{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:30:21Z","timestamp":1790400621444,"version":"4.1.0"},"reference-count":21,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,10,17]]},"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Nodding syndrome (NS) is a poorly understood neurological disorder affecting thousands of children in Africa. In March 2012, we introduced a treatment intervention that aimed to provide symptomatic relief. This intervention included sodium valproate for seizures, management of behaviour and emotional difficulties, nutritional therapy and physical rehabilitation. We assessed the clinical and functional outcomes of this intervention after 12\u2005months of implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was a cross-sectional study of a cohort of patients with NS receiving the specified intervention. We abstracted preintervention features from records and compared these with the current clinical status. We performed similar assessments on a cohort of patients with other convulsive epilepsies (OCE) and compared the outcomes of the two groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Participants were patients with WHO-defined NS and patients with OCE attending the same centres.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was the proportion of patients with seizure freedom (\u22651\u2005month without seizures). Secondary outcome measures included a reduction in seizure frequency, resolution of behaviour and emotional difficulties, and independence in basic self-care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with NS had had a longer duration of symptoms (median 5 (IQR 3, 6) years) compared with those with OCE (4 (IQR 2, 6) years), p&lt;0.001. The intervention resulted in marked improvements in both groups; compared to the preintervention state, 121\/484 (25%) patients with NS achieved seizure freedom and there was a &gt;70% reduction in seizure frequency; behaviour and emotional difficulties resolved in 194\/327 (59%) patients; 193\/484 (40%) patients had enrolled in school including 17.7% who had earlier withdrawn due to severe seizures, and over 80% had achieved independence in basic self-care. These improvements were, however, less than that in patients with OCE of whom 243\/476 (51.1%) patients were seizure free and in whom the seizure frequency had reduced by 86%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ugandan children with NS show substantial clinical and functional improvements with symptomatic treatments suggesting that NS is probably a reversible encephalopathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2014-006476","type":"journal-article","created":{"date-parts":[[2014,11,15]],"date-time":"2014-11-15T00:56:32Z","timestamp":1416012992000},"page":"e006476","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":48,"title":["Patients with nodding syndrome in Uganda improve with symptomatic treatment: a cross-sectional study"],"prefix":"10.1136","volume":"4","author":[{"given":"Richard","family":"Idro","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Child Health, Mulago Hospital\/Makerere University College of Health Sciences, Kampala, Uganda"},{"name":"Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanifa","family":"Namusoke","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Mulago Hospital\/Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Abbo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Mulago Hospital\/Makerere University College of Health Sciences, Kampala, Uganda"},{"name":"Division of Child and Adolescent Psychiatry, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byamah B","family":"Mutamba","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Mulago Hospital\/Makerere University College of Health Sciences, Kampala, Uganda"},{"name":"Butabika National Referral Hospital, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelina","family":"Kakooza-Mwesige","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Mulago Hospital\/Makerere University College of Health Sciences, Kampala, Uganda"},{"name":"Astrid Lindgren Children's Hospital, Neuropediatric Research Unit, Karolinska Institutet, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert O","family":"Opoka","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Mulago Hospital\/Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdu K","family":"Musubire","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mulago Hospital\/Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amos D","family":"Mwaka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mulago Hospital\/Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard T","family":"Opar","sequence":"additional","affiliation":[{"name":"Ministry of Health Headquarters, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,11,14]]},"reference":[{"key":"2025121221225450000_4.11.e006476.1","first-page":"242","article-title":"Clinical and epidemiologic characteristics of nodding syndrome in Mundri County, 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International scientific meeting on nodding syndrome. Geneva: World Health Organization, 2012."},{"key":"2025121221225450000_4.11.e006476.14","first-page":"219","article-title":"Proposed guidelines for the management of nodding syndrome","volume":"13","author":"Idro","year":"2013","journal-title":"Afr Health Sci"},{"key":"2025121221225450000_4.11.e006476.15","doi-asserted-by":"publisher","DOI":"10.1177\/088307389601100307"},{"key":"2025121221225450000_4.11.e006476.16","doi-asserted-by":"publisher","DOI":"10.1046\/j.1528-1157.2001.21101.x"},{"key":"2025121221225450000_4.11.e006476.17","doi-asserted-by":"crossref","first-page":"409","DOI":"10.2174\/157015910793358196","article-title":"Epileptic encephalopathy\u201d of infancy and childhood: electro-clinical pictures and recent understandings","volume":"8","author":"Parisi","year":"2010","journal-title":"Curr Neuropharmacol"},{"key":"2025121221225450000_4.11.e006476.18","first-page":"52","article-title":"Nodding syndrome\u2014South Sudan, 2011","volume":"61","author":"Centers for Disease Control and Prevention (CDC)","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025121221225450000_4.11.e006476.19","doi-asserted-by":"publisher","DOI":"10.1007\/s00430-007-0062-1"},{"key":"2025121221225450000_4.11.e006476.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)04581-5"},{"key":"2025121221225450000_4.11.e006476.21","first-page":"205","article-title":"Neuropsychiatric perspectives on nodding syndrome in northern Uganda: a case series study and a review of the literature","volume":"13","author":"Musisi","year":"2013","journal-title":"Afr Health Sci"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2014-006476","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:23:06Z","timestamp":1765603386000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2014-006476"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11]]},"references-count":21,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2014,11,14]]},"published-print":{"date-parts":[[2014,11]]}},"alternative-id":["10.1136\/bmjopen-2014-006476"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2014-006476","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,11]]}}}