Cerebrospinal Fluid Analysis in Multiple Sclerosis Diagnosis: An Update
Abstract
:1. Introduction
2. Etiopathogenesis
3. Diagnostic Criteria
4. CSF Diagnostics
5. Conclusions
Funding
Conflicts of Interest
References
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Clinical Presentation | Additional Data Needed for MS Diagnosis |
In patient with a typical attack/CIS at onset | |
≥2 clinical attacks and evidence of ≥2 lesions | None * |
≥2 clinical attacks and evidence of 1 lesion with history of previous attack involving lesions in different location | None * |
≥2 clinical attacks and evidence of 1 lesion | Evidence for DIS established by an additional clinical attack implicating different CNS site OR by MRI |
1 clinical attack and evidence of ≥2 lesions | Evidence for DIT established by an additional clinical attack implicating different CNS site or by MRI OR positive CSF-specific (i.e., not in serum) oligoclonal bands ** |
1 clinical attack and evidence of 1 lesion | Evidence for DIS established by an additional clinical attack implicating different CNS site or by MRI ORevidence for DIT established by an additional clinical attack implicating different CNS site OR by MRI OR positive CSF-specific (i.e., not in serum) oligoclonal bands ** |
Clinical presentation | Additional data needed for MS Diagnosis |
In patient with a progression of disability from onset (PPMS) | |
Progression from onset | 1 year of disability progression (retrospective or prospective) AND two of these criteria:
|
Authors [Ref.] | Number of Subjects | Assay Method | Metrics | Cut-Off | Sensitivity, % | Specificity, % |
---|---|---|---|---|---|---|
Menendez-Valladares, P. et al. [50] | 334 patients | Nephelometry | kFLC Index | 10.62 | 91% | 89% |
Saez, M.S. et al. [47] | 77 patients | Turbidimetry | OCB | Positive | 93% | 90.4% |
CSF kFLC | 7.1 mg/L | 95% | 97% | |||
CSF λFLC | 0.7 mg/L | 71% | 81% | |||
kFLC + λFLC | / | 95% | ||||
Puthenparampil, M. et al. [20] | 70 patients | Nephelometry | IgG Index | / | / | / |
CSF and serum kFLC | / | / | / | |||
37 controls | CSF and serum λFLC | / | / | / | ||
kFLC Index | 4.25 | 93.8% | 100.0% | |||
λFLC Index | / | / | / | |||
Christiansen, M. et al. [48] | 230 patients | Turbidimetry | OCB | Positive | 82.3% (MS) 56.8% (CIS) | 93.8% |
IgG Index | 0.64 | 72.9% (MS) 51.3% (CIS) | 95.9% | |||
CSF kFLC | 0.42 mg/L | 93.8% (MS) 70.3% (CIS) | 85.6% | |||
CSF λFLC | 0.14 mg/L | 93.8% (MS) 86.5% (CIS) | 35.1% | |||
kFLC Index | 5.9 | 92.7% (MS) 70.3% (CIS) | 86.6% | |||
λFLC Index | 2.8 | 93.8% (MS) 81,1% (CIS) | 46.4% | |||
Gurtner, K.M. et al. [49] | 325 residual paired CSF and serum samples | Nephelometry | OCB | Positive (≥4 bands) | 86.6% | 89.6% |
CSF kFLC | 0.0611 mg/dL | 92.5% | 86.1% | |||
CSF λFLC | 0.0244 mg/dL | 75.8% | 84.4% | |||
kFLC Index | ≥8.87 | 88.1% | 88.7% | |||
Valencia-Vera, E. et al. [32] | 123 unselected consecutive patients with CSF OCB request | Nephelometry | OCB | Positive | 89.2% | 81.2% |
≥0.92 | 97.3% | 45.88% | ||||
kFLC index | ≥2.91 | 83.8% | 85.8% | |||
≥8.33 | 70.2% | 95.6% | ||||
Goffette et al. [46] | 33 patients with clinical suspicion of MS | Immunoaffinity-mediated capillary blot | Free K Bands | Presence of free kappa bands | / | / |
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Lo Sasso, B.; Agnello, L.; Bivona, G.; Bellia, C.; Ciaccio, M. Cerebrospinal Fluid Analysis in Multiple Sclerosis Diagnosis: An Update. Medicina 2019, 55, 245. https://doi.org/10.3390/medicina55060245
Lo Sasso B, Agnello L, Bivona G, Bellia C, Ciaccio M. Cerebrospinal Fluid Analysis in Multiple Sclerosis Diagnosis: An Update. Medicina. 2019; 55(6):245. https://doi.org/10.3390/medicina55060245
Chicago/Turabian StyleLo Sasso, Bruna, Luisa Agnello, Giulia Bivona, Chiara Bellia, and Marcello Ciaccio. 2019. "Cerebrospinal Fluid Analysis in Multiple Sclerosis Diagnosis: An Update" Medicina 55, no. 6: 245. https://doi.org/10.3390/medicina55060245