{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:30:42Z","timestamp":1790400642821,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,12,27]],"date-time":"2018-12-27T00:00:00Z","timestamp":1545868800000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p><jats:italic>Aims<\/jats:italic>. Nodding syndrome is a poorly understood acquired disorder affecting children in sub\u2010Saharan Africa. The aetiology and pathogenesis are unknown, and no specific treatment is available. Affected children have a distinctive feature (repeated clusters of head nodding) and progressively develop many other features. In an earlier pilot study, we proposed a five\u2010level clinical staging system. The present study aimed to describe the early features and natural history of nodding syndrome and refine the proposed clinical stages.<\/jats:p><jats:p><jats:italic>Methods<\/jats:italic>. This was a retrospective study of the progressive development of symptoms and complications of nodding syndrome. Participants were a cohort of patients who had been identified by community health workers and were referred for treatment. A detailed history was obtained to document the chronological development of symptoms before and after onset of head nodding and a physical examination and disability assessment performed by a team of clinicians and therapists.<\/jats:p><jats:p><jats:italic>Results<\/jats:italic>. A total of 210 children were recruited. The mean age at the onset of head nodding was 7.5 (SD: 3.0) years. Five overlapping clinical stages were recognised: prodromal, head nodding, convulsive seizures, multiple impairments, and severe disability stages. Clinical features before the onset of head nodding (prodromal features) included periods of staring blankly or being inattentive, complaints of dizziness, excessive sleepiness, lethargy, and general body weakness, all occurring two weeks to 24 months before nodding developed. After the onset of head nodding, patients progressively developed convulsive seizures, cognitive and psychiatric dysfunction, physical deformities, growth arrest, and eventually, in some patients, severe disability.<\/jats:p><jats:p><jats:italic>Conclusions<\/jats:italic>. The description of the natural history of nodding syndrome and especially the prodromal features has the potential of providing a means for the early identification of at\u2010risk patients and the prompt initiation of interventions before extensive brain injury develops. The wide spectrum of symptoms and complications emphasises the need for multi\u2010disciplinary investigations and care.<\/jats:p>","DOI":"10.1684\/epd.2018.1012","type":"journal-article","created":{"date-parts":[[2019,8,2]],"date-time":"2019-08-02T13:24:29Z","timestamp":1564752269000},"page":"508-516","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["The natural history of nodding syndrome"],"prefix":"10.1002","volume":"20","author":[{"given":"Richard","family":"Idro","sequence":"first","affiliation":[{"name":"Makerere University College of Health Sciences Uganda"},{"name":"Centre for Tropical Neuroscience, Kitgum Site Uganda"},{"name":"Nuffield Department of Medicine, University of Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney","family":"Ogwang","sequence":"additional","affiliation":[{"name":"Makerere University College of Health Sciences Uganda"},{"name":"Centre for Tropical Neuroscience, Kitgum Site Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Kayongo","sequence":"additional","affiliation":[{"name":"Makerere University College of Health Sciences Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Gumisiriza","sequence":"additional","affiliation":[{"name":"Busitema University Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Lanyero","sequence":"additional","affiliation":[{"name":"Gulu Regional Referral hospital Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelina","family":"Kakooza\u2010Mwesige","sequence":"additional","affiliation":[{"name":"Makerere University College of Health Sciences Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Opar","sequence":"additional","affiliation":[{"name":"Ministry of Health, Headquarters Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,27]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"52","article-title":"Nodding syndrome \u2010 South Sudan, 2011","volume":"61","author":"CDC","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12421"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.109-4210"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.1997.tb01545.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-002540"},{"key":"e_1_2_7_7_1","first-page":"219","article-title":"Proposed guidelines for the management of nodding syndrome","volume":"13","author":"Idro R.","year":"2013","journal-title":"Afr Health Sci"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006476"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2016.03.002"},{"key":"e_1_2_7_10_1","first-page":"603","article-title":"Prevalence of nodding syndrome\u2010Uganda, 2012\u20132013","volume":"63","author":"Iyengar P.J.","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aaf6953"},{"key":"e_1_2_7_12_1","first-page":"361","article-title":"The prevalence of epilepsy follows the distribution of onchocerciasis in a West Ugandan focus","volume":"74","author":"Kaiser C.","year":"1996","journal-title":"Bull World Health Organ"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006195"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2008.03104.x"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(13)70003-6"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.13-0546"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2006.75.219"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70321-6"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.09m05305whi"},{"key":"e_1_2_7_20_1","first-page":"183","article-title":"Nodding syndrome in Mundri county. South Sudan: environmental, nutritional and infectious factors","volume":"13","author":"Spencer P.S.","year":"2013","journal-title":"Afr Health Sci"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/13557858.2013.780233"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003880"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12483"},{"key":"e_1_2_7_24_1","unstructured":"World Health Organization.International Scientific Meeting on Nodding Syndrome Kampala 2012.http:\/\/www.who.int\/neglected_diseases\/diseases\/Nodding_syndrom_Kampala_Report_2012.pdf."},{"key":"e_1_2_7_25_1","volume-title":"Onchocerciasis","author":"World Health Organization","year":"2017"}],"container-title":["Epileptic Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1684\/epd.2018.1012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T16:05:57Z","timestamp":1710777957000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1684\/epd.2018.1012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.1684\/epd.2018.1012"],"URL":"https:\/\/doi.org\/10.1684\/epd.2018.1012","archive":["Portico"],"relation":{},"ISSN":["1294-9361","1950-6945"],"issn-type":[{"value":"1294-9361","type":"print"},{"value":"1950-6945","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12]]},"assertion":[{"value":"2017-11-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}