Environmental Triggers of Eating Seizures in Nodding Syndrome

点头综合征中饮食性癫痫发作的环境诱因

• 批准号: 8520413
• 负责人: Peter S Spencer
• 金额: $ 29.72万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8520413
• 关键词: 21 year old; Affect; Africa; Africa South of the Sahara; Am 80; Amygdaloid structure; Anticonvulsants; Antiepileptic Agents; Blood; Brain; Brain Injuries; Camping; Canned Foods; Child; Cognitive deficits; Communicable Diseases; Communities; Community Health; Complex; Convulsants; Counseling; Country; County; Cyanides; Data; Diet; Disease; Eating; Edible Plants; Environmental Risk Factor; Epidemiologic Studies; Epidemiology; Epilepsy; Ergot Fungus; Etiology; Exposure to; Family; Fatal Outcome; Female; Focal Seizure; Food; Foundations; Glutamates; Head; Health; Individual; Infection; Infectious Agent; Infectious Skin Diseases; Investigation; Iodine; Life; Low income; Malnutrition; Manihot; Mastication; Measures; Mediating; Millet; Minerals; Motor Manifestations; Movement; Mycotoxins; Nematoda; Nested Case-Control Study; Neurologic; Neurons; Nutritional; Nutritional status; Ocular Onchocerciasis; Onchocerca volvulus; Onchocerciasis; Oral; Patients; Pharmaceutical Preparations; Pilot Projects; Plants; Population; Preparation; Prevalence; Prevention; Preventive; Province; Recommendation; Recording of previous events; Recurrence; Reflex Epilepsy; Refractory; Refrigeration; Relative (related person); Research; Risk; Role; Rural; Rural Community; Seizures; Sentinel; Smell Perception; Sorghum; Sudan; Syndrome; Tanzania; Taste Perception; Teenagers; Testing; Time; Tonic - clonic seizures; Toxin; Uganda; Urine; Vitamin B6; Vitamins; World Health Organization; Zinc; aged; authority; base; case control; cohort; cyanogen; disease characteristic; displaced person; food preparation; gamma-Aminobutyric Acid; male; neurotoxic; nutrition; pyridoxine; wasting

DESCRIPTION (provided by applicant): Nodding Syndrome is a brain seizure disorder found in hotspots in sub-Saharan Africa, including Mundri County, Western Equatoria Province, South Sudan, the setting of the proposed epidemiological study. Children typically develop an uncontrollable, rhythmic nodding of the head shortly after beginning to eat their local diet, a phenomenon termed "eating seizures/epilepsy". With time, head nodding may advance to tonic-clonic seizures, wasting, and cognitive deficits, eventually with a fatal outcome. Preliminary studies show that Nodding Syndrome is associated with skin infection with the nematode worm Onchocerca volvulus, the cause of onchocerciasis (River Blindness), but additional local environmental factors must participate because, in other parts of Africa, onchocerciasis is variably associated with epilepsy and rarely with Nodding Syndrome. We hypothesize that plant and/or fungal toxins in food, in the presence or absence of specific nutritional deficiencies, contribute in triggering eating epilepsy in children with Nodding Syndrome. We will test this hypothesis in a cohort of 1000 eligible subjects (males and females, aged 5-21 years), from which we will select 50 subjects with Nodding Syndrome (Cases) and 100 subjects with no history of head nodding or other seizure types (absence, grand mal) (Controls). We will carry out this nested Case:Control study of Nodding Syndrome to examine the relative contributions of exposure to environmental factors associated with epilepsy and other convulsive disorders. These include infectious agents (Onchocerca volvulus), nutritional status (vitamin B6, zinc), plant toxins (cyanogens) and fungal toxins (tremorgens, ergot). These factors will be analyzed in food, blood and urine collected from Cases and Controls and analyzed with respect to Nodding Syndrome. The results will be shared with families, community and health authorities. Recommendations will be made on food preparation and storage to minimize exposure to plant and fungal agents that may trigger seizure activity and thereby advance brain damage. Discovery that plant/fungal toxins can promote seizures in individuals prone to epileptic attacks would have relevance in the prevention and treatment of epileptic disorders worldwide.

描述（由申请人提供）：点头综合症是一种脑部癫痫症，发现于撒哈拉以南非洲的热点地区，包括南苏丹西赤道省蒙德里县，也是拟议流行病学研究的所在地。儿童通常在开始吃当地饮食后不久就会出现无法控制的有节奏的点头，这种现象被称为“饮食性癫痫/癫痫”。 随着时间的推移，点头可能会发展为强直阵挛性癫痫发作、消瘦和认知缺陷，最终导致致命的结果。初步研究表明，诺丁综合征与盘尾丝虫线虫皮肤感染有关，盘尾丝虫病是盘尾丝虫病（河盲症）的病因，但必须有其他当地环境因素参与，因为在非洲其他地区，盘尾丝虫病与癫痫有不同程度的相关性，而且很少见。患有点头综合症。我们假设，无论是否存在特定营养缺乏，食物中的植物和/或真菌毒素都会引发点头综合征儿童的饮食性癫痫。我们将在 1000 名符合条件的受试者（男性和女性，年龄 5-21 岁）组成的队列中检验这一假设，从中我们将选择 50 名患有点头综合症的受试者（病例）和 100 名没有点头或其他癫痫类型病史的受试者（缺席，大病）（控制）。我们将进行这种嵌套的案例：点头综合症对照研究，以检查暴露于与癫痫和其他惊厥性疾病相关的环境因素的相对贡献。其中包括传染源（盘尾丝虫）、营养状况（维生素 B6、锌）、植物毒素（氰）和真菌毒素（震颤菌、麦角菌）。这些因素将在从病例和对照中收集的食物、血液和尿液中进行分析，并针对点头综合征进行分析。结果将与家庭、社区和卫生当局分享。将对食物的制备和储存提出建议，以尽量减少接触可能引发癫痫发作并从而加剧脑损伤的植物和真菌物质。发现植物/真菌毒素可以促进易患癫痫发作的个体癫痫发作，这对于全世界癫痫病的预防和治疗具有重要意义。