Who's vCJD case definition should be revised

The World Health Organization's (WHO) definition of patients with variant Creutzfeldt-Jakob disease (vCJD) should be revised to prevent cases being missed, according to the authors of a case report in this week's issue of The Lancet.

In their report, Masahito Yamada (Kanazawa University Graduate School of Medicine Science, Kanazawa, Japan) and colleagues detail the first Japanese case of definitive vCJD. The authors found that 19 months after the onset of symptoms the patient's brainwave patterns, measured on an electro-encephalogram (EEG), had no periodic synchronous discharges (PSD). The absence of PSD on EEG is one feature that defines vCJD. However, the PSD brainwave pattern appeared 30 months after symptoms developed. There have been no previous reports of PSD on EEG in vCJD, state the authors.

Professor Yamada comments: "Our case shows that PSD does not exclude the possibility of vCJD. We suggest revision of the WHO vCJD case definition to prevent missing cases of vCJD."

Contact: Prof Masahito Yamada, Creutzfeldt-Jakob Disease Surveillance Committee, Japan, Department of Neurology and Neurobiology of Ageing, Kanazawa University Graduate School of Medicine Science, 13-1, Takara-machi, Kanazawa, 920-8640, Japan. T) 0081 76 265 2290 m-yamada@med.kanazawa-u.ac.jp

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