Cerebrospinal fluid in the diagnosis of multiple sclerosis: a consensus report.

Abstract

The Committee of the European Concerted Action for Multiple Sclerosis (Charcot Foundation) organised five workshops to discuss CSF analytical standards in the diagnosis of multiple sclerosis. This consensus report from 12 European countries summarises the results of those workshops. It is hoped that neurologists will confer with their colleagues in clinical chemistry to arrange the best possible local practice. The most sensitive method for the detection of oligoclonal immunoglobulin bands is isoelectric focusing. The same amounts of IgG in parallel CSF and serum samples are used and oligoclonal bands are revealed with IgG specific antibody staining. All laboratories performing isoelectric focusing should check their technique at least annually using "blind" standards for the five different CSF and serum patterns. Quantitative measurements of IgG production in the CNS are less sensitive than isoelectric focusing. The preferred method for detection of blood-CSF barrier dysfunction is the albumin quotient. The CSF albumin or total protein concentrations are less satisfactory. These results must be interpreted with reference to the age of the patient and the local method of determination. Cells should be counted. The normal value is no more than 4 cells/microliters. Among evolving optional tests, measurement of the combined local synthesis of antibodies against measles, rubella, and/or varicella zoster could represent a significant advance if it offers higher specificity (not sensitivity) for identifying chronic rather than acute inflammation. Other tests that may have useful correlations with clinical indices include those for oligoclonal free light chains, IgM, IgA, or myelin basic protein concentrations.

Keywords

MeSH Terms

Affiliated Institutions

• University of Gothenburg SE
• University of Bologna IT
• Université Paris Cité FR
• UCL Australia AU
• Hospital Universitario Ramón y Cajal ES
• Ospedale Sacro Cuore Don Calabria IT
• UCLouvain BE
• Vita-Salute San Raffaele University IT
• Sahlgrenska University Hospital SE
• Ospedale Civile Di Ivrea IT
• University of Göttingen DE
• Linköping University SE
• University of Copenhagen DK
• Fondazione IRCCS Istituto Neurologico Carlo Besta IT
• Karolinska Institutet SE
• Medizinische Hochschule Hannover DE
• Radboud University Nijmegen NL
• University of Lausanne CH
• University Radiology US

Related Publications