Cerebrospinal fluid analysis in affective and schizophrenic spectrum disorders: Identification of subgroups with immune responses and blood–CSF barrier dysfunction

Bechter, Karl; Reiber, Hansotto; Herzog, S.; Fuchs, Dietmar; Tumani, Hayrettin; Maxeiner, H.

doi:10.1016/j.jpsychires.2009.08.008

Cited by 201 publications

(137 citation statements)

References 65 publications

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“…Such a calculation could be necessary to show the influence of a treatment in a patient group or to proof the null hypothesis for a group without intrathecal synthesis like a group of psychiatric patients 18 . The software of Albaum 21 offers a corresponding statistics program.…”

Section: Recommendation For the Csf Laboratory And Igm Assay Suppliersmentioning

confidence: 99%

“…This calculation takes into account that each patient has a different QAlb with a correspondingly different Qmean for calculation of the Ig loc (mean). The free software 21 offers the data to perform a t-test sufficient to check the Null hypothesis 18 and calculate significances with p-values. As control data the data set of the 4300 patients, used for the development of the Reibergrams 8 , are integrated in the program 21 .…”

Section: Recommendation For the Csf Laboratory And Igm Assay Suppliersmentioning

confidence: 99%

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Knowledge-base for interpretation of cerebrospinal fluid data patterns. Essentials in neurology and psychiatry

Reiber¹

2016

Arq. Neuro-Psiquiatr.

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The physiological and biophysical knowledge base for interpretations of cerebrospinal fluid (CSF) data and reference ranges are essential for the clinical pathologist and neurochemist. With the popular description of the CSF flow dependent barrier function, the dynamics and concentration gradients of blood-derived, brain-derived and leptomeningeal proteins in CSF or the specificity-independent functions of B-lymphocytes in brain also the neurologist, psychiatrist, neurosurgeon as well as the neuropharmacologist may find essentials for diagnosis, research or development of therapies. This review may help to replace the outdated ideas like “leakage” models of the barriers, linear immunoglobulin Index Interpretations or CSF electrophoresis. Calculations, Interpretations and analytical pitfalls are described for albumin quotients, quantitation of immunoglobulin synthesis in Reibergrams, oligoclonal IgG, IgM analysis, the polyspecific ( MRZ- ) antibody reaction, the statistical treatment of CSF data and general quality assessment in the CSF laboratory. The diagnostic relevance is documented in an accompaning review.

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Section: Recommendation For the Csf Laboratory And Igm Assay Suppliersmentioning

confidence: 99%

Section: Recommendation For the Csf Laboratory And Igm Assay Suppliersmentioning

confidence: 99%

Knowledge-base for interpretation of cerebrospinal fluid data patterns. Essentials in neurology and psychiatry

Reiber¹

2016

Arq. Neuro-Psiquiatr.

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“…So multiple sclerosis patients with initial exclusive symptoms of the bipolar spectrum disorder might see first a psychiater and might get a false symptomatic treatment, if CSF is not analysed ( Figure 5). This defines the primary target of CSF analysis in psychiatry: the exclusion of CSF abnormalities 40 . Due to the high frequency of oligoclonal IgG (isoelectric focussing not CSF electrophoresis) in chronic inflammatory diseases this analysis is the basic information a psychiatrist should ask for, to exclude an inflammatory cause of psychiatric symptoms, like in the cases with MS ( Figure 5).…”

Section: Psychiatric Diseasesmentioning

confidence: 99%

Cerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases. Diagnostic patterns not to be missed in neurology and psychiatry

Reiber

2016

Arq. Neuro-Psiquiatr.

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REVIEWCerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases. Diagnostic patterns not to be missed in neurology and psychiatry Liquido cefalorraquidiano: compilação dos dados e interpretação avançada de doenças bacterianas, virais, parasitarias, oncológicas, inflamatórias cronicas e desmielinizantes. Padrões diagnósticos que não devem faltar em neurologia e psiquiatria Hansotto ReiberGeorg August-University, Former Neurochemistry Laboratory, Goettingen, Germany. AbstrACtThe analysis of intrathecal IgG, IgA and IgM synthesis in cerebrospinal fluid (CSF) and evaluation in combined quotient diagrams provides disease-related patterns. The compilation with complementary parameters (barrier function, i.e., CSF flow rate, cytology, lactate, antibodies) in a cumulative CSF data report allows a knowledge-based interpretation and provides analytical and medical plausibility for the quality assessment in CSF laboratories. The diagnostic relevance is described for neurological and psychiatric diseases, for which CSF analysis can't be replaced by other diagnostic methods without loss of information. Dominance of intrathecal IgM, IgA or three class immune responses give a systematic approach for Facial nerve palsy, Neurotrypanosomiasis, Opportunistic diseases, lymphoma, Neurotuberculosis, Adrenoleucodystrophy or tumor metastases. Particular applications consider the diagnostic power of the polyspecific antibody response (MRZ-antibodies) in multiple sclerosis, a CSF-related systematic view on differential diagnostic of psychiatric diseases and the dynamics of brain-derived compared to blood-derived molecules in CSF for localization of paracytes.Keywords: cerebrospinal fluid; immunoglobulins; antibody; nervous system diseases; clinical record. resumo A análise da síntese intratecal de IgG, IgA e IgM no liquido cefalorraquidiano (LCR) e a avaliação destas em diagramas com quocientes sugere padrões de diversas doenças. Estes dados, juntamente com outros parâmetros como a função de barreira, o fluxo liquórico, a citologia, o lactato e a pesquisa de anticorpos, integrados em uma ficha de paciente, permite uma interpretação baseada em conhecimento e permite também uma aferição da qualidade em laboratórios de LCR. A relevância diagnóstica é descrita para doenças neurológicas e psiquiátricas pois a análise do LCR não pode ser substituída por outros metódos diagnósticos sem perda de informação para o diagnóstico do paciente. O aumento da síntese intratecal de IgM, IgA ou das 3 classes de imunoglobulinas sugerem um diagnóstico sistemático de paralisia facial periférica, neurotripanosomiase, doenças oportunísticas, linfoma, neurotuberculose, adrenoleucodistrofia ou metástases de tumores cerebrais. A resposta poliespecífica de anticorpos contra sarampo, rubéola e varicela zoster (MRZ reação) é sugestiva de esclerose múltipla. Uma visão sistemática considera o diagnóstico diferencial de doenças psiquiátricas e doenças chrônicas. A...

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“…0 300 600 900 0 300 600 900 0 300 600 900 90 100 110 120 130 80 90 100 60 70 80 90 This consideration could also give the rational for a mild encephalitis hypothesis of schizophrenia (47). Neither the decreased CSF flow rate (48), nor the detection of changes in the cytokine pattern is an unambiguous sign of an antigen-driven immune response. Some patients with Schizophrenia may have a history of immune system associated pathology (ISAP) or a nervous system-or endocrine system associated pathology, or in another fraction of the patients it may happen as an uninfluenced spontaneous fluctuation leading to a phase transition in certain brain functions.…”

Section: Cytokinesmentioning

confidence: 99%

Chronic Diseases with Delayed Onset After Vaccinations and Infections. A Complex Systems Approach to Pathology and Therapy

Reiber¹

2017

J Arch Mil Med

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Background: The medical community fails dramatically in the understanding of chronic diseases and development of causal therapies. Statistical associations between vaccinations or infections and autoimmune diseases or a multitude of chronic diseases remains without any scientific rational. The Gulf War illness, with an unexpected high health risk (34%) for military personnel after a manifold of vaccinations, points to the need of a scientific approach different from insufficient linear clonal selection concepts in immunology. Methods: Non-linear dynamics analyzed in time series, phase portraits, and mathematical models. Results: Three different types of chronic diseases, different from lasting acute diseases, are discriminated by Cerebrospinal fluid analysis and nonlinear dynamics. A nonlinear model for a virus-driven chronic disease explains the chronification of the infection, as one of the stable optional states between complete immunity and death. The model also helps create causal therapies and facilitating phase transitions to complete immunity based on individual connectivity in the immune network. Chronic diseases with a sudden change from stable health to a pathological but stable state are phase transitions based on metabolic fluctuations spontaneous or facilitated by external influences (via the immune, endocrine or nervous system). A reduced complexity in diseases is shown by the numerical analysis of time series (e.g., heart rate) or attractor phase portraits. In chronic diseases, with immune system associated pathology, vaccination or infection has to be regarded as a facilitator for a phase transition, like a catalyst, but not as the cause. With this causation we understand why no traces, like causative antigens, are found in Gulf War illness, chronic fatigue syndrome, post lyme syndrome, or the mild encephalitis in schizophrenia.Conclusions: The complexity approach shows why antiviral or antibiotic medications fail in chronic diseases. Disease as an emergent property should be investigated on the phenotype level. Nonlinear analysis of time series of the individual patient gives information not available from group statistics of molecular "multiscale" systems or systems biology. New research perspectives could base on the extended time of registry after vaccinations and should focus on causal therapies, which need financial support, independent from the medical-industrial complex, with its divergent interests.

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Cerebrospinal fluid analysis in affective and schizophrenic spectrum disorders: Identification of subgroups with immune responses and blood–CSF barrier dysfunction

Cited by 201 publications

References 65 publications

Knowledge-base for interpretation of cerebrospinal fluid data patterns. Essentials in neurology and psychiatry

Knowledge-base for interpretation of cerebrospinal fluid data patterns. Essentials in neurology and psychiatry

Cerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases. Diagnostic patterns not to be missed in neurology and psychiatry

Chronic Diseases with Delayed Onset After Vaccinations and Infections. A Complex Systems Approach to Pathology and Therapy

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