An Epidemic of Psychosis in a Sudanese Village – a challenging experience
Osheik Abu’Asha Seidi (1), E.M. Abdelmotaal (2), M. El Karsani (3), I. Bushara (2), S. El Tahir (4), A. Al Mahjoub (5), A.A. Mohamed (6), H.H. Abu Aisha (7)
(1)Department of Medicine, Faculty of Medicine, Department of Neurosciences, Soba University Hospital, (2)Epidemics and Infections Disease Control Directorate, (3)The Central Public Health Laboratories, Federal Ministry of Health, (4)Medicine, Soba University Hospital, Khartoum, (5)Medicine, Soba University Hospital, Sudan, (6)Central Veterinary Research Laboratories, Federal Ministry of Health, (7)Vice Chancellor, Al Moghtaribeen University, Khartoum, Sudan
In January 2010 a wave of pathological laughter, crying and bizarre behavior affected about 122 people in a remote village in the far North West State of Kordofan in Sudan.
Patients, Methods and Results:
Our team performed a detailed investigation of the clinical presentations and possible underlying causes and provided medical treatment as well. Children constituted 52% and were more severely affected than adults. The main presentations were visual hallucinations, uncontrolled laugher, twisting movements, delirium, and convulsions. No vascular 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).
The patients were treated symptomatically with benzodiazepines. Carbamazepine was used in those presenting with recurrent seizures. Routine urine, blood and CSF basic parameters were within normal limits for routines, but the toxicology screen of urine missed the critical period for detection of the suspected toxic substances. Samples from the water sources were clear, but the wheat consumed by the villagers grew the fungus Claviceps purpurea in abundance. Further tests on the fungi revealed their production of very high level of LSD- like ergot alkaloids.
No long term neurological sequalae were noticed on follow up. The wheat came from stores in Darfur which is near the affected village. The epidemic was contained and a public education campaign was launched to avoid recurrence of the event. This paper includes videos and a literature review Conclusions: This study draws attention to the importance of vigilance about neurotoxins as causes of bizarre presentations.