The National Prion Clinic provides inpatient and outpatient services for the comprehensive assessment of all forms of suspected prion disease (sporadic, acquired and inherited). We also facilitate the co-ordination of subsequent long-term management of patients and their families, in conjunction with local healthcare professionals. We provide expert advice and support by clinical nurse specialists, medical staff and counselling services for patients, their families, carers and health professionals. Additionally we facilitate the research programme of the MRC Prion Unit at UCL, in particular with respect to diagnostics and the development of clinical trials.
Prion diseases, also known as transmissible spongiform encephalopathies (TSE's) are a group of progressive and ultimately fatal neurodegenerative conditions. These illnesses exist in both animals and humans. Various forms of the disease have been identified since Creutzfeldt and Jakob first described the illness later known as CJD (Creutzfeldt-Jakob disease) in the 1920s. These diseases in humans are now grouped together according to whether they are sporadic, inherited or acquired.
In sporadic prion disease there is no clear reason why someone develops prion disease. In the inherited form the individual has a faulty gene which has usually been passed on from the previous generation. Acquired forms are caused in many ways. 1) The individual has been given human growth hormone which was contaminated with sporadic prion disease (this practice has now ceased). 2) Dietary exposure through exposure of infected Bovine Spongiform Encephalopathy (BSE) food products has resulted in Variant CJD (vCJD). 3) There have been 4 cases of possible infection as a result of blood transfusion contaminated with vCJD. 4) A small number of cases have occurred as a result of contaminated surgical instruments.
The disease occurs because the prion protein changes shape resulting in the prion protein building up in the brain. Due to the build up of the prion protein which has changed shape, the individual will develop symptoms of the disease. The term CJD has been used since the disease was first recognised by Creutzfeldt and Jakob in the 1920s.
Sporadic prion disease has an average duration of 4-6 months, although there have been some atypical durations of up to 3 years.
Some inherited forms of the disease can have very short durations of around 4-6 months while other forms can last for as many as twenty years.
Acquired prion disease caused by contaminated human growth hormone usually ranges from 8-18 months. Acquired prion disease caused by consumption of BSE infected food products has average disease duration of 13-14 months.
Sporadic prion disease is not the same as mad cow disease. We do not know what causes sporadic prion disease it occurs spontaneously for no known reason. We do know however that ‘mad cow disease’ or new variant CJD/prion disease has been caused due to humans ingesting contaminated meat products from cows affected by Bovine Spongiform encephalopathy (BSE).
There is no infection risk through normal social, clinical or sexually intimate contact. For clinicians, normal infection control practices apply e.g. appropriate use of gloves when dealing with bodily fluids and sharps containers to dispose of needles.
Though we can be confident in the diagnosis of CJD in the living, having a post mortem is the only way to give a conclusive diagnosis for sporadic and acquired forms of the disease. Post mortems are also carried out for research purposes.
Yes, there is no reason why you should not see your relative after a post mortem.
There are no precautions required to view your relative Superficial contact such as touching the face is allowed but you should not try to move the body as this may encourage leaking of fluid from the brain. If you want to take part in dressing the body, this will need to be done under supervision of the funeral director. Funeral home staff will provide guidance on using standard infection control measures to minimise risk.
In the majority of cases having a post mortem will not delay funeral arrangements. Occasionally due to public holidays or if there are many post mortems being carried out, this may delay a funeral.
There are no special arrangements required for burial or cremation of a patient with known or suspected CJD, though the process of embalming is discouraged due to the possible risk of onwards transmission.
If your family has a history of prion disease you can ask your GP to refer you to local genetic counsellor. A genetic counsellor will initially meet with you to discuss why you would like to have a genetic test. Following your initial visit with the genetic counsellor you will be given a ‘cooling off’ period (usually about 6 weeks) to further think about testing. You can then meet with the genetic counsellor again to have a blood sample taken if they feel you are ready to have the test. The blood sample will then be sent to the National Prion Clinic where it will be tested for gene abnormalities.
You will still be able to get insurance.
Currently there is no treatment for prion disease, however we can help advise on medications for symptoms experienced. Scientists and clinicians at the MRC Prion Unit at UCL and elsewhere in the world continue to work towards the development of effective therapeutics.
A quinacrine trial carried out in San Fransico, USA, led by Dr Michael Geshwind and here at the National Prion Clinic unfortunately showed no survival benefit.
Unfortunately there is no simple test such as a blood test to diagnose prion disease. Many of the symptoms initially experienced could indicate a number of diseases. Often neurologists will carry out extensive investigations to rule out other diseases which they may be able to treat before considering prion disease. Results of investigations: MRI, EEG and Lumbar puncture can help reach a diagnosis of prion disease.
Counselling and emotional support is provided by the National Prion Clinic, either through psychology or nursing staff. Counselling can be provided face to face or by telephone contact.
Service provision varies across the UK. Care provided is based on assessment of care needs. There is a care package which can be accessed via the National CJD Care Co-ordinators based at the National CJD Research & Surveillance Unit (NCJDRSU) in Edinburgh. Please liaise with your allocated clinicians to discuss your options.