Affected people also suffer optic atrophy and sensory neural deafness, on both sides of the body. There is neurological damage to the pyramidal tract of the spinal cord. For these older patients, evidence of malnutrition is rarer, and improving nutrition does not improve symptoms.Most of those with the older-onset form have symptoms in their legs, but a third to a half also have arm symptoms. Symptoms tend to worsen during the rainy season (see monsoon, harmattan), and are often worse at night. Symptoms associated with the lower cranial nerve are rarer; most patients do not show them. These symptoms include dysarthria (difficulty articulating words), dysphagia (difficulty swallowing), shortness of breath, and dysphonia (difficulty speaking); dysphonia is more common in women, and shows as hypophonia (lack of co-ordination in the vocal cords) and an inability to shout. Treatment
Nutritional improvements; supplying nutritional yeast, teaching improved cassava preparation, and ceasing cassava consumption. Outlook
Unclear, with contradictory reports from different studies. Research directions
A 2016 review listed twenty-one open research questions. The value of international co-operation on TAN research has also been highlighted. Epidemiology
TAN has only been described as developing in Africa, South-east Asia, and the Caribbean (if Guiana be included). It does not seem to occur in temperate countries. People affected by TAN tend to be poor and live in rural areas. In some areas, more than a quarter of the population are affected. In India and Africa, more women are affected; in Africa, the elderly are most likely to suffer, and in India, people in their thirties.
Latency antibiotics: The time from PROM to labor is termed the latency period, and there is an inverse relationship between gestational age and the length of latency, meaning that the earlier the rupture, the longer it will take for labor to begin naturally. As expected, antibiotics given to mothers that experience PPROM serve to protect against infections during this lengthened latency period. Additionally, antibiotics increase the time that babies stay in the womb. Antibiotics dont seem to prevent death or make a difference in the long-term (years after the baby is born). But, because of the short-term benefits, routine use of antibiotics in PPROM is still recommended. The American Congress of Obstetricians and Gynecologists (ACOG) recommends a seven-day course of intravenous ampicillin and erythromycin followed by oral amoxicillin and erythromycin if watchful waiting is attempted before 34 weeks. Amoxicillin/clavulanic acid increases the risk of fetal bowel death (necrotizing enterocolitis) and should be avoided in pregnancy. Prophylactic antibiotics: If a woman is colonized with GBS, than the typical use of antibiotics during labor is recommended to prevent transmission of this bacteria to the fetus, regardless of earlier treatments. Controversial or not recommended
Preventative tocolysis (medications to prevent contractions): the use of tocolytic medications to prevent labor contractions is controversial. On the one hand, this can delay delivery and allow the fetus more time to develop and benefit from antenatal corticosteroid medication, on the other hand it increases the risk of infection or chorioamnionitis.