Critical Reviews in Clinical Laboratory Sciences
ISSN: 1040-8363 (Print) 1549-781X (Online) Journal homepage: http://www.tandfonline.com/loi/ilab20
Diagnostic Usefulness of Cerebrospinal Fluid in Multiple Sclerosis Pankaj D. Mehta To cite this article: Pankaj D. Mehta (1991) Diagnostic Usefulness of Cerebrospinal Fluid in Multiple Sclerosis, Critical Reviews in Clinical Laboratory Sciences, 28:3, 233-251 To link to this article: http://dx.doi.org/10.3109/10408369109106864
Published online: 27 Sep 2008.
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Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ilab20 Download by: [Australian National University]
Date: 06 November 2015, At: 13:28
Volume 28, Issue 3 (1991)
233
Diagnostic Usefulness of Cerebrospinal Fluid in Multiple Sclerosis Pankaj D. Mehta
Downloaded by [Australian National University] at 13:28 06 November 2015
ABSTRACT Multiple sclerosis (MS) is one of the most common demyelinating diseases of the central nervous system affecting adults between the ages of 20 and 40 years. Clinically, it is characterized by episodes of exacerbations and remissions. Although the cause of MS is unknown, it is generally believed that one or more infectious agents triggers an autoimmune response that causes myelin destruction. There is no known cure for this disease; however, early diagnosis is helpful in the management of patients with MS. The diagnosis of MS is commonly made on the basis of established clinical criteria. No specific laboratory diagnostic test exists, but detection of abnormalities in cerebrospinal fluid (CSF) is a useful aid to support the clinical diagnosis of MS. This review describes the most common CSF abnormalities. These include (a) elevation of immunoglobulin G (IgG), IgG index and IgG synthesis rate; and (b) detection of oligoclonal IgG bands in the CSF by electrophoresis and isoelectricfocusing procedures.
1. INTRODUCTION MS is a relapsing and remitting demyelinating disease of the central nervous system (CNS) that is characterized by multiple lesions occurring at different times and in various locations.' MS plaques are characterized by primary demyelination (breakdown of myelin sheaths with relative sparing of axons) and loss of oligodendrocytes (myelin producing cells) in relatively old lesions.' Clinical symptoms may be mild or severe, of long duration or short and may appear in various combinations, depending on the area of myelin affected. Manifestations at onset of MS are usually motor (incoordination, weakness, spasticity), general sensory (radicular pain, paresthesias) or visual (blurred or double vision, blindness). 3.4 Speech impediments, fatigue, tremors, and dizziness are other common symptoms. As the disease progresses, bowel and bladder control and sexual dysfunction become major problem^.^.^ The diagnosis of MS is commonly based on established clinical criteria because no definite test is yet available to diagnose MS .' When neurological examination suggests that a patient has possible or probable MS, physicians use a variety of tools to rule out other possible causes, such as a brain tumor or stroke. Magnetic resonance imaging (MRI) and computerized topographic scans can help locate brain lesions.8 Investigation of visual, auditory, and sensory stimuli can sometimes detect lesions that are missed by the scanner^.^ Although there is no specific laboratory test that can be used to diagnose MS, changes in the cerebrospinal fluid (CSF) can be helpful.''.'' The most widely used indicators are a significant increase in the ratio of CSF immunoglobulin G (IgG) to albumin and presence
P. D. Mehta, B.Sc., M.Sc., Ph.D., Chief, Department of Immunology, NY State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, New York 10314.
