Multiple sclerosis in Brazil: analysis of cerebrospinal fluid by standard methods

Abstract

-The demonstration of intrathecal IgG synthesis has been used as an important laboratory parameter to support the diagnosis of multiple sclerosis(MS). The Committee for European Concerted Action for Multiple Sclerosis has recommended a protocol for the assessment of intrathecal IgG synthesis. We applied this methodology to determine the cerebrospinal (CSF) profile of 128 Brazilian patients with MS. We detected hypercytosis lower than 35 cells/mm 3 in 97%, protein lower than 80mg/dl in 99%, normal blood-CSF barrier function in 76%, increased IgG local production around 53% and oligoclonal IgG bands by isoelectric focusing in 85% of the definite MS patients. The diagnostic accuracy of the quantitative analysis was lower than the qualitative. The detection of oligoclonal bands was especially important in the cases of normal quantitative assays of IgG. In addition, we found a lower frequency of inflammatory reaction in CSF in our MS cases, in comparison to some European studies.KEY WORDS: multiple sclerosis, cerebrospinal fluid, oligoclonal bands, isoelectric focusing. Esclerose múltipla no Brasil: análise do líquido cefalorraquidiano por métodos padronizadosRESUMO -A demonstração da síntese intratecal de IgG tem sido usada como importante parâmetro de apoio laboratorial ao diagnóstico de esclerose múltipla (EM). O Comitê Europeu de Ação para Esclerose Múltipla recomenda um protocolo para avaliação de síntese intratecal de IgG. Esta metodologia foi utilizada para determinar o perfil do líquido cefalorraquidiano (LCR) de 128 pacientes com o diagnóstico de esclerose múltipla. Verificouse pleocitose menor do que 35 células/mm 3 em 97%, produção local de IgG por métodos quantitativos em 53% e presença de bandas oligoclonais em 85% dos casos de EM clinicamente definida. A análise qualitativa apresentou maior acurácia diagnóstica do que a avaliação quantitativa de IgG. A detecção de bandas oligoclonais foi especialmente importante nos casos de analise quantitativa de IgG. Observamos menor frequência de reação inflamatória no LCR, em relação aos estudos europeus. PALAVRAS-CHAVE: esclerose múltipla, líquido cefalorraquidiano, bandas oligoclonais, focalização isoelétrica.

Optic neuromyelitis syndrome in Brazilian patients

“…This would seem to be in accordance with previous reports of the high numbers of non-white cases of Devic's syndrome in the United Kingdom, 14 the United States, 15 and Martinique. 12 There were important differences in the CSF findings between our ONM patients and those with definite MS: mild pleocytosis and increased CSF protein content were more common in ONM and increased IgG indices and oligoclonal bands, which occurred in 85% of the clinical definite MS Brazilian patients, 24 were very rare. Compared with MS where the CSF changes are independent of the activity of the disease, in ONM all the CSF abnormalities (pleocytosis, high level of protein, high IgG index, and oligoclonal bands) disappeared during remission in the majority of the cases.…”

“…These data support the proposition that the majority of patients with Devic's syndrome should only rarely be included as cases of MS. 6 RNMO must be differentiated from relapsing remitting MS (RRMS) on the basis of demographic, clinical, MRI, and CSF features. Recent data from the South Atlantic Project, a Brazilian survey on MS confirm that Brazilian MS patients have clinical, MRI, CSF, and genetic data [23][24][25] that are quite similar to the "western type" of MS. Demographic data indicated that in Brazilians, a highly ethnically diversified population, the disease was most prevalent in young white women. RRMS was present in 89% and a primary progressive disease in 11%; the EDSS scores in the RRMS group showed mild disability in 70%, moderate in 9.8%, and severe in 19.9% of the patients after a mean duration of disease of seven years.…”

Esclerose múltipla: correlação clínico-laboratorial

“…Ocorre um processo seletivo de inflamação local com desmielinização, envolvendo mecanismos imunes celular e humoral. Como consequência deste processo surgem as alterações no líquido cefalorraqueano (LCR) características da doença, tais como a presença de bandas IgG oligoclonais e aumento do índice de IgG, indicando a síntese intratecal de imunoglobulinas 1,2 . A maioria dos pacientes (85%) inicia o seu quadro clínico com a forma surto-remissão e, em cerca de 10 anos, evoluem para forma clínica crônica progressiva secundária.…”

Cerebrospinal fluid oligoclonal IgG bands in multiple sclerosis: what does it mean?

“…It contributes to the monitoring of inflammatory processes in the CNS. A Brazilian pioneering study showed the presence of CSF oligoclonal IgG bands in 85% of patients with definite MS 3 . However, it may found up to 95% of cases utilizing isoelectric focusing with IgG immunoblotting 2 .…”

“…Therefore, the test has a high predictive negative value. It does not represent a disease marker, considering that it is not specific for MS, since it may be found in other neurological disorders of the CNS [2][3][4] . Demonstration of oligoclonal IgG bands locally synthesized has been used more recently for the MS prognostic evaluation.…”