Eur. Neurol. 13: 54-64 (1975)

Comparative Quantitation of Immunoglobulin G (IgG) in Cerebrospinal Fluid and Serum of Children D ieter H arms University Children’s Hospital Erlangen-Nürnberg, Erlangen

Abstract. Report on quantitation of IgG in cerebro­ Key Words spinal fluid (CSF) and serum of 84 children at different Immunoglobulin G ages. A relation was shown between the content of IgG BIood-CSF barrier in CSF and serum depending on age. The decrease of the Cerebrospinal fluid ratio CSF-IgG/serum-IgG as well as of the total protein Childhood in the CSF during the first trimenon points out a post- Neurologic disease partal impediment of the diffusion from the blood to the Radial immunodiffusion CSF compartment. Beyond the first year of life the ratio of the concentrations mostly remains constant. Measurements in 135 children suf­ fering from several neurological diseases showed that quantitation of IgG is of val­ ue only in case of suspicion of encephalitis with local synthesis of IgG.

Introduction

Received: June 24, 1974; accepted: August 8, 1974.

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With several methods for quantitation of immunoprécipitation it was possible to demonstrate a characteristic change of the level of immuno­ globulins in the serum of children depending on age [Stiehm and F uden berg , 1966; J ohansson and B erg , 1967; B uckley et al, 1968; Steg e , 1968; G eiger and H offm ann , 1970; U ffelman et al, 1970]. While there are existing numerous measurements of IgG and IgA in the cerebrospinal fluid (CSF) of adults with the same methods, it was reported on quantita­ tive estimation in childhood only on the basis of small groups of patients mostly with neurological diseases [H artley et al, 1966; N ellhaus , 1971; Savory and H eintges , 1973; W iedermann et al, 1973]. The aim of this study was the search of changes of the IgG concentration in the CSF in relationship to age. Furthermore, we were interested in the reached pro-

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portion of IgG to total protein in several neurological diseases in child­ hood. Material and Methods Patients. Neurological disorders having been excluded, 84 children at ages rang­ ing from 3 days to 15 years had a normal lumbar CSF. As normal limits were fixed: up to 3 cells/,«1, normal CSF cytology, up to 400mg/l total protein, and i/2- 2/, of the adult value for blood glucose as glucose content of the CSF. CSF samples with an admixture of 15 erythrocytes/,«! and more were rejected. Until the 6th week of life we assumed as normal limit 12 cells/,«1, 1,200 mg/1 total protein, and two thirds of blood glucose as glucose of CSF. Indication for lumbar puncture resulted from rigidity of the neck in fevered infections or from a suspected meningitis of the newborn. Children having been ad­ mitted to the hospital on suspicion of encephalitis or increased intracranial pressure and whose later diagnostics finally revealed an intoxication (Metoclopramide, seda­ tives), an endogene psychosis, asthenopia, or sinusitis maxillaris, were accepted as normal. The group with neurological disorders consists of 135 children at ages ranging from 5 days to 14 years. Additionally, there are 4 children with actue lymphocytic leukemia. The serum of all patients was gained on the same day. Techniques. After cell counting and cytological examination the samples of CSF were centrifuged and stored up to 4 days at + 2 °C together with the serum. Total protein was measured according to the method of Lowry. IgG was estimated by means of radial immunodiffusion on Tripartigen and LC plates (Behring, Marburg). When ranging from 3 to 12.8 mg/1 IgG was measured on special plates which were prepared in our laboratory (2°/o agarose, Michaelis buffer, ionic strength 0.1, pH = 8.6, anti-IgG serum 0.35%, staining with Coomassie blue R 250).

Levels of Immunoglobulin G in Children without Evident Neurologi­ cal Disorders In the CSF of newborns we found IgG concentrations during the first 14 days of life which ranged near the upper normal limit of adults or even above. In 5 premature infants who had a birth weight between 1,580 and 2,300 g the contents of CSF-IgG were between 70 and 94.5 mg/1. On fur­ ther course of postpartal life the IgG levels in CSF quickly decreased. The lowest values in the CSF were measured between the 2nd and 8th month of life. Thereafter, a gradual increase was observed (fig. 1). The lower normal level of the adult age was reached only after the 8th year of life. Measurements of IgG in the serum of premature infants and new­ borns showed values equivalent to those of adults. Until the end of the first trimenon the concentrations of the serum reached their minimum, af-

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Results

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ter which the content of IgG increased again. In agreement with results of earlier studies mentioned above, the level of serum-IgG corresponding to that of adults was found only after the 8th year of life (fig. 1). The total protein content in the CSF of premature infants and new­ borns without perceptible affections of the CNS and the meninges was much higher than the values of the later childhood and of the age of the adult. During the first 3-4 weeks of life a rapid decrease of total protein in the CSF could be seen. In the course of infancy only the values grad­ ually fell below the limit of 400 mg/1. Up to the 5th year the standard de­ viation of the measurements decreased. For the time after the first year an

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Fig. 1. Parallel alterations in immunoglobulin G levels of CSF (above) and ser­ um (below) according to age of children without neurological disorders.

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IgG in CSF and Serum of Children

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Comparative quantitation of immunoglobulin G (IgG) in cerebrospinal fluid and serum of children.

Report on quantitation of IgG in cerebrospinal fluid (CSF) and serum of 84 children at different ages. A relation was shown between the content of IgG...
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