 Such episodes are identical to the initial onset and can therefore be interpreted as a "second onset".The severity of konzo varies; cases range from only hyperreflexia in the lower limbs to a severely disabled, bedridden patient with spastic paraparesis, associated weakness of the trunk and arms, impaired eye movements, speech and possibly visual impairment.Although the severity varies from patient to patient, the longest upper motor neurons are invariably more affected than the shorter ones.