ABSTRACT
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare fatal degenerative disease of the central nervous system. The clinical course is characterized by rapid progression of neurological and neuromuscular symptoms. The late stage with loss of consciousness is not well characterized. We report a 62-year-old male patient with sCJD with the clinical picture of a vegetative state/apallic syndrome, in whom we studied cortical responses using a vibration paradigm. The functional magnetic resonance imaging (fMRI) investigation demonstrated a clear response within the sensorimotor cortex, the cerebellum, the parietal cortex, the insular, and frontal inferior region. The finding of persistent cortical activity on fMRI in a patient with CJD in a state of unconsciousness has implications for the clinical management and for ethical considerations.
ABSTRACT
BACKGROUND: Long-term use of opioids causes cognitive decline. Transcutaneous nerve stimulation (TENS) applied preincisionally and postoperatively reduces postoperative opioid requirement and provides sufficient analgesia after major spinal surgery. Aim of this study was to find out the impact of TENS compared to opioids, prescribed for postoperative analgesia on early postoperative cognitive function. METHODS: This study was prospective and randomised-controlled. Patients and observers were blinded to the study design. Forty-one patients of both sexes planned for lumbar interbody fusion were admitted and divided randomly into 2 groups. 35 Patients finished the study. Group A received TENS preincisionally and postoperatively, group B received piritramide intravenously (i.v.) by patient-controlled analgesia pump. The adjuvant analgesic therapy diclofenac 75 mg i.v. and the rescue medication paracetamol 1g i.v. was the same for all patients. Pain intensity was assessed by visual analogue scale (VAS). A battery of objective, standardized psychological tests was administered in the same order the day before surgery and 24 to 30 hours postoperatively. RESULTS: The two groups were compared by pairs. Pre- and postoperative attention and memory differed significantly in both groups (p < 0.05). The postoperative fatigue was lower in group A (p < 0.05). Neither age, sex, body mass index, duration of operation, the need of rescue medication nor the incidents of hypotensive phases showed any significant association with postoperative cognitive decline. CONCLUSIONS: Augmentation of fatigue in early postoperative phase was less in patients treated with TENS than with opioids for analgesic therapy after major spinal surgery. Further investigations on the duration of opioid therapy when cognitive functions decline are necessary.
