Multiple sclerosis INDEX

During inflammation, permeability increases in the blood-CSF barrier, elevating levels of sICAM in the CSF. Thus, in settings of acute meningitis, multiple sclerosis, and Guillain-Barre polyradiculoneuritis, CSF concentrations of 44 /rg L 4.5 ixg L and 16.2 /rg L respectively, were measured (R8). A precise, quantitative differentiation between the serum portion and the intrathecal fraction, comparable to the immunoglobulins, is still not possible therefore, the ICAM index represents the best approximation ... 

An increased IgG index is found in more than 80% of patients with multiple sclerosis. However, there seems to be no relationship in multiple sclerosis between the severity or the activity of the disease and the intrathecal production of IgG (F5, LI, S8, VI). The intrathecal IgA synthesis is found in only 12% of patients with multiple sclerosis (LI). 

An increased IgM index is seen in cerebral lupus erythematosus and in 30-60% of multiple sclerosis patients with a short disease duration (A20, A24, L1). An increase in the IgM index is usually associated with oligoclonal IgM bands on electrophoresis. This indicates an oligoclonal aspect of intrathecally produced IgM. Cerebral IgM production is related to the activity of multiple sclerosis, and the early detection of oligoclonal IgM in patients with acute isolated lesions of the brainstem and spinal cord has more predictive value for the development of multiple sclerosis than does detection of oligoclonal IgG bands (LI). 

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. 

The reference interval for the index is 0.30 to 0.70. Values >0.70 are considered evidence of increased IgG synthesis in more than 80% of cases of multiple sclerosis, this index exceeds 0.70. This estimator is now the one most often used. 

T6. Tourtellote, W. W., Ma, B. I., Baumhefner, R. W., Dickstein, P., Gowhig, G., Delmotte, P., and Potvin, A. R., Multiple sclerosis (MS) de novo central nervous system (CNS) IgG synthesis monitored by isotachophoresis (ITP), isoelectric focusing (lEF) Link s IgG Index, and an Empirical formula Effect of ACTH, corticosteroids, CNS X-ray and cytosine arabinoside. Proc. ITP 80, Elsevier, Amsterdam, 1981. 

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