A longitudinal study on nodding syndrome—a new African epilepsy disorder. Issue 1 (20th December 2013) - Winkler, Andrea S.
Summary Objectives Nodding syndrome (NS), a new epilepsy disorder of sub‐Saharan Africa, has only recently been classified. In a study conducted in southern Tanzania in 2005, 62 patients with NS were analyzed in great detail. The present study, a follow‐up investigation, was conducted to evaluate the progression of NS over time and to obtain serial electroencephalography (EEG) data. Methods Of the 62 NS patients, 53 (85.5%), the majority of whom were currently on some form of antiepileptic treatment, could be reevaluated in 2009 with a standardized questionnaire. A subset of these patients (25/53) underwent EEG investigation. Results In patients with "head nodding (HN) only" in 2005, 10 (43.5%) of 23 remained with the same diagnosis, whereas 5 (21.7%) of 23 had developed "HN plus" (i.e., HN and generalized tonic–clonic seizures). Six patients (26.1%) had seizures other than HN only, and two patients (8.7%) had fully recovered. In the "HN plus" group of 2005, 9 (30.0%) of 30 patients remained "HN plus, " and 15 patients (50.0%) had seizures other than HN only. Four patients (13.3%) reverted to "HN only, " and two patients (6.7%) stopped all seizures. In 11 (44.0%) of 25 patients, electroencephalography (EEG) showed generalized slowing. Six (54.6%) of these 11 abnormal EEG studies further showed generalized epileptiform discharges: (1) ictal electroencephalographic pattern with generalized 2.5 Hz spike and waves in two patients and (2) interictal bursts of 1.5–2 Hz spike and waves in four patients. Significance This follow‐up study confirms that HN represents an epilepsy disorder, possibly of the atypical absence type with dynamic development over time.