Objectives: Nodding syndrome (NS) is a poorlyunderstood neurological disorder affecting thousandsof children in Africa. In March 2012, we introduced atreatment intervention that aimed to providesymptomatic relief. This intervention included sodiumvalproate for seizures, management of behaviour andemotional difficulties, nutritional therapy and physicalrehabilitation. We assessed the clinical and functionaloutcomes of this intervention after 12 months ofimplementation.Design: This was a cross-sectional study of a cohortof patients with NS receiving the specified intervention.We abstracted preintervention features from recordsand compared these with the current clinical status. Weperformed similar assessments on a cohort of patientswith other convulsive epilepsies (OCE) and comparedthe outcomes of the two groups.Participants: Participants were patients with WHO-defined NS and patients with OCE attending the samecentres.Outcome measures: The primary outcome was theproportion of patients with seizure freedom (â¥1 monthwithout seizures). Secondary outcome measuresincluded a reduction in seizure frequency, resolution ofbehaviour and emotional difficulties, and independencein basic self-care.Results: Patients with NS had had a longer duration ofsymptoms (median 5 (IQR 3, 6) years) compared withthose with OCE (4 (IQR 2, 6) years), p<0.001. Theintervention resulted in marked improvements in bothgroups; compared to the preintervention state, 121/484(25%) patients with NS achieved seizure freedom andthere was a >70% reduction in seizure frequency;behaviour and emotional difficulties resolved in 194/327(59%) patients; 193/484 (40%) patients had enrolled inschool including 17.7% who had earlier withdrawn dueto severe seizures, and over 80% had achievedindependence in basic self-care. These improvementswere, however, less than that in patients with OCE ofwhom 243/476 (51.1%) patients were seizure free andin whom the seizure frequency had reduced by 86%.Conclusions: Ugandan children with NS showsubstantial clinical and functional improvements withsymptomatic treatments suggesting that NS is probablya reversible encephalopathy
