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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Jul;69(1):96–101. doi: 10.1136/jnnp.69.1.96

Persistence of tropical ataxic neuropathy in a Nigerian community

O Oluwole 1, A Onabolu 1, H Link 1, H Rosling 1
PMCID: PMC1736992  PMID: 10864612

Abstract

OBJECTIVES—The term tropical ataxic neuropathy (TAN) is currently used to describe several neurological syndromes attributed to toxiconutritional causes. However, TAN was initially proposed to describe a specific neurological syndrome seen predominantly among the Ijebu speaking Yorubas in south western Nigeria. In this study, the prevalence of TAN was determined in Ososa, a semiurban community in south western Nigeria described as endemic for TAN in 1969, and its neurological features were compared with Strachan's syndrome, prisoners of war neuropathy, the epidemic neuropathy in Cuba, and konzo.
METHODS—A census of Ososa was followed by door to door screening of all subjects aged 10 years and above with a newly designed screening instrument. Subjects who screened positive had a neurological examination, and the diagnosis of TAN was made if any two or more of bilateral optic atrophy, bilateral neurosensory deafness, sensory gait ataxia, or distal symmetric sensory polyneuropathy were present.
RESULTS—A total of 4583 inhabitants were registered in the census. Of these, 3428 subjects aged 10 years and above were screened. The diagnosis of TAN was made in 206 of 323 subjects who screened positive for TAN. The prevalence of TAN was 6.0%, 3.9% in males and 7.7% in females. The highest age specific prevalence was 24% in the 60-69 years age group in women.
CONCLUSION—The occurrence of TAN in Ososa continues at a higher prevalence than was reported 30 years ago. Its neurological features and natural history do not resemble those described for Strachan syndrome, epidemic neuropathy in Cuba, or konzo. The increasing consumption of cassava foods linked to its causation makes TAN of public health importance in Nigeria, the most populous African country.



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Selected References

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  1. Hendrie H. C., Osuntokun B. O., Hall K. S., Ogunniyi A. O., Hui S. L., Unverzagt F. W., Gureje O., Rodenberg C. A., Baiyewu O., Musick B. S. Prevalence of Alzheimer's disease and dementia in two communities: Nigerian Africans and African Americans. Am J Psychiatry. 1995 Oct;152(10):1485–1492. doi: 10.1176/ajp.152.10.1485. [DOI] [PubMed] [Google Scholar]
  2. Howlett W. P., Brubaker G. R., Mlingi N., Rosling H. Konzo, an epidemic upper motor neuron disease studied in Tanzania. Brain. 1990 Feb;113(Pt 1):223–235. doi: 10.1093/brain/113.1.223. [DOI] [PubMed] [Google Scholar]
  3. Le Quesne P. M. Persisting nutritional neuropathy in former war prisoners. Br Med J (Clin Res Ed) 1983 Mar 19;286(6369):917–918. doi: 10.1136/bmj.286.6369.917-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. MONEKOSSO G. L., ANNAN W. G. CLINICAL EPIDEMIOLOGICAL OBSERVATIONS ON AN ATAXIC SYNDROME IN WESTERN NIGERIA. Trop Geogr Med. 1964 Dec;16:316–323. [PubMed] [Google Scholar]
  5. MONEY G. L. Clinical aspects of tropical ataxic neuropathies related to malnutrition. West Afr Med J. 1959 Feb;8(1):3–17. [PubMed] [Google Scholar]
  6. MONEY G. L. Endemic neuropathies in the Epe district of Southern Nigeria. West Afr Med J. 1958 Mar;7(1):58–62. [PubMed] [Google Scholar]
  7. Mantakassa: an epidemic of spastic paraparesis associated with chronic cyanide intoxication in a cassava staple area of Mozambique. 1. Epidemiology and clinical and laboratory findings in patients. Ministry of Health, Mozambique. Bull World Health Organ. 1984;62(3):477–484. [PMC free article] [PubMed] [Google Scholar]
  8. Mantakassa: an epidemic of spastic paraparesis associated with chronic cyanide intoxication in a cassava staple area of Mozambique. 2. Nutritional factors and hydrocyanic acid content of cassava products. Ministry of Health, Mozambique. Bull World Health Organ. 1984;62(3):485–492. [PMC free article] [PubMed] [Google Scholar]
  9. Mojon D. S., Kaufmann P., Odel J. G., Lincoff N. S., Márquez-Fernandez M., Santiesteban R., Fuentes-Pelier D., Hirano M. Clinical course of a cohort in the Cuban epidemic optic and peripheral neuropathy. Neurology. 1997 Jan;48(1):19–22. doi: 10.1212/wnl.48.1.19. [DOI] [PubMed] [Google Scholar]
  10. Monekosso G. L., Wilson J. Plasma thiocyanate and vitamin B12 in Nigerian patients with degenerative neurological disease. Lancet. 1966 May 14;1(7446):1062–1064. doi: 10.1016/s0140-6736(66)91009-9. [DOI] [PubMed] [Google Scholar]
  11. Olaleye O. D., Ogunniyi A., Sheng Z. J., Li Z., Rasheed S. Detection of HTLV-I antibodies and DNA in blood sample of a patient with myelopathy in Nigeria. Rev Inst Med Trop Sao Paulo. 1998 Jan-Feb;40(1):55–57. doi: 10.1590/s0036-46651998000100011. [DOI] [PubMed] [Google Scholar]
  12. Osuntokun B. O., Adeuja A. O., Schoenberg B. S., Bademosi O., Nottidge V. A., Olumide A. O., Ige O., Yaria F., Bolis C. L. Neurological disorders in Nigerian Africans: a community-based study. Acta Neurol Scand. 1987 Jan;75(1):13–21. doi: 10.1111/j.1600-0404.1987.tb07883.x. [DOI] [PubMed] [Google Scholar]
  13. Osuntokun B. O. An ataxic neuropathy in Nigeria. A clinical, biochemical and electrophysiological study. Brain. 1968 Jun;91(2):215–248. doi: 10.1093/brain/91.2.215. [DOI] [PubMed] [Google Scholar]
  14. Osuntokun B. O. An ataxic neuropathy in Nigeria. A clinical, biochemical and electrophysiological study. Brain. 1968 Jun;91(2):215–248. doi: 10.1093/brain/91.2.215. [DOI] [PubMed] [Google Scholar]
  15. Osuntokun B. O. Cassava diet, chronic cyanide intoxication and neuropathy in the Nigerian Africans. World Rev Nutr Diet. 1981;36:141–173. doi: 10.1159/000393156. [DOI] [PubMed] [Google Scholar]
  16. Osuntokun B. O. Epidemiology of tropical nutritional neuropathy in Nigerians. Trans R Soc Trop Med Hyg. 1971;65(4):454–479. doi: 10.1016/0035-9203(71)90156-8. [DOI] [PubMed] [Google Scholar]
  17. Osuntokun B. O. Epidemiology of tropical nutritional neuropathy in Nigerians. Trans R Soc Trop Med Hyg. 1971;65(4):454–479. doi: 10.1016/0035-9203(71)90156-8. [DOI] [PubMed] [Google Scholar]
  18. Osuntokun B. O., Langman M. J., Wilson J., Adeuja A. O., Aladetoyinbo Controlled trial of combinations of hydroxocobalamin-cystine and riboflavine-cystine, in Nigerian ataxic neuropathy. J Neurol Neurosurg Psychiatry. 1974 Jan;37(1):102–104. doi: 10.1136/jnnp.37.1.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Osuntokun B. O., Langman M. J., Wilson J., Adeuja A. O., Aladetoyinbo Controlled trial of combinations of hydroxocobalamin-cystine and riboflavine-cystine, in Nigerian ataxic neuropathy. J Neurol Neurosurg Psychiatry. 1974 Jan;37(1):102–104. doi: 10.1136/jnnp.37.1.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Osuntokun B. O., Langman M. J., Wilson J., Aladetoyinbo A. Controlled trial of hydroxocobalamin and riboflavine in Nigerian ataxic neuropathy. J Neurol Neurosurg Psychiatry. 1970 Oct;33(5):663–666. doi: 10.1136/jnnp.33.5.663. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Osuntokun B. O., Monekosso G. L., Wilson J. Relationship of a degenerative tropical neuropathy to diet: report of a field survey. Br Med J. 1969 Mar 1;1(5643):547–550. doi: 10.1136/bmj.1.5643.547. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Plant G. T., Mtanda A. T., Arden G. B., Johnson G. J. An epidemic of optic neuropathy in Tanzania: characterization of the visual disorder and associated peripheral neuropathy. J Neurol Sci. 1997 Feb 12;145(2):127–140. doi: 10.1016/s0022-510x(96)00162-1. [DOI] [PubMed] [Google Scholar]
  23. Román G. C. Epidemic neuropathy in Cuba: a public health problem related to the Cuban Democracy Act of the United States. Neuroepidemiology. 1998;17(3):111–115. doi: 10.1159/000026161. [DOI] [PubMed] [Google Scholar]
  24. Román G. C., Spencer P. S., Schoenberg B. S. Tropical myeloneuropathies: the hidden endemias. Neurology. 1985 Aug;35(8):1158–1170. doi: 10.1212/wnl.35.8.1158. [DOI] [PubMed] [Google Scholar]
  25. Román G. Tropical myeloneuropathies revisited. Curr Opin Neurol. 1998 Oct;11(5):539–544. doi: 10.1097/00019052-199810000-00017. [DOI] [PubMed] [Google Scholar]
  26. Tylleskär T., Banea M., Bikangi N., Fresco L., Persson L. A., Rosling H. Epidemiological evidence from Zaire for a dietary etiology of konzo, an upper motor neuron disease. Bull World Health Organ. 1991;69(5):581–589. [PMC free article] [PubMed] [Google Scholar]
  27. Tylleskär T., Howlett W. P., Rwiza H. T., Aquilonius S. M., Stålberg E., Lindén B., Mandahl A., Larsen H. C., Brubaker G. R., Rosling H. Konzo: a distinct disease entity with selective upper motor neuron damage. J Neurol Neurosurg Psychiatry. 1993 Jun;56(6):638–643. doi: 10.1136/jnnp.56.6.638. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Zehender G., Meroni L., Varchetta S., De Maddalena C., Cavalli B., Gianotto M., Bosisio A. B., Colasante C., Rizzardini G., Moroni M. Human T-lymphotropic virus type 2 (HTLV-2) provirus in circulating cells of the monocyte/macrophage lineage in patients dually infected with human immunodeficiency virus type 1 and HTLV-2 and having predominantly sensory polyneuropathy. J Virol. 1998 Sep;72(9):7664–7668. doi: 10.1128/jvi.72.9.7664-7668.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]

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