Cerebrospinal And Body Fluids

CSF has been evaluated from diagnostic and research standpoints. Typical CSF findings in patients with MS include less than 20 white blood cells per cubic milliliter. These cells are mostly lymphocytes and occasionally macrophages. Total protein and glucose levels are usually normal; however, protein levels may be slightly elevated but rarely above 100mg/dl. The abnormalities in CSF are primarily those of immuno-globulin production. Oligoclonal bands (O bands) represent multiple monoclonal globulins that are mostly of the immunoglobulin-G (IgG) type. O bands are determined by agarose electrophoresis or isoelec-tric focusing and indicate two or more IgG bands in the gamma region. Agarose electrophoresis is less sensitive but currently more commonly performed. Once O bands are present, they persist indefinitely. There is a low false-positive rate of approximately 4 or 5%. The presence of O bands may be a predictor of the chances of developing clinically definite MS in those indivi duals with monosymptomatic disease. Patients with O bands in the CSF are more likely to have a confirmed diagnosis of clinically definite MS. Other measures of CSF IgG production include the IgG synthesis rate and the IgG index, which are based on comparison of albumin and immunoglobulin production in the CSF to serum. These measures are considered less specific and sensitive than oligoclonal bands, but they are useful in indicating immune abnormalities and confirming the clinical diagnosis.

Because CSF is more difficult to obtain, other markers for disease activity have been pursued. Urine is an easily accessible fluid, although volume, collection timing, and infections may influence results. Myelin basic protein-like (MBP-L) is smaller than MBP found in the CSF. It has a cryptic epitope that is not exposed in central nervous system myelin—possibly a small peptide. MBP-L fluctuates independent of acute relapses; however, a sustained increase is present in patients with secondary progressive MS. Levels were also elevated in those individuals with relapsing-remitting MS who went on to develop secondary progressive MS. There are currently no markers in the blood that are used for diagnosis of MS. Markers that have been considered include circulating adhesion molecules, antibodies, cell subpopulation, cytokines, and cytokine receptors.

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