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J Neurol. 2016 Dec;263(12):2499-2504. Epub 2016 Oct 11.

Importance of cerebrospinal fluid analysis in the era of McDonald 2010 criteria: a German-Austrian retrospective multicenter study in patients with a clinically isolated syndrome.

Author information

1
Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
2
Hannover Medical School, Hannover, Germany.
3
University of Göttingen, Göttingen, Germany.
4
NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.
5
Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.
6
Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria.
7
University of Würzburg, Würzburg, Germany.
8
University of Heidelberg, Heidelberg, Germany.
9
UCL Institute of Neurology, London, UK.
10
University of Freiburg, Freiburg, Germany.
11
Neuroimmunological Section, Department of Neurology, University of Rostock, Rostock, Germany.
12
University of Leipzig, Leipzig, Germany.
13
Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
14
Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
15
University of Düsseldorf, Düsseldorf, Germany.
16
Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany. hayrettin.tumani@uni-ulm.de.

Abstract

The majority of patients presenting with a first clinical symptom suggestive of multiple sclerosis (MS) do not fulfill the MRI criteria for dissemination in space and time according to the 2010 revision of the McDonald diagnostic criteria for MS and are thus classified as clinically isolated syndrome (CIS). To re-evaluate the utility of cerebrospinal fluid (CSF) analysis in the context of the revised McDonald criteria from 2010, we conducted a retrospective multicenter study aimed at determining the prevalence and predictive value of oligoclonal IgG bands (OCBs) in patients with CIS. Patients were recruited from ten specialized MS centers in Germany and Austria. We collected data from 406 patients; at disease onset, 44/406 (11 %) fulfilled the McDonald 2010 criteria for MS. Intrathecal IgG OCBs were detected in 310/362 (86 %) of CIS patients. Those patients were twice as likely to convert to MS according to McDonald 2010 criteria as OCB-negative individuals (hazard ratio = 2.1, p = 0.0014) and in a shorter time period of 25 months (95 % CI 21-34) compared to 47 months in OCB-negative individuals (95 % CI 36-85). In patients without brain lesions at first attack and presence of intrathecal OCBs (30/44), conversion rate to MS was 60 % (18/30), whereas it was only 21 % (3/14) in those without OCBs. Our data confirm that in patients with CIS the risk of conversion to MS substantially increases if OCBs are present at onset. CSF analysis definitely helps to evaluate the prognosis in patients who do not have MS according to the revised McDonald criteria.

KEYWORDS:

Biomarker; CSF; Multiple sclerosis; OCB

PMID:
27730374
PMCID:
PMC5110610
DOI:
10.1007/s00415-016-8302-1
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Compliance with ethical standards Conflicts of interest The authors declare that they have no conflict of interest. Ethical approval This procedure and sample analysis for the purpose of this study was approved by the local Ethics Committees of each participating center in accordance with the Declaration of Helsinki. Informed consent All patients gave written informed consent for the use of remaining samples for research.

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