2 (99.7%), T-2 triol (56%) and HT-2 (30%). Regarding T-2-3-Glc, a low prevalence of the parent mycotoxin (1%) and its metabolites were observed, with HT-2-3-Glc (17%) being the most prevalent compound, although hydroxylated products were also detected. Attending to the large number of testing positive for T-2 or its metabolites, this study found a frequent exposure in Italian population.
Collapse
|