Human Form Of 'Mad Cow'
Disease Can Show Signs Early


NEW YORK (Reuters Health) - The human form of "mad cow" disease is hard to diagnose early on, but UK researchers have put together a profile of symptoms that may help catch more cases sooner.
They say that early on, the brain-wasting condition, known as variant Creutzfeldt-Jakob disease (vCJD), is largely one of anxiety, depression and other psychiatric symptoms. However, in some cases, nervous system problems may precede or accompany such mood symptoms--and these combinations of features may help pinpoint vCJD, according to a report in the June 22nd issue of the British Medical Journal.
Right now, the only way to definitively diagnose vCJD is after death, through a brain autopsy. And although the disease is invariably fatal, experts say it is important to understand the common early symptoms.
For one, this could aid in recognizing outbreaks of vCJD sooner. Although most cases have occurred in Britain, where more than 100 people have died of confirmed or probable vCJD, a few have been reported elsewhere, including France, Ireland and Italy. And there is the possibility that exposure to the agent believed to cause vCJD has been even more widespread, according the authors of the new study.
The human disease is believed to be transmitted through beef from cows with a similar brain-wasting condition called bovine spongiform encephalopathy, or BSE. Most countries in the European Union have now reported BSE cases, as have Japan and a few other nations.
To put together a picture of early vCJD symptoms, a team led by Dr. Robert G. Will, of the National CJD Surveillance Unit in Edinburgh, Scotland, reviewed the medical records of the first 100 people diagnosed with the disease in the UK.
They found that in the first few months, vCJD is "dominated" by psychiatric symptoms. In this early stage, patients commonly suffered withdrawal, anxiety, depression and insomnia, and were often seen by a psychiatrist.
There were no common neurological symptoms early on, according to Will's team. Instead, features such as unsteady movement, slurred speech and numbness usually arose later.
However, Will and colleagues report, some patients early on had "persistent and unpleasant" pain, often affecting their limbs, trunk or face. And for 15% of patients, nervous system symptoms arose before psychiatric problems, while another 22% had a combination of the two symptom types.
The researchers conclude that although early diagnosis of vCJD may be "impossible" in many cases, particular combinations of psychiatric and neurologic problems could allow it in "an appreciable proportion of patients."
SOURCE: British Medical Journal 2002;324:1479-1482.
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