The utility of cerebrospinal fluid analysis in patients with multiple sclerosis

• Published in: Nature reviews. Neurology Vol. 9; no. 5; pp. 267 - 276
• Main Authors: Stangel, Martin, Fredrikson, Sten, Meinl, Edgar, Petzold, Axel, Stüve, Olaf, Tumani, Hayrettin
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.05.2013; Nature Publishing Group
• Subjects: 692/53; 692/699/249/2510; 692/699/375/1666; 692/700/139; Biomarkers; Care and treatment; Cerebrospinal fluid; Cerebrospinal Fluid Proteins; Chemokine CXCL13 - cerebrospinal fluid; Disease; Humans; Immunoglobulins; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Multiple sclerosis; Multiple Sclerosis - cerebrospinal fluid; Multiple Sclerosis - diagnosis; Neurology; Oligoclonal Bands - cerebrospinal fluid; Pathogenesis; Puncture; review-article; Spine; United States; United States > US; Germany
• ISSN: 1759-4758; 1759-4766; 1759-4766
• DOI: 10.1038/nrneurol.2013.41

Cerebrospinal fluid (CSF) investigation should be routinely performed in patients with a first clinical event that is suggestive of multiple sclerosis (MS). This Review highlights the value of existing CSF biomarkers in eliminating potential differential diagnoses for MS and understanding the underlying pathophysiology of this condition. The authors also discuss the potential for novel biomarkers that could be used in prognosis. Diagnosis of multiple sclerosis (MS) requires the exclusion of other possible diagnoses. For this reason, the cerebrospinal fluid (CSF) should be routinely analysed in patients with a first clinical event suggestive of MS. CSF analysis is no longer mandatory for diagnosis of relapsing–remitting MS, as long as MRI diagnostic criteria are fulfilled. However, caution is required in diagnosing MS in patients with negative MRI findings or in the absence of CSF analysis, as CSF investigation is useful to eliminate other causes of disease. The detection of oligoclonal IgG bands in CSF has potential prognostic value and is helpful for clinical decision-making. In addition, CSF analysis is important for research into the pathogenesis of MS. Pathophysiological and neurodegenerative findings of inflammation in MS have been derived from CSF investigations. Novel CSF biomarkers, though not yet validated, have been identified for diagnosis of MS and for ascertaining disease activity, prognosis and response to treatment, and are likely to increase in number with modern detection techniques. In this Review, we summarize CSF findings that shed light on the differential diagnosis of MS, and highlight the potential of novel biomarkers for this disease that could advance understanding of its pathophysiology. Key Points Cerebrospinal fluid (CSF) analysis is used to exclude other diseases in the differential diagnosis of multiple sclerosis (MS) Detection of oligoclonal IgG bands and elevated CXCL13 levels in the CSF can be used to make a prognosis and predict subsequent relapse in patients with clinically isolated syndrome Investigation of CSF has helped to elucidate inflammatory and neurodegenerative mechanisms in MS New candidate markers for MS have been described in CSF, but require validation in large cohorts of patients Standardized assays to identify and quantify potential MS markers in CSF are needed to enable comparisons between studies and cohorts of patients