Can Tears replace Lumbar Punctures

Lebrun C, Forzy G, Collongues N, Cohen M, de Seze J, Hautecoeur P; on behalf Club francophone de la SEP and RIS Consortium.Tear analysis as a tool to detect oligoclonal bands in radiologically isolated syndrome. Lebrun C, Forzy G, Collongues N, Cohen M, de Seze J, Hautecoeur P; on behalf Club francophone de la SEP and RISConsortium.Rev Neurol. 2015 Jan 19. pii: S0035-3787(14)01074-1. doi: 10.1016/j.neurol.2014.11.007. [Epub ahead of print]

BACKGROUND: Although radiologically isolated syndrome (RIS) is a newly defined entity, incidental findings of T2 hypersignals on brain MRI can lead to misdiagnosis or useless investigations. The detection of oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) is a major indicator that helps in diagnosis of subclinical inflammatory disease of the central nervous system, but lumbar puncture still remains an invasive option.
METHODS:We have prospectively included patients with RIS, have compared the results of CSF and tear OCB detection by isoelectric focusing (IEF) and assessed concordance between OCB detection in tears and in CSF. Tears were collected using a Schirmer strip.
RESULTS: In 45 recruited RIS patients, OCBs were detected in CSF for 55% (25/45) and in tears for 50% (21/42) of samples.
CONCLUSIONS:We suggest that tear OCB detection may replace CSF OCB detection as a diagnostic tool in patients with RIS and be useful in follow-up.

Some of you are no longer getting Lumbar punctures to look for oligoclonal bands, as diagnosis is being called with MRI lesions,and there are a few people that have an MRI before they have noticed clinical symptoms that make them go to neuros and they contact lesions. Rather than do a lumbar puncture in this study they collected tears.

Would you prefer a needle in your spine or something absorbant in your eyes. 

There have been questions of whether B cells in the brain are key to progression and whether oligoclonal blands are going to be important. Should we aim to get rid of them? However many of you said I'm negative so what does this mean. Now OCB in tears and the question is what is the significance of this in terms of oligoclonal bands in the brains. OCB in blood and brain points to infections

Will ProfG start looking for neurofilaments in tears?

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