CerebroSpinal Fluid & Multiple Sclerosis

In 2001, an international panel suggested new diagnostic criteria for Multiple Sclerosis (MS).

These criteria integrate clinical, imaging (MRI), and paraclinical results in order to facilitate diagnosis. Since then, these so-called McDonald criteria have been broadly accepted and widely propagated.

In the meantime a number of publications have dealt with the sensitivity and specificity for MS diagnosis and with implementing these new criteria in clinical practice.

Based on these empirical values and newer data on MS, an international expert group recently proposed a revision of the criteria.

Substantial changes affect:
1. MRI criteria for the dissemination of lesions over time
2. The role of Spinal Cord lesions in the MRI and
3. The diagnosis of Primary/Progressive MS

In this article we present recent experiences with the McDonald and revised criteria.

New criteria for the diagnosis of Multiple Sclerosis (MS) were published as the result of an internationally formed committee. To increase the specificity of diagnosis and to minimize the number of false diagnoses.

The committee recommended the use of both clinical and paraclinical criteria, the latter involving information obtained from Magnetic Resonance Imaging, Evoked Potentials, and CerebroSpinal Fluid (CSF) analysis.

Although rigorous Magnetic Resonance Imaging requirements were provided, the "new criteria paper" fell short in terms of guidelines as to how the CSF analysis should be performed and simply equated the IgG index with isoelectric focusing, without any justification.

The spectrum of parameters analyzed and methods for CSF analysis differ worldwide and often yield variable results in terms of sensitivity, specificity, accuracy, and reliability, with no decided "optimal" CSF test for the diagnosis of MS.

To address this question specifically, an international panel of experts in MS and CSF diagnostic techniques was convened and the result was this article, representing a consensus of all the participants.

These recommendations for establishing a standard for the evaluation of CSF in patients suspected of having MS should greatly complement the new criteria in ensuring that a correct diagnosis of MS is being made.

CerebroSpinal Fluid (CSF) analysis differentiates between Relapsing/Remitting and Secondary/Progressive MS.

Objectives
To find whether CSF analysis may differentiate between Relapsing/Remitting and Secondary/Progressive Multiple Sclerosis.

Methods
In 17 patients with R/R and 16 patients with S/P Multiple Sclerosis, all without current or recent relapses, Albumin CSF: Peripheral Blood Ratio, MonoNuclear Cell number, CD4⁺, CD8⁺, and B1⁺ subsets, CD4⁺:CD8⁺ ratio, IgG, IgG index, IgM, IgM index, Complement components C3 and C4, and C3 and C4 indices, Myelin Basic Protein, Neuron specific Enolase, S100, and Lactate were determined.

For each measure the statistical distance measure D2 was calculated. For computation of a discriminant score variables with a P value< or =0.15 were included (two sided univariate t test).

These were Albumin CSF: Peripheral Blood Ratio, MonoNuclear Cell number, IgM, IgM index, C3, C4, Neuron specific Enolase, S100, and Lactate.

Simultaneous distributions of the variables were compared between both groups (multivariate t test) and a discriminant score was computed (linear discriminant analysis).

Results
The discriminant score allocated all 14 R/R patients to the Relapsing/Remitting group (positive score) and 12 of 13 S/P patients to the Secondary/Progressive group (negative score). One Secondary/Progressive patient was allocated to the Relapsing/Remitting group.