Lathyrism

Lathyrism

• Neurolathyrism (NL) is a neurodegenerative disease that is caused by heavy consumption of grass pea, Lathyrussativus.

Toxin

• The pulse contains the neurotoxin called b-N-oxalyl-a,b-diaminopropionic acid (b-ODAP).[Synonym b-oxalylaminoalanine(BOAA)]

History

• Ancient disease.
• Often occurs in epidemics.
• Several epidemics occurred in most parts of the world

.Prevalance

• India 5.3 per 1000

Onset

• Depending on the amount of the pulse consumed and the susceptibility of the patients the paralysis can start as early as 3 weeks of consumption.
• Paralysis can develop acutely overnight or progressively over days.
• 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)
• Micronutrient deficiency (Zn, Cu, Vit C, Vit A) 

Clinical features

• Upper motor neuron disorder with symmetrical spastic paralysis.
• Sensation and sphincters are spared.

Stages of disease

1. Stage II(No stick stage): spastic gait with no need to use a walking stick and no Babinski sign.
2. Stage II( 1 stick stage): spastic gait with the need of one walking stick. Ankle clonus and Babinski sign present.
3. Stage III( 2 stock stage): Spastic cross adductor gait with the need of two walking sticks. Ankle clonus and Babinsi sign present.
4. Stage IV(Crawler stage): There is bedridden (wheelchair) state with loss of leg use and contracture. Arms are strong and pyramidal signs present.

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.