CSF profile in primary progressive multiple sclerosis: Re-exploring the basics

Abstract

ObjectiveThe aim of this study was to report the basic cerebrospinal fluid (CSF) profile in patients with primary progressive multiple sclerosis (PPMS).MethodsThe results of CSF analysis from 254 patients with PPMS were collected at four university hospitals in Germany. Routine CSF parameters and different indices of intrathecal immunoglobulin synthesis were evaluated. We assessed possible correlations between the various CSF parameters and the expanded disability status scale (EDSS) both at the time of lumbar puncture and during the course of the disease.ResultsThe median cell count and albumin concentration in the CSF did not deviate from normal values. The CSF-serum albumin-quotient (QALB) was elevated in 29.6% of the patients, while intrathecal immunoglobulin G (IgG) oligoclonal bands (OCBs) were detected in 91.1% of the patients. CSF-lactate levels as well as local IgM- and IgA-synthesis were correlated with the yearly disease progression rate, as assessed by EDSS.ConclusionWe present the results of the hitherto largest and most detailed CSF biomarker profile in a cohort of 254 patients with PPMS. As reported previously, OCBs are the most sensitive marker for intrathecal IgG synthesis. CSF-lactate concentrations are positively correlated with the progression rate, which might suggest that mitochondrial dysfunction plays a relevant role in PPMS. The negative correlation between intrathecally produced IgM and IgA and disease progression may indicate their hitherto unexplored protective role.

Cerebrospinal fluid lactate in dogs with inflammatory central nervous system disorders

“…Cerebrospinal fluid lactate is increased in subsets of human patients with multiple sclerosis (MS), a well‐known, immune‐mediated inflammatory CNS disorder . This can occur in patients with both primary progressive and remitting‐relapsing forms of the disease, particularly during exacerbations, relapses, or with secondary progression .…”

“…This can occur in patients with both primary progressive and remitting‐relapsing forms of the disease, particularly during exacerbations, relapses, or with secondary progression . Despite this, a number of MS patients have CSF lactate concentrations within established reference intervals . However, even when CSF lactate concentrations remain within normal reference intervals, these concentrations can be higher than those seen in control groups .…”

“…Perhaps, the greatest utility in humans is to distinguish bacterial from aseptic meningitis . However, lactate concentrations are also increased in some patients with presumed autoimmune inflammatory conditions such as neuromyelitis optica and multiple‐sclerosis …”

Comparative characteristic of laboratory indicators for encephalitis, disseminated encephalomyelitis and multiple sclerosis in children

“…В работе A. Abdelhak и соавт. [9] проведено сопоставление альбуминового индекса и интратекальной продукции иммуноглоблулинов у пациентов с первично-прогрессирующей формой РС. Средние показатели количества клеток и концентрации альбумина в цереброспинальной жидкости не отклонялись от нормальных значений, альбуминовый индекс был повышен только у 29,6 % пациентов, тогда как олигоклональные полосы интратекального IgG обнаружены у 91,1 % пациентов.…”

Differential diagnosis of primary progressive multiple sclerosis

“…Изменения в цереброспинальной жидкости вклю-чают в себя нормальное или слегка повышенное число лейкоцитов (<25 клеток на см 3 ; преимущественно лимфоциты) и содержание белка (обычно <1 г/л), повышенное содержание IgG или наличие олигоклональных IgG, отсутствующих в сыворотке крови [19]. Каче ственный анализ IgG в цереброспинальной жидкости с помощью изоэлектрофокусирования и иммунофиксации является оптимальным методом выявления олигоклональных IgG, которые встречаются у 90% пациентов с РС [20,21]. Тем не менее, олигоклональные IgG иногда определяются у больных с другими неврологическим воспалительными заболеваниями, а их наличие необходимо интерпретировать с осторожностью.…”