Objective:

Explore the clinical presentations of an epidemic of abnormal behavior and convulsions in a remote village in Northwest Sudan and search for the case, treat the affected and prevent recurrence

Background:

In January 2010 a wave of pathological laughter, crying and bizarre behavior

affected about 122 people in a remote village in the far Northwest State of

Kordofan in Sudan

Design/Methods:

This sis a cross sectional community  based cohort study. All affected individuals were included in this study and in selected patients blood , urine and CSF samples were collected.

Results:

122 patients were included.Children constituted 52% and were more severely affected than adults. The

main presentations were visual hallucinations, uncontrolled laugher, twisting

movements, delirium, and convulsions. No cadriovascular manifestations were

detected. Males were affected more than females (60%).

In a few of the severely affected patients a lumbar puncture was performed

(7/122). Routine urine (13) , blood (18) and CSF (7) basic parameters were within normal limits for routine tests,

but the toxicology screen of urine missed the critical period for detection of

the suspected toxic substances. Samples from the water sources (5) were clear,

but the wheat consumed by the villagers grew the fungus Claviceps purpurea

in abundance (3/4 ), while one millet sample was clear. Further tests on the fungi revealed their production of very

high level of LSD- like ergot alkaloids.

Conclusions:

 This study draws attention to the importance of vigilance about

neurotoxins as causes of bizarre neurological presentations