Sunday, 17 May 2015

Does CS analysis predict outcome?..No

Moroso A, Deloire MS, Ruet A, Ouallet JC, Casey R, Brochet B.
Does cerebrospinal fluid analysis add predictive value to magnetic resonance imaging for long term irreversible disability in patients with early multiple sclerosis? J Neurol Sci. 2015 May 2. pii: S0022-510X(15)00254-3. doi: 10.1016/j.jns.2015.04.044. [Epub ahead of print

BACKGROUND: The independent prognostic value of cerebrospinal fluid analysis in multiple sclerosis is not established.
OBJECTIVE: To determine the prognostic value of intrathecal synthesis in a cohort of patients with relapsing-onset MS taking into consideration demographic and imaging parameters.
METHODS:In this prospective cohort study conducted from 1993 to 2013, we analyzed the time to confirmed disability (persistent above 6months) and irreversible disability (persistent for the entire disease course) of two disability milestones, Expanded Disability Status Scale score ≥4 or 6, and the time to secondary progressive onset in 579 patients with relapsing-onset multiple sclerosis. Demographic parameters (age at onset, gender) and imaging parameters (periventricular lesions) were included in the Cox models.
RESULTS:447 patients (77.2%) had intrathecal synthesis (oligoclonal bands and/or increased immunoglobulin G index value). No statistically significant relation was found between intrathecal synthesis and the time to reach each disability milestone or secondary progressive onset. An age older than 40years and more than 3 periventricular lesions predicted a worse prognosis.
CONCLUSIONS:Cerebrospinal fluid analysis did not predict the time to disability milestones in relapsing-onset multiple sclerosis independently of age and imaging data

So the answer to the question is no, if you have IgG in your CSF it is not going to  determine your fate. Hardly surprising as this is a diagnostic tests used for years and has this provided insight of prognosis.

3 comments:

  1. I thought prof g has stated before that ocb negative might even be a different disease?
    And that people were of the belief that clear LP was a better prognosis?
    Also would clear LP not indicate that there's no inflammation in the spinal cord area or have I got that wrong?

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    Replies
    1. Prof G wiĺ need to answer and maybe provide the link but no antibodies in csf may not mean no inflammation.

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  2. I've read studies that claim the complete opposite and with quite a strong predictive value too

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