234
Critical Reviews in Clinical Laboratory Sciences
Table 1 Quantitation of IgG in Multiple Sclerosis Value
Downloaded by [Australian National University] at 13:28 06 November 2015
CSF IgG concentration CSF IgG/alburnin CSF IgG index (CSFIgGlalbumin) (serum InGlalburnin) CNS IgG synthesis rate
Controls
MS
ISSN: 1040-8363 (Print) 1549-781X (Online) Journal homepage: http://www.tandfonline.com/loi/ilab20
Diagnostic Usefulness of Cerebrospinal Fluid in Multiple Sclerosis Pankaj D. Mehta To cite this article: Pankaj D. Mehta (1991) Diagnostic Usefulness of Cerebrospinal Fluid in Multiple Sclerosis, Critical Reviews in Clinical Laboratory Sciences, 28:3, 233-251 To link to this article: http://dx.doi.org/10.3109/10408369109106864
Published online: 27 Sep 2008.
Submit your article to this journal
Article views: 29
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ilab20 Download by: [Australian National University]
Date: 06 November 2015, At: 13:28
Volume 28, Issue 3 (1991)
233
Diagnostic Usefulness of Cerebrospinal Fluid in Multiple Sclerosis Pankaj D. Mehta
Downloaded by [Australian National University] at 13:28 06 November 2015
ABSTRACT Multiple sclerosis (MS) is one of the most common demyelinating diseases of the central nervous system affecting adults between the ages of 20 and 40 years. Clinically, it is characterized by episodes of exacerbations and remissions. Although the cause of MS is unknown, it is generally believed that one or more infectious agents triggers an autoimmune response that causes myelin destruction. There is no known cure for this disease; however, early diagnosis is helpful in the management of patients with MS. The diagnosis of MS is commonly made on the basis of established clinical criteria. No specific laboratory diagnostic test exists, but detection of abnormalities in cerebrospinal fluid (CSF) is a useful aid to support the clinical diagnosis of MS. This review describes the most common CSF abnormalities. These include (a) elevation of immunoglobulin G (IgG), IgG index and IgG synthesis rate; and (b) detection of oligoclonal IgG bands in the CSF by electrophoresis and isoelectricfocusing procedures.
1. INTRODUCTION MS is a relapsing and remitting demyelinating disease of the central nervous system (CNS) that is characterized by multiple lesions occurring at different times and in various locations.' MS plaques are characterized by primary demyelination (breakdown of myelin sheaths with relative sparing of axons) and loss of oligodendrocytes (myelin producing cells) in relatively old lesions.' Clinical symptoms may be mild or severe, of long duration or short and may appear in various combinations, depending on the area of myelin affected. Manifestations at onset of MS are usually motor (incoordination, weakness, spasticity), general sensory (radicular pain, paresthesias) or visual (blurred or double vision, blindness). 3.4 Speech impediments, fatigue, tremors, and dizziness are other common symptoms. As the disease progresses, bowel and bladder control and sexual dysfunction become major problem^.^.^ The diagnosis of MS is commonly based on established clinical criteria because no definite test is yet available to diagnose MS .' When neurological examination suggests that a patient has possible or probable MS, physicians use a variety of tools to rule out other possible causes, such as a brain tumor or stroke. Magnetic resonance imaging (MRI) and computerized topographic scans can help locate brain lesions.8 Investigation of visual, auditory, and sensory stimuli can sometimes detect lesions that are missed by the scanner^.^ Although there is no specific laboratory test that can be used to diagnose MS, changes in the cerebrospinal fluid (CSF) can be helpful.''.'' The most widely used indicators are a significant increase in the ratio of CSF immunoglobulin G (IgG) to albumin and presence
P. D. Mehta, B.Sc., M.Sc., Ph.D., Chief, Department of Immunology, NY State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, New York 10314.
234
Critical Reviews in Clinical Laboratory Sciences
Table 1 Quantitation of IgG in Multiple Sclerosis Value
Downloaded by [Australian National University] at 13:28 06 November 2015
CSF IgG concentration CSF IgG/alburnin CSF IgG index (CSFIgGlalbumin) (serum InGlalburnin) CNS IgG synthesis rate
Controls
MS
![[Diagnostic value of cerebrospinal fluid study in multiple sclerosis].](/assets/img/hold.png)
