Cerebrospinal fluid multiple sclerosis

In multiple sclerosis, which is a demyelinating disease, there is loss of both phospholipids (particularly ethanolamine plasmalogen) and of sphingolipids from white matter. Thus, the lipid composition of white matter resembles that of gray matter. The cerebrospinal fluid shows raised phospholipid levels. 

Concentration of total protein in cerebrospinal fluid is an essential biochemical parameter. It is impossible to agree with the opinion of some clinicians (many of whom are fascinated by the latest examination methods) that this is an unnecessary parameter. It is tme that the concentration of total protein in cerebrospinal fluid varies with respect to the reference range. It is known that the concentration of total protein in cerebrospinal fluid exceeding 1 g represents a principal challenge to the diagnosis of some CNS diseases (e.g., multiple sclerosis). This is fully in accordance with the results of a study (A24) in which the highest detectable level of total protein was 0.92 g... 

The concentration of total protein increases slightly with age. In multiple sclerosis, we have not proved any dependence of the level of total protein in cerebrospinal fluid on other clinical parameters. 

The most characteristic abnormality in patients with multiple sclerosis is certainly the intrathecal synthesis of IgG. It can be demonstrated—with different sensitivity— by various methods, which can be divided into qualitative and quantitative methods. The gold standard for the demonstration of intrathecal synthesis of IgG is the detection of oligoclonal bands, which are not present in CSF, in the appropriately diluted serum (i.e., to the same concentration of IgG) by isoelectric focusing. This is a qualitative method and the description of its different modifications and interpretations goes beyond the scope of this chapter. This method is by far the most sensitive, and its sensitivity is reported between 90 and 100%. Here it is suitable to repeat that the detection of plasmocytic forms in cerebrospinal fluid may also be regarded as qualitative proof of intrathecal synthesis of immunoglobulins— although in this case the proof is obviously not specific for IgG from the theoretical point of view. 

In patients with multiple sclerosis, a qualitative cytological examination should always be carried out. Besides the finding of plasmocytic forms, which are considered to be one of the proofs of intrathecal synthesis of immunoglobulins, this examination also provides invaluable information concerning the reaction of the monocyte-macrophage system in the CSF compartment. It should be noted on the scope of biochemical examinations of cerebrospinal fluid in multiple sclerosis that it is most important to return to the simple and inexpensive method. 

Chiodi, R, Sundqvist, V. A., Link, H., and Norrby, E., Viral IgM antibodies in serum and cerebrospinal fluid in patients with multiple sclerosis and controls. Acta Neurol. Scand. 75(3), 201-208 (1987). 

H2. Havrdova, E., Racek, P., and JedUcka, R, Relation of intrathecal synthesis of IgG including IgG subclasses to cytokine levels in cerebrospinal fluid in patients with multiple sclerosis. Clin. 

R6. Reiber, H., Cerebrospinal fluid analysis. In CSF Analysis in Multiple Sclerosis (E. J. Thomson, M. Trojano, and R Livrea, eds.). Springer-Verlag, Milano, 1996. 

Spence, A. M., Immunoglobulins in cerebrospinal fluid in multiple sclerosis. Hurru Pathol. 14, 99-103 (1983). 

Stourac, R, Differential diagnostic relevance of the blood-CSE barrier function and oligoclonal IgG synthesis in cerebrospinal fluid in multiple sclerosis. Clin. Biochem. Metab. 6(27), 210-212 (1998). 

Glucocorticoids given intrathecally can cause a rise in cerebrospinal fluid protein and carry the risk of arachnoiditis (SED-8, 820). Chemical meningitis has been reported after two intrathecal injections of methylpredni-solone acetate (450) and after lumbar facet joint block (SEDA-17, 450). Intraspinal injections of hydrocortisone for multiple sclerosis apparently led in one case to a cauda equina syndrome, with subsequent ulceromutilating acro-pathy (SEDA-17, 450). Intra-discal injections of triamcinolone acetonide in a number of French cases led to disk or epidural calcification, sometimes symptomless (SEDA-17, 450). 

M19. Misu, T., Onodera, H., Fujihara, K., Matsushima, K., Yoshie, O., Okita, N., Takase, S., and Itoyama, Y., Chemokine receptor expression on T cells in blood and cerebrospinal fluid at relapse and remission of multiple sclerosis Imbalance of Thl/Th2-associated chemokine signaling. J. Neuroimmunol. 114, 207-212 (2001). 

Cerebrospinal Fluid Analysis in Multiple Sclerosis Francisco A. Luque and Stephen L. Jaffe... 

Terzi M, Birinci A, Cetinkaya E, Onar MK (2007) Cerebrospinal fluid total tau protein levels in patients with multiple sclerosis. Acta Neurol Scand 115 325-330 Tolnay M, Probst A (1999) REVIEW tau protein pathology in Alzheimer s disease and related disorders. Neuropathol Appl Neurobiol 25 171-187 Trojanowski JQ, Lee VM (2002) The role of tau in Alzheimer s disease. Med CUn North Am 86 615-627... 

Noben IP, Dumont D, Kwasnikowska N, Verhaert P, Somers V, et al. Lumbar cerebrospinal fluid proteome in multiple sclerosis characterization by ultraflltration, liquid chromatography, and mass spectrometry. J. Proteome Res. 2006 5 1647-1657. 

Determinations of antigen by the quantitative precipitin method were used routinely for many years in some institutions for the estimation of IgG in human cerebrospinal fluid, increases in cerebrospinal fluid IgG being found in multiple sclerosis and in neurosyphilis.In recent... 

In contrast to T cells, in different immunopathologies, the brain provides a fostering envkonment to B cells. Primary central nervous system (CNS) lymphomas are usually of B cell origin. The cerebrospinal fluid (CSF) of patients with chronic infections and autoimmune diseases of the CNS typically contains remarkably stable oligoclonal Ig bands. In the CNS of multiple sclerosis patients, clonally expanded B cells and plasma cells persist. Ectopic B cell follicles develop in the meninges of patients with secondary progressive MS, and B cell differentiation may be recapitulated in the CNS of MS patients (Krumbholz et al., 2006) (see Chapters 18-24). 

Matusevicius D, Navikas V, Soderstrom M, Xiao BG, Haglund M, Frediikson S, Link H (1996) Multiple sclerosis The proinflammatory cytokines lymphotoxin-alpha and tumour necrosis factor-alpha aie upregulated in cerebrospinal fluid mononuclear cells. J Neuroimmunol 66 115—123. 

Keywords Multiple sclerosis experimental allergic encephalomyelitis central nervous system virus cerebrospinal fluid T-cell receptor acute disseminated encephalomyelitis lymphocyte immune system... 

Dore-Duffy P, Newman W, Balabanov R, Lisak RP, Mainolfi E, Rothlein R, Peterson M (1995) Circulating, soluble adhesion proteins in cerebrospinal fluid and serum of patients with multiple sclerosis Correlation with clinical activity. Ann Neurol 37 55-62. 

Fortini AS, Sanders EL, Weinshenker BG, Katzmann JA (2003) Cerebrospinal fluid oligoclonal bands in the diagnosis of multiple sclerosis. Isoelectric focusing with IgG immunoblotting compared with high-resolution agarose gel electrophoresis and cerebrospinal fluid IgG index. Am J Clin Pathol 120 672-675. 

Holmoy T, Kvale EG, Vartdal F (2004) Cerebrospinal fluid CD4-I-T cells from a multiple sclerosis patient cross-recognize Epstein-Barr virus and myelin basic protein. 1 Neurovirol 10 278-283. 

Niino M, Ogata A, Kikuchi S, Tashiro K, Nishihira J (2000) Macrophage migration inhibitory factor in the cerebrospinal fluid of patients with conventional and optic-spinal forms of multiple sclerosis and neuro-Behcet s disease. J Neurol Sci 179 127-131. 

Hammack BN, Eung KY, Hunsucker SW, Duncan MW, Burgoon MP, Owens GP, Gilden DH (2004) Proteomic analysis of multiple sclerosis cerebrospinal fluid. Mult Scler 10 245-260. 

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