Are you about to have a lumbar puncture? If yes, what needle is your neurology team going to use to perform the lumbar puncture? If you want a simple guide to LPs please visit our LP web app.
One of the biggest successes we have had at Barts-MS is the derisking of lumbar punctures. This was driven by our PROXIMUS trial and subsequently informed our clinical practice. LPs are also becoming more important as CSF analysis is now center-stage with the new rendition of the McDonald diagnostic criteria. The presence of oligoclonal immunoglobulin bands, or OCBs, in the spinal fluid now confirm dissemination in time. So if you are having a lumbar puncture for diagnostic, or monitoring, purposes please ask your neurologist to make sure they use an atraumatic or non-cutting needle. This reduces the risk of post-LP headaches by an order of magnitude and if you do get a headache they tend to be mild and self-limiting. What do we mean by monitoring LP? We are increasingly doing LPs to assess spinal fluid neurofilament levels. Neurofilaments are released in response to axonal and neuronal damage. If you have a raised neurofilament levels it means there is ongoing damage and something should be done about it. Knowing your spinal fluid neurofilament levels helps decision making about treatment initiation and switching. It adds more information about your MS and prognosis and simply helps us get a better picture of your disease. I am confident that within a year, or two, almost all MSologists will be using spinal fluid and possibly blood neurofilament levels as part of their clinical decision making. This has been a long time coming. I have been working on neurofilaments for over 20 years. Who said research translates quickly into clinical practice?