(head nodding syndrome)

Atonic type epileptic seizures characterized by bouts (5-20 times per minute) of the head falling on the chest. This pathology is described since 1960 in 3 South-Saharan countries: Tanzania, Uganda, and southern Sudan where it begins between 3 and 18 years. The prevalence is estimated at 6.8 per 1000 children 5 to 18 years old.

Apart from these bouts of unintentional fall of the head on the chest, the diagnostic criteria are:

-        onset between 3 and 18 years of age

-        presence of other neurologic signs: convulsions, school dropout

-        presence of similar cases in the region or at the same time

-        triggering of the crises by feeding or cool weather

-        weigth loss, or stunting

-        psychiatric signs.

The etiology is unknown but an association has been observed between a recent or ongoing by Onchocerca volvulus infection or  vitamin B6 deficiency. . It could also be an atypical form of temporal lobe epilepsy or a genetic disorder.

Anesthetic implications:

epilepsy, vitamin B6 deficiency ?

References : 

-        Winkler AS, Friedrich K, Meindl M et al. 
Clinical characteristics of people with head nodding in southern Tanzania. 
Trop Doct 2010; 40: 173-5. 

-         Winkler AS, Friedrich K, König R et al. 
The head nodding syndrome: clinical classification and possible causes. 
Epilepsia 2008; 49: 2008-15.

Updated: November 2018