CerebroSpinal Fluid & Multiple Sclerosis

  1. Revision of McDonald's new diagnostic criteria for Multiple Sclerosis
    Nervenarzt 2006 Oct;77(10):1235, 1237-45

  2. Recommended standard of CerebroSpinal Fluid analysis in the diagnosis of Multiple Sclerosis: a consensus statement
    Arch Neurol 2005 Jun;62(6):865-70

  3. CytoImmunological profile of CerebroSpinal Fluid in diagnosis of Multiple Sclerosis
    Pathol Biol (Paris) 2005 Mar;53(2):68-74

  4. Bulk Listing - CerebroSpinal Fluid  

  5. Intrathecal IgM synthesis is a prognostic factor in Multiple Sclerosis
    Ann Neurol 2003 Feb;53(2):222-6

  6. Intrathecal IgM synthesis predicts the onset of new relapses and a worse disease course in MS
    Neurology 2002 Aug 27;59(4):555-9

  7. Apoptosis in Neurons exposed to CerebroSpinal Fluid from patients with Multiple Sclerosis or acute PolyRadiculoNeuropathy
    J Neurol Sci 2001 May 1;186(1-2):31-6

  8. Axonal damage induced by CerebroSpinal Fluid from patients with Relapsing/Remitting Multiple Sclerosis
    J NeuroImmunol 2000 Apr 3;104(1):58-67

  9. CerebroSpinal Fluid abnormalities in a phase III trial of Avonex
    J NeuroImmunol 1999 Jan 1;93(1-2):8-14

  10. B-Cell hypermutation from Multiple Sclerosis CerebroSpinal Fluid
    J Clin Invest 102: 1045-50 (1998)

  11. CerebroSpinal Fluid and Cytokines in R/R MS
    ImmunoPharmacol ImmunoToxicol 1998 Aug;20(3):373-82

  12. CerebroSpinal Fluid Analysis Differentiates Between Relapsing/Remitting And Secondary/Progressive Multiple Sclerosis
    J Neurol NeuroSurg Psychiatry 1997 Oct;63(4):446-51

  13. CerebroSpinal Fluid in Acute Optic Neuritis
    Experience of the Optic Neuritis Treatment Trial

    Neurology 1996 Feb;46(2):368-72

  14. CerebroSpinal Fluid
    by: Faculty Of John Hopkins Univ.

CerebroSpinal Fluid Links


Revision Of McDonald's New Diagnostic Criteria For Multiple Sclerosis

Wiendl H, Kieseier BC, Gold R, Hohlfeld R, Bendszus M, Hartung HP
Nervenarzt 2006 Oct;77(10):1235, 1237-45
Neurologische Klinik und Poliklinik, Julius-Maximilians-Universität, Würzburg
PMID# 16912904

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.


Recommended Standard Of CerebroSpinal Fluid Analysis In The Diagnosis Of Multiple Sclerosis: A Consensus Statement

Freedman MS, Thompson EJ, Deisenhammer F, Giovannoni G, Grimsley G, Keir G, Ohman S, Racke MK, Sharief M, Sindic CJ, Sellebjerg F, Tourtellotte WW
Arch Neurol 2005 Jun;62(6):865-70
Multiple Sclerosis Research Clinic, University of Ottawa, Department of Medicine (Neurology), The Ottawa Hospital, Ottawa, Ontario, Canada
PMID# 15956157

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 Analysis Differentiates Between Relapsing/Remitting And Secondary/Progressive Multiple Sclerosis

Jongen PJ; Lamers KJ; Doesburg WH; Lemmens WA; Hommes OR
J Neurol NeuroSurg Psychiatry 1997 Oct;63(4):446-51
University Hospital Nijmegen, Dept of Neurology, The Netherlands

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

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

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).

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.

Patients with Relapsing/Remitting or S/P Multiple Sclerosis differ in CSF profile and CSF analysis may help to differentiate between Relapsing/Remitting and Secondary/Progressive Multiple Sclerosis.

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