Nodding syndrome (NS) is a devastating neurologic disorder affecting thousands of children in
Africa. A number of toxic, nutritional, infectious, para-infectious and environmental causes
have been studied but the only consistent association has been with infection by the parasite
Onchocerca volvulus. There is no specific treatment for NS and also for the adult onchocerca.
However, antibiotic depletion of the Onchocerca volvulus co-symbiotic bacteria Wolbachia with
tetracyclines such as doxycycline results in sterilisation and premature death of the adult
worm and marked reductions in dermal microfilaria density. Potentially, such therapy that
kills adult onchocerca volvulus may improve the outcome of NS if the association were true.