Indian J Pediatr 1988; 55 : 440-442

Clinical Brief s

Lathyrism in AfghanistanL.S. Arya, M.A. Qureshi, A. Jabor and Meharban Singh

Institute of Child Health, Kabul, Afghanistan

Lathyrism is a crippling neurologicaldisease characterised by gradually develop-ing spastic paralysis of lower limbs. It isdue to the consumption of large quanti-ties of lathyrus sativus pulse popularlyknown as Khesari dahl, Teora dahl orLakh dahl. The toxin, betaoxalyl amino-alanine (BOAA) present in lathyrus sati-vus is responsible for this disease.1 Lathy-rism is an ancient disease and the firstdetailed account of an outbreak of lathy-rism was recorded in 1844 from India.2

The first graphic description of the diseaseand its association with the consumptionof lathyrus sativus pulse has been given in1884 by General Sleeman in his bookRambles and recollections of an IndianOfl5cial.3 Lathyrism is mainly reportedfrom India, Greece, Germany, Russia andBangladesh. It is a serious public healthproblem especially in the central andnorth western parts of India.4 Somescattered cases are also reported fromcountries like France, Spain, Syria, Italy,Abyssinia, Algeria and Iran.5 But inAfghanistan the disease has never beenpreviously identified or recorded. Wetake this opportunity to report the first 3cases of neurolathyrism from Afghanistan.

Reprint requests : Dr. L.S. Arya, AssistantProfessor, Department of Pediatrics, All IndiaInstitute of Medical Sciences, New Delhi 110 029.

Case Reports

Case I. K., 12-year old girl resi-dent of a village Balagil, district parwanof Gorband Province, which is about 100km from Kabul was admitted to thehospital with the complaints of difficultyin walking since one month. She waseating bread made up of lathyrus sativusseeds for the past 4 months. Physicalexamination showed a fairly nourishedchild with a weight of 25 kg. She wasafebrile with a pulse rate of 80/min andblood pressure of 120/70 mm Hg. Therewas no pallor, jaundice, edema or peri-pheral lymphadenopathy or hepato-splenomeglg. Central nervous system exa-mination revealed a fully conscious childwith no involvement of the cranial ner-ves. Fundus examination did not show anyabnormality. She was walking with shortsteps and jerky movements with a typicalscissoring gait. Both lower limbs werespastic with exaggerated knee and anklejerks. Plantars were extensors on bothsides. Upper limbs were essentially normaLThere was no sensory loss or inconti-nence of urine and stools. Examination ofthe spine did not show any abnormality.She had a thyroid swelling of 4cm x 4cmin diameter with a smooth surface andsoft in consistency. There was no bruiseover the swelling. The thyroid swelling

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ÁRYA ET AL : LATHYRISM IN AFGHANISTAN 441

was present for the last 7 years.Laboratory findings revealed hemo-

globulin of 12 gm/dl, TLC 6000/cumm witha polymorphonuclear leukocytes of 56%lymphocytes 42%, monocytes 1% andeosinophils 1%. Urine, stool and liverfunction tests were normal. Tuberculintest was negative. Skiagrams of chestand skull did not reveal any abnormality.CSF examination was within normal limits.She was given multivitamins and irontherapy and was discharged after onemonth of physiotherapy with mild sub-jective improvement.

Case If. A., a 10-year old boy, abrother of case 1, presented with inabilityto walk 2 months and inability to standsince 1 month duration. He was consum-ing lathyrus sativus seeds for the past5 months. Physical examination revealedan underweight child weighing 20 kg.He was afebrile with a pulse rate of84/min. blood pressure of 115/70 mm Hg.He had pallor but there was no jaundiceedema, lymphadenopathy or hepatosple-nomegaly. Central nervous system exa-mination showed a fully conscious, intelli-gent child with no cranial nerve involve-ment. Fundus examination was normal.He was not able to walk or even standwithout support. He had marked spasti-city in both the lower limbs with a typicalscissoring. He was almost in a crawlingstage. Deep tendon jerks in both lowerlimbs were exaggerated. There was nosensory loss. Bladder and bowels werenot involved, upper limbs were normal,examination of the spine did not revealany abnormality. He also had a thyroidswelling of 3 cm x 3 cm in diameter withsmooth surface and soft in consistancy.There was no thrill palpable over thyroidswelling which was present for the past7 years.

Laboratory investigations showedhemoglobin of 10-5 gm/dl, TLC 8000/cumm with neutrophils of 60%, lympho-cytes 37%, monocytes 1% and eosinophils2%. Urine and stool examination werenormal. Liver function tests were withinnormal limits. CSF examination wasessentially normal. Mantou test was nega-tive. Skiagram chest and skull did notshow any abnormality. He was givenmultivitamins and iron therapy and wasdischarged after one month without anyappreciable improvement.

Case III. T.,a 6-year—old boy,brother of Case I and II (one of the sib-lings from the same family) presented withthe complaints of difficulty in walkingsince 20 days duration. He was also eatingthe same bread made up of lathyrussativus seeds for the past 5 months.Physical examination showed an undernourished child with a weight of 13 kg.He was afebrile with a pulse rate of 90/minblood pressure of 100/60 mm Hg. Therewas mild but no edema, jaundice, lympha-denopathy or hepatosplenomegaly. CNSexamination revealed a fully conscious,well oriented child with no involvementof cranial nerves. Fundus examination wasnormal. He had difficulty in walkingwhich was characterized by short andjerky steps with scissoring. Deep tendonjerks in the lower limbs were exaggeratedwith extensor plantars. There was nomuscle wasting. Upper limbs wereessentially normal. He also hada mildthyroid swelling for the last 3 years.

Laboratory investigations showedhemoglobin of 9 • 6 gm/dl, TLC 7000/cummwith a polymorphon uclearleucocytes of47% lymphocytes 52% and eosinophils1%. Liver function tests were normal.

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CSF examination did not show any abnor-mality. Tuberculin test was negative.Skiagrams of chest and skull were normal.He was treated with nutritious diet, multi-vitamin and iron syrup and was dis-charged after one month with slightimprovement in walking. There was how-ever, no appreciable change in the neuro-logical findings in the lower limbs.

Discussions

The crippling neurological diseaselathyrism is associated with excessive con-sumption of the lathyrus sativus seeds.The term neurolathyrism was coined byselye in 1957.6 Epidemics seemed tooccur following droughts and poor cropsof wheat, barly or other edible cerealswhen increased quantity of the variouslathyrus species are consumed. In Afgha-nistan because of the disturbed politicalconditions, this family which was ex-tremely poor got trapped in their homevillage Balagil. They could neither go outto get wheat bread which is staple food inAfghanistan nor other eatables couldreach the village. Obviously as a resultof nonavailability and high premium onother food grains the family was forcedto eat cheap lathyrus sativus pulse almostexclusively without realizing the harmfuleffects of the neurotoxin present in thepulse. After a period of about 4 months,these siblings got affected with pro-gessive spastic paralysis of both lowerlimbs. Unfortunately, lathyrism tends toaffect the youth and children of the com-munity more often and early. All personsconsuming the same diet do not get thedisease. Young male population is believedto be more susceptible as compared tothe females. It is apparently related to theintake of lathyrus sativus per unit bodyweight. In the family being reported only

the children got the disease and both theparents were spared. The neurologicaldisability is progressing but early casessometimes recover.7 Recently it has beendocumented that early cases of lathyrismmay be cured by intravenous administ-ration of vitamin C.8 Unfortunately, epi-demiological survey of the habitat of theseindex cases could not be undertaken due tothe prevailing socio-political conditionsin the country.

Lathyrism can be prevented by ban-ning the cultivation of lathyrus sativuswhich of course is very difficult due to thesocial and economic reasons particularlyin the developing countries. The othermost important approach towards theprevention of the disease would be anintensive educational programme to makethe people aware of the crippling neuro-logical consequences following consump»tion of lathyrus sativus seeds. The fightagainst lathyrism is, "therefore, a part ofthe fight against poverty and ignorance.

References

1. Adiga PR, Rao SLN and Sharma PS. Somestructural features and neurotoxic action of acompound from L. sativus seeds. Curr Sei1963; 32 :153

2. Schuchardt B. Zur Geschichte and Gasuistikdes Lothyrismus Deutsch Arch Klin Med 1886-87; 40 : 312

3. Sleeman WH in "Rambles and recollectionsof an Indian Official, 1884

4. Gopalan C. Some recent studies in the Nutri-tion Research Laboratories, Hyderabad. Am JClin Nutr 1970; 23 : 35

5. Lathyrism a preventable paralysis. IndianCouncil of Medical Research 1983

6. Selye H. Lathyrism. Revue Cavad de Biol1957;16 : 1

7. Stockman R. Lathyrism. J Pharm Expther1929;37:43

8. Ahmed K, Jahan K. Prevention is easy, cureis possible. Future 1983-84 winter 9