The cause of the nodding syndrome has not been definitively identified, but there is a strong epidemiological association with being infected with Onchocerca volvulus.
Distribution: Tanzania, South Sudan, Uganda
The nodding syndrome presents with head nodding:
(1) it is a form of epilepsy
(2) there is a loss of tonus in the neck muscle extensors
(3) the head repeatedly drops forward
The onset is between 3 and 18 years. Prior to onset the patient usually shows normal development.
Others findings that may develop over time:
(1) psychiatric problems (aggression, wandering, depression)
(2) cognitive impairment
(3) epilepsy
(4) subsequent growth retardation
(5) muscle wasting
(6) deformities of the chest, trunk and limbs
