Neurolathyrism Haileyesus Getahun South Gonder Health Department, Ethiopia Neurolathyrism • Synonym lathyrism • Neurolathyrism (NL) is a neurodegenerative disease that is caused by heavy consumption of grass pea, Lathyrus sativus. The Toxin The pulse contains the neurotoxin called -N- oxalyl-,-diaminopropionic acid (-ODAP).[Synonym - oxalylaminoalanine(BOAA)] Grass pea • Resist water shortage and water logging. • Improves soil fertility. • Needs no fertilizer. • Gives high yield. History of Neurolathyrism • Ancient disease. • Often occurs in epidemics. • Several epidemics occurred in most parts of the world. Prevalence • Varies from country to country. • Often occur in inaccessible areas. • Not many epidemiological studies. Mean Prevalence • Ethiopia 6 per 1000 • India 5.3 per 1000 • Bangladesh 1.4 per 1000. Recent epidemics • 1973 : China • 1976: Bangladesh • 1976: Ethiopia • 1998: Nepal (non published) • 1998: Afghanistan (non published) • 1997-99: Ethiopia Onset of the disease • Mostly 3-6 months. • Acute or chronic. • Dose dependent. • Critical level = 400gm/day. Risk factors • Heavy physical activity • Male gender • Young age (15-25 years) • Micro nutrient deficiency (Zn,Cu, Vit C, Vit A) Clinical features • Upper motor neuron disorder with symmetrical spastic paralysis. • Sensation and sphincters are spared. Stages of the disease • Stage I (No stick stage) • Stage II (One stick stage) • Stage III (Two sticks stage) • Stage IV (Crawler stage) Treatment • No definitive treatment. • The neuronal damages are permanent. • Symptomatic treatment with muscle relaxants help. Prevention • Home based detoxifying methods. • New seed lines. • Cultivation of alternate crops. Prevention Although cultivation of the grass pea is legally banned in India and Nepal, Neurolathyrism continued to manifest itself.