Cerebrospinal fluid in the diagnosis of multiple sclerosis: a consensus report.

Andersson, Mats; Alvarez‐Cermeño, J. C.; Bernardi, Gaetano; Cogato, I.; Fredman, Pam; Frederiksen, Jette Lautrup; Fredrikson, Sten; Gallo, Paolo; Grimaldi, L. M E; Grønning, Marit; Keir, Geoff; Lamers, K.J.B.; Link, H.; Magalhães, Albino V.; Ar, Massaro; Ohman, S; Reiber, Hansotto; Rönnbäck, Lars; Schluep, Myriam; Schuller, E; Sindic, Christian; Thompson, E. J.; Trojano, María; Wurster, Ulrich

doi:10.1136/jnnp.57.8.897

Cited by 629 publications

(555 citation statements)

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“…Nevertheless, the molecular analysis shows a relative rise of the immunoglobulines, mainly the IgG. the most characteristic findings are, in frequency order: the appearance of the local IgG synthesis and the presence of oligoclonal bands in 90% of the cases, the raise of IgG in 80%, a discrete rise of gammaglobulines in 70% of the cases, and a moderate rise of cells and tubular proteins in 40% of the patients 9,10 .…”

mentioning

confidence: 99%

C3c intrathecal synthesis evaluation in patients with multiple sclerosis

Padilla-Docal¹,

Dorta‐Contreras²,

Fundora-Hernández³

et al. 2007

Arq. Neuro-Psiquiatr.

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-Introduction: Multiple sclerosis (Ms) is a chronic, inflammatory and progressive disease of the central nervous system in which local inflammatory injuries of the brain white matter appears, being the most outstanding feature the myeline loss (demyelination). Objective: to determine if the complement system might be involved in the Ms immunopathogeny favouring the mechanism intervening in the myelin destruction. Method: samples of sera and csF from twelve patients with a diagnosis of Ms obtained at the moment of the admission to the hospital at the beginning of the break out, were collected. Levels of c3c and albumin in sera and in csF were quantified using radial immunodiffusion plates. Results: High values over 80% of intrathecal synthesis were obtained except in one of the patients. Conclusion: Intrathecal synthesis of c3c and its liberation to the csF means that the activation of the complement system in any of the two ways has taken place, and that once performed its biological functions, has suffered a degradation process Key words: cytotoxicity, complement, multiple sclerosis, hypersensibility, immunopathogenicity, reibergram.evaluación de la síntesis intratecal de C3c en pacientes con esclerosis múltiple resuMeN -Introducción: La esclerosis múltiple (eM) es una enfermedad crónica, inflamatoria y progresiva del sistema nervioso central que cursa con la aparición de lesiones inflamatorias focales en la sustancia blanca cerebral, en las que lo más llamativo es la pérdida de mielina (desmielinización). Objetivo: conocer si el sistema de complemento puede estar involucrado en la inmunopatogenia de la eM favoreciendo los mecanismos que median la destrucción de la mielina. Método: se colectaron muestras de suero y Lcr de doce pacientes con diagnóstico de eM obtenidas en el momento del ingreso al inicio del brote. se cuantificaron los niveles de c3c y albúmina en suero y en Lcr en placas de inmunodifusión radial. Resultados: se obtuvieron altos valores que superan el 80% de síntesis intratecal, menos en uno de los pacientes. Conclusion: La síntesis intratecal de c3c y su liberación al Lcr significa que ha sucedido la activación del sistema de complemento en alguna de las dos vías y que una vez cumplidas sus funciones biológicas, ha sufrido un proceso de degradación y liberación al Lcr en forma de c3c.PALABrAs-cLAve: citotoxicidad, complemento, esclerosis múltiple, hipersensibilidad, inmunopatogenia, reibergrama.

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mentioning

confidence: 99%

C3c intrathecal synthesis evaluation in patients with multiple sclerosis

Padilla-Docal¹,

Dorta‐Contreras²,

Fundora-Hernández³

et al. 2007

Arq. Neuro-Psiquiatr.

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“…This causes action potentials to travel at reduced velocity, and conduction may become partially or completely blocked. [1][2][3] It is well established that conduction of action potentials in healthy axons can be blocked by pressure, and the threshold for this effect is inversely related to the duration of applied pressure. In in vivo and in vitro animal studies, propagation of evoked compound action potentials may be blocked by pressures as low as 30 mmHg when applied for hours, and much more rapid block is observed with pressures exceeding 200 mmHg.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Cerebral spinal fluid samples obtained by lumbar puncture may be performed to help support the diagnosis of MS. 4 A well-described complication of lumbar puncture is the postdural puncture headache (PDPH), but the classic treatment of this complication -epidural blood patch (EBP) -may be of theoretical concern in this unique type of patient. There is extensive literature showing that pressure can interfere with axonal conduction of nervous impulses, [5][6][7][8] and it is unknown whether affected axons of the MS patient are particularly vulnerable to the increase in epidural pressure that can occur as a consequence of the blood patch.…”

Section: Résumémentioning

confidence: 99%

Epidural blood patch in a patient with multiple sclerosis: is it safe?

Koeva

Bar‐Or

Gendron

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Multiple sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system resulting in demyelination and axonal injury. Epidural blood patch (EBP) to treat postdural puncture headache (PDPH) in an MS patient may be of concern because of the potential for this to interfere with axonal conduction. Even with normal axons, pressure can interfere with impulse conduction, and it is unknown whether affected axons of the MS patient are particularly vulnerable to the increase in epidural pressure that occurs as a consequence of the EBP. We describe our experience with EBP in an MS patient. While peridural pressure changes were not measured, we attempted to quantify any pressure-induced interference with axonal conduction by measuring changes in somatosensory evoked responses.Clinical features A 50-yr-old female MS patient required an EBP for a PDPH after a diagnostic lumbar puncture. The first EBP (20 mL autologous blood, L3-4 interspace) was followed by a transient improvement in PDPH and then a worsening with increased lower-extremity weakness. A second EBP was performed (12 mL autologous blood, L3-L4 interspace) with concomitant evoked potential recordings (stimulating electrodes over the left posterior tibial nerve and recording electrodes at CZ-FZ coordinates). Postdural puncture headache symptoms were permanently relieved, and the effects of the EBP on evoked P40 latency responses (39.7 msec and 44.3 msec pre-and post-EBP, respectively) were considered to be physiologically insignificant. Conclusion A report of EBP to treat PDPH in an MS patient is presented. We postulate that this type of patient may be at risk for impaired conduction of impulses in affected axons due to the increase in pressure produced by epidural injection of blood. Literature review indicates that pressure increases may be reduced by injecting the blood slowly. When EBP is considered in patients with axon conduction deficits, consideration should be given to concomitant monitoring of somatosensory evoked responses to help quantify interference with axonal conduction as a consequence of injection of blood into the epidural space. RésuméObjectif La scle´rose en plaques (SP) est une maladie inflammatoire et de´ge´ne´rative chronique du syste`me nerveux central qui entraıˆne une de´mye´linisation et une le´sion axonale. Le colmatage sanguin pe´ridural (CSP) pour traiter les ce´phale´es post-ponction durale (CPPD) chez un patient atteint de SP pourrait eˆtre inquie´tant parce qu'il peut entraver la conduction axonale. Meˆme lorsque les axones sont normaux, une pression peut perturber la Author contributions Vesselina Koeva helped perform the literature review and wrote the initial draft of the manuscript. Amit Bar-Or and Steven Backman helped provide clinical care for the patient. Amit Bar-Or and Daniel Gendron were involved in editing the manuscript. Daniel Gendron helped with interpretation of the electrophysiological data. Steven Backman supervised the project.

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“…Many reports recommend expertise in neuroimmunology diagnostic tests and their implementation in specialized laboratories [3,[8][9][10][11]. Nevertheless, laboratory medicine of autoimmune diseases is being increasingly conducted in large generalist laboratories that, differently from small specialized laboratories, can comply with the certification rules requested by regional agencies and national healthcare system in Italy.…”

Section: Normative Landscape and Guideline Application In Routine Diamentioning

confidence: 99%