Eur. Neurol. 17: 160-165 (1978)
Gamma-Globulins Patterns in CSF of Inflammatory Neurological Diseases in Tropical Africa C. Giordano, M. Clerc, C. Doutriaux and M. Piquemal Departments of Neurology and Biochemistry, Abidjan University Hospital, Abidjan
Key Words. Cerebrospinal fluid • Electrophoresis • Black African • 7 -Globulins • Multiple sclerosis • Trypanosomiasis Abstract. 400 CSF electrophoreses were performed on Black West Africans (Ivory Coast) with inflammatory infections of the nervous system. In the normal state, the CSF of the Black African contains a higher concentration of 7 -globulins than the European (15.8% compared to 8—10%). This study permits us to confirm indirectly the classical idea of the extreme rarity of MS in tropical areas: an increase in the 7 -globulins of the CSF has been shown in 22% of the cases and the two principal responsible infections are trypanosomiasis (57.3%) and SSPE (16.8%). The oligoclonal distribution described by various authors in trypanosomiases was not found. On the contrary, a nonclonal aspect of 7 -zone was constantly found (49/50). It is possible that the differences are in accordance with the different evolutionary phases of the disease, and that the oligoclonal distribution is a marker of the autoimmune state of the disease.
Materials and Methods
Material Firstly, the electrophoretic profile of normal CSF was determined with 30 control subjects (hospitalized patients or volunteers) with the following criteria: clinical examination, normal level of blood consti tuents, normal fundus oculi, and less than 3 cells/mm3 in the CSF. Finally, electrophoreses of the CSF proteins of 400 subjects with certain or supposed inflammatory neuro logical infections were performed. Thereby, cerebro vascular disease, tumors, degenerative, and toxic diseases were eliminated.
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
The increase in the 7 -globulins of cerebro spinal fluid (CSF) with a slight increase or a normal level of total CSF proteins is charac teristic of certain subacute or chronic inflam matory states of the nervous system. — In the temperate zone, the most common infection is multiple sclerosis (MS). — In the tropical areas, this disease is very rare. In view of these facts, the goal of this preliminary research in a group of patients with neurological diseases was to determine the principal inflammatory infec tions which could provoke quantitative and qual itative changes in the 7 -globulins of the CSF.
Gamma-Globulins Patterns in CSF
161
For this study, only the patients with inflam matory CSF according to the definition of l.aterre (6) and Schuller (9) were used: their definition indicates an inflammatory CSF as being ‘an increase of the 7-globulins occurring with a normal or slightly in creased level of total CSF proteins, which were always less than 1 g/l\ These CSF are characterized by a cell-mediated local immunologic reaction, where there exists in intrathecal synthesis of 7-globulins from plasmocytes and from lymphocytes which have crossed the meninges to enter the CSF and eventually the CNS. With an increase, therefore, in the total proteins of the CSF, this would be due solely to the 7-globulins.
Methods The CSF was obtained by lumbar puncture. The total CSF proteins were measured by the method of Lowry. The needed concentration for electrophoresis was effected by dialysis in vacuo at + 4 °C. Electro phoresis was performed using Cellogel RS triangular, according to a method already described (3). This is a cellulose acetate gel with a high resolving power which permits a multiple fractioning of the proteins.
Results
Protein Electrophoresis o f Normal CSF Table I gives the relative and absolute mean values, the SD, and permits a comparison with the values obtained with Europeans. Similar studies done at Dakar in 1975 (5 ,8 ) give similar results. Pathological Aspects 7 -Globulins are considered as elevated when they are superior both to 26.6% and to 107 mg/1 which would be twice the SD of the normal sample. Accordingly, a hypergammaglobulinemia of the CSF with total protein less than 1 g/1 has been found in 89 cases, 22% of the 400 electro phoreses performed. The principal neurological infections re sponsible for this rise can be divided into 2 groups: ( l ) a very important homogeneous
Table I. CSF proteins on cellulose acetate foils
Total protein
White Europeans (Paris) 28 cases (Schuller, 1976)
rel. %
mg/1
rel. %
mg/1
5.8 ± 2.7 50.5 ± 8 4.7 ± 1.6 4.5 ± 1.4 10.4 ± 2.3 6.8 ± 1.8 15.8 ± 5.4 1.5
17 165 15 15 33 21 53
6±2 58.5 ± 7 4.7 ± 1.5 4.5 t 1.4 10 ± 3.2 6 ± 2.5 9.5 ± 2.4
24 239 18 19 42 26 39
324
408
1 With bovine albumin as a reference substance, giving about 8% too high values compared with the real human protein composition.
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
Pre-albumin Albumin o^-Globulin dj-Globulin (3,-Globulin /3j-Globulin 7-Globulin Post 7-Globulin
Black African 30 cases
Giordano/Clerc/Doutriaux/Piquemal
162
Table II. Main inflammatory neurological diseases causing changes in the CSF 7-globulins in the tropical zone Number Total of CSF cases protein mg/i
Number of cells found in CSF by first LP cells/pl
Quantitative aspects
Qualitative aspects
7-globulin % (mean)
7-globulin mg/1 (mean)
nonclonal aspect
31.5
236
1
38
347
4
oligoclonal with more than 2 fractions
Acute meningoencephalitis with probable viral cause
4
700
120
Chronic meningoencephalitis with unknown origin
4
895
92
Subacute myelitis with unknown origin
4
680
6
35.7
240
-
4
Neuro-syphilis
3
590
42
33.6
195
3
-
SSPE
15
549
2
49.6
307
-
13
Confirmed trypanosomiasis
44
919
385
48.7
457
43
1
Suspected trypanosomiasis
6
403
16
30.2
169
6
—
Cerebral cysticercosis
1
430
2
28.8
115
1
-
58
21
Total
81
group comprising the inflammatory syndromes throughout the CNS: encephalitis, meningo encephalitis, meningomyelitis, meningoencephalomyelitis and myelitis = 81 cases (table 11), and ( 2 ) a smaller heterogeneous group: neuro logical complications of acute myeloblastic leukemia (1 case), metastatic polyra diculoneuritis (1 case), dementia (3 cases), and others (3 cases). The different qualitative aspects found: one
3
notes the homogeneity or the heterogeneity of the 7 -zone (fig. 1), 3 aspects are described ( 6 , 9): (l ) The monoclonal aspect: a sharp peak with a narrow base, caused by myeloma and other Ig. Paraproteinemias. (2) The nonclonal aspect: a broad, irregular, but not really subfractional aspect, caused by the fusion of many clones as in normal serum. This aspect was found in 62 cases of the 89 cases of 7 -globulins increase in the CSF. (3) The oligoclonal aspect,
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
Diseases
Fig. 1. Qualitative aspects of the 7-zones, a Normal aspect, b High increase of nonclonal aspect in try panosomiasis. c Oligoclonal aspect in SSPE.
or oligoclonal distribution: characterized by the appearance of 2—5 7 -fractions and evoked by an abnormal immunologic reaction, due, most often if not always, to the continuance of an infectious aggression. This aspect was found 27 times, with 23 cases having more than 2 7 fractions. The difference between the nonclonal and oligoclonal aspects according to the etiologies is given on the right side of table II.
Discussion
The normal CSF of the West African is characterized by an elevated percentage of the 7 -globulins, superior to that of the European. The results of Dakar and Abidjan are in ac cordance. Because of the African immigration to Europe, this is a point to keep in mind. Among the limits defined by us (exclusive augmentation of the 7 -globulins, with total CSF
163
proteins found between 0.50 and 0.90 g/1), an increase in CSF 7 -globulins appears less fre quent among Africans: 22% of the performed examinations. The two principal causes in our study are: trypanosomiasis at the meningoencephalitic stages, 50 cases among 89 (57.3%), and subacute sclerosing panencephalitis (SSPE), 15 cases among 89 (16.8%). We believe that this study is a confirmation of the rarity of MS in tropical zones. Already, clinically, this rarity has been confirmed a long time ago by global studies ( 1 ) and local studies in Senegal (7) and South Africa (7). Among 2,000 patients hospitalized during a 5-year period at the Neurological Department in Abidjan, and 5,000 seen in outpatient con sultation, a diagnosis of MS has never been confirmed with certainty. During the same period, 6 Europeans with MS were confirmed. The study of the 7 -globulins gives an indirect confirmation. It is known that in MS 80% of the cases are accompanied by an increased concentration of the 7 -globulins of the CSF and that this is the most frequent cause of this
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
Gamma-Globulins Patterns in CSF
Giordano/Clerc/Doutriaux/Piquemal
Fig. 2. Oligoelonal aspect in 4 cases with subacute sclerosing panencephalitis (anode to the left).
Fig. 3. Nonclonal aspect in 4 cases of try panosomiasis (anode to the left, arrows indicating the 7-rcgion).
increase in the temperate zones (2, 6 ,9 , 10). In our 89 cases, our exact diagnoses were able to completely exclude MS in 84 of them. Only the cases of subacute myelitis could be caused by a demyelinating process in presenting considerable differences in the clinical evolu tion. Even by accepting this diagnosis, these four cases out of a total of 2,000 patients cannot justify contradicting the fact that MS is very rare in the tropical zone, at least in Abidjan. For many authors ( 6 , 8 ), the modifications of the 7 -zone have more importance than the quantitative variations. One would point out in using this term the homogeneous or hetero geneous aspects of the 7 -zone. The oligoelonal aspect is a rare anomaly: 6% of the electrophoreses performed in Europe (2), and is characteristic of four infections: MS, SSPE, neuro-syphilis, and trypanosomiasis, which are responsible for 87% of the oligoclonal distributions with more than 2 7 -frac tions. Our results are completely in agreement for the SSPE: 15 oligoelonal distributions for 15
cases of which 13 have over 2 7 -fractions (fig. 2). On the other hand, for trypanosomiasis out of the 50 cases we have found a nonclonal aspect (fig. 3) 49 times. Our results can be explained by an assump tion: our patients and those of the above authors were examined at different periods of the evolution of the disease. It is well known that in meningoencephalitis of trypanosomiasis there are 2 stages: Stage I: Characterized by mesenchymal and perivascular lesions caused by the dissemination and penetration of the parasite reversible with specific treatment. Stage II: Not always occurring, with a varying evolution, characterized by diffuse, ir reversible parenchymal lesions, leading to leu koencephalitis with demyelinization probably due to an autoimmune mechanism. With the parasite no longer being the cause, specific treatment is without effect. Because of the known etiopathology (4), one can, from our first results, put forward the following working hypothesis: (a) The first stage of meningoence phalitis is characterized in the CSