Clinical Topics — Neurolathyrism Resource Center

Neurolathyrism: A Clinical Vignette

HPI
A 19-year-old male from rural northern Ethiopia presents to a hospital in Addis Ababa with difficulty ambulating. He works as a sustenance farmer in Debre Sina. Approximately 12 years ago, he noticed acute onset bilateral lower extremity weakness. His previous history is unremarkable. Over a period of 2 weeks, the weakness progressed and he began using a rigid, 6-foot-long pole to assist with ambulation. There was no pain anywhere in his body, and he denied a history of recent trauma. The weakness is not associated with any other symptom. His upper extremities are unaffected. There is no bowel or bladder incontinence, fevers, or sick contacts.
Approximately 12 years ago, there was a drought that affected Debre Sina. His diet consisted exclusively of the grass pea (Lathyrus sativus, locally termed as gwaya). The crop is cultivated during times of drought because of it’s incredible hardiness, as well as its resistance to drought and flooding. He previously sustained his family, which includes his mother and 2 sisters. He states that other male farmers were affected similarly.
Examination
This young man is alert and oriented. Gait exam is narrow-based and spastic with a component of scissoring and toe-scraping. There are 6 beats of clonus bilaterally. Cranial nerves are intact. Upper extremity motor strength is 5/5. No sensory deficits are present. Pinprick and light touch sensation are intact throughout.
Diagnosis
Among the differential diagnosis are the various tropical myelopathies including HTLV-associated myelopathy (HAM), neurocassavism (also known as konzo), and neurolathyrism. Neurolathyrism presents with characteristics upper motor neuron symptoms including spastic paraparesis. It can be distinguished by the absence of bowel or bladder incontinence, acute onset, and constant character. It is irreversible.
Treatment
The primary effective interventions for this preventable disease are education, avoidance of traditional clay pots, leeching of the causative amino acid derivative toxin (β-N-oxalyl-a,b-diaminoproprionic acid [β-ODAP]), and food aid to dilute the proportion of the diet constituted by this otherwise elite germplasm. Onset of symptoms begins within 2-3 months of a monotonous diet. During droughts, hundreds can be affected in regions where the grass pea is relied upon as a staple resource. Ambulation assistance devices can be provided, as well as physiotherapy and in refractory cases adductor release as a salvage operation. Further exposure to grass pea should be avoided if possible.

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grasspea

Yegwaya t’enik’ina mekelakeyawi
Gwaya minidini newi?
Gwaya be’ānesetenya ye’irit’ibeti met’eni miriti yemīšet’i tebayinina āremīni yemīk’wak’wami yet’ira t’irē ‘ayineti sīhoni dirik’i bemīyat’ek’achewi ākababīwochi bešefīwi yemīmereti šebili newi።
Yihi šebili be’ābizanyawi terarama ye’ītiyop’iya ākababī beteleyi be’āmara kililina beshewa zoni yimeretali።
Gwaya ishetu bek’olo ina benifiro meliki yibelali።
Beshiro meliki degimo bichawinina kelēlochi t’irat’irē gari tedebalik’o bebizati bet’ik’imi layi yiwilali።
Gwayani memegebi yemīyasiketilewi t’enik’i beshita minidini newi።
Gwayani bebizati (beyek’enu kemīwesedewi migibi ānidi sositenya) kehuleti weyimi kesositi werati belayi sīmegebu meshimedimedi weyimi huleti igirochini shiba yemadiregi chigirini yasiketilali። beshitawi be’inigilīzenya k’wanik’wa laterīzimi yibalali።
Begwaya t’irē wisit’i yemīgenyewi merizama nit’ire negeri (ādapi) yeshibaneti (yemashimedimedi) chigirini yemīyamet’awi bememegebi Bicha newi። bezelimadi inidemīnegerewi yaliderek’e yegwaya sebili bemesebisebi፣ bemeshekemina bemewik’ati shibanetu āyikesetimi።
Yegwaya t’enik’i beshita inidēti yimet’ali yemīyasayachewi milikitochisi minidini nachewi?
Bizu gwayani kehuleti weri isike sositi werati beteketatayi ānidi sewi ketemegebe sayasibewi igirochu yishimedemedalu meramedimi yišanewali።
ānidi gīzē ye’igiri shibaneti ketekesete gwayani mebilati mak’omi weyimi ḥikimina madiregi bech’irashi ayimelisewimi። zelak’ī ina k’wamī yeḥiyiweti zemeni chigiri newi።
Yegwaya t’enik’i be’ābizanyawi yemīyat’ek’awi wet’atochini sīhoni beteleyimi bewenits’ochi layi yamezinali።
Yegwaya t’enik’i beshita hunēta be’āgerachini mini yimesilali?
Beteleyayu zemenati gwaya besemēnina semēni mi‘irabi ye’āgerachini ākababīwochi bewererishinyi meliki tekesito bizu wegenochachinini āt’ik’itwali።
Be1960 ‘a.mi bedenibīyana befogera፣ inidīhumi። be1987 ‘a.mi bewadilana delanita ke’āmisiti shī belayi sewochi begwaya mikiniyati shiba honewali።
Wererishinyochi kemīkesetubachewi ākababīwochi wich’ī gwaya bemīmeretibachewi ākababīwochi yemīnoru sewochi begwaya wokiniyati shibaneti sīderisibachewi bebizati yitayali።
Bek’iribumi chigiru bedebubi welo tekesitwali።
Begwaya mikiniyati yemīkesetewini t’enik’i beshita bemini āyineti menigedi mekelakeli yichalali?
Gwaya shibanetini inidayasiketili beteketatayi፣ bebizati bichawini kememegebi tilik’i t’inik’ak’ē madiregi yasifeligali።
-Gwaya tek’ek’ilo weyimi tezefizifo wihawini mafisesi bewiset’u yalewini nit’ire-negeri bīyanisi hamiša bemeto yik’enisewali። Yihi menigedi k’olo፣ genifo ina shiro bemīzegajibeti gīzē mewesedi yalebeti irimija newi።
-Be’ānidi gwaya āmirachi’ ākababī zinabi t’efito dirik’i sīkeseti yegibirina ina t’ēna t’ibek’a kifilochi፦
-Leḥibiretesebu yet’ēna āt’ebabek’i timihiriti bemesit’eti mek’enesi yigebachewali።
-Chigiruni lemenigisiti āsetedaderi masitawek’ina kititili madiregi yinoribachewali።
-Be’āsichekwayi menigisitawī ina menigisitawī lalihonu dirijitochi ye’ihili ‘iridata inidīk’eribi t’iyak’ē mak’irebina k’idime zigijiti madiregi yit’ebek’ibachewali።
Kelayi yetet’ek’esetini irimijawochi begilesebi፣ bebudini bilomi ḥibiretesebu begarana betek’enaje meliku tegibarawī ke’āderegachewi yegwayani t’enik’i beshita lemekelakeleli bilomi lemasiwegedi yiredali።

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