Objective To assess whether the involvement of the peripheral nervous system (PNS) belongs to the phenotypic spectrum of sporadic Creutzfeldt-Jakob disease (sCJD).
Methods We examined medical records of 117 sCJDVV2 (ataxic type), 65 sCJDMV2K (kuru-plaque type) and 121 sCJDMM(V)1 (myoclonic type) subjects for clinical symptoms, objective signs and neurophysiological data. We reviewed two diagnostic nerve biopsies and looked for abnormal prion protein (PrPSc) by western blotting and real-time quaking-induced conversion (RT-QuIC) in postmortem PNS samples from 14 subjects.
Results Seventy-five (41.2%) VV2-MV2K patients, but only 11 (9.1%) MM(V)1, had symptoms or signs suggestive of PNS involvement occurring at onset in 18 cases (17 VV2-MV2K, 9.3%; and 1 MM(V)1, 0.8%) and isolated in 6. Nerve biopsy showed a mixed predominantly axonal and demyelinating neuropathy in two sCJDMV2K. Electromyography showed signs of neuropathy in half of the examined VV2-MV2K patients. Prion RT-QuIC was positive in all CJD PNS samples, whereas western blotting detected PrPSc in the sciatic nerve in one VV2 and one MV2K.
Conclusions Peripheral neuropathy, likely related to PrPSc deposition, belongs to the phenotypic spectrum of sCJDMV2K and VV2 and may mark the clinical onset. The significantly lower prevalence of PNS involvement in typical sCJDMM(V)1 suggests that the PNS tropism of sCJD prions is strain dependent.
- peripheral neuropathology
- creutzfeldt-jakob disease
- rapidly progressive dementia
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Contributors Study design: SB, PP. Data acquisition: SB, VR, PR, MR, AF, MM, PS, AL, PF, AM, SC, AG, BC, PC, PP. Data analysis and interpretation: SB, MR, AF, PR, PP. Drafting of the manuscript: SB, PP. Study supervision: PP. All authors critically reviewed and approved the manuscript.
Funding The study was supported by the Italian Ministry of Health, grant RF2011-02351092, and by the Gino Galletti Foundation.
Competing interests None declared.
Patient consent Not required.
Ethics approval Ethical approval for the study was provided by the Local Ethics Committee (AUSL of Bologna, n. 16184/CE).
Provenance and peer review Not commissioned; externally peer reviewed.
Data statement The datasets analysed during the present study are available from the corresponding author and will be shared on reasonable request.