Research ArticleONCHOCERCIASIS

Nodding syndrome may be an autoimmune reaction to the parasitic worm Onchocerca volvulus

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Science Translational Medicine  15 Feb 2017:
Vol. 9, Issue 377, eaaf6953
DOI: 10.1126/scitranslmed.aaf6953

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Linking parasitic infection to autoimmune epilepsy

Nodding syndrome is a unique seizure disorder affecting children in parts of East Africa. The cause of nodding syndrome has been an enigma, although an epidemiological association with the parasite Onchocerca volvulus has been established. Johnson et al. demonstrate that patients with nodding syndrome have autoantibodies to leiomodin-1 that are neurotoxic in vitro and that leiomodin-1 is expressed in regions of the brain affected during disease. Leiomodin-1 antibodies cross-react with O. volvulus proteins, linking the parasite to the autoantibody. Thus, nodding syndrome may be an autoimmune epilepsy initiated by a parasitic infection and may be preventable by treatment with antiparasitic strategies such as the drug ivermectin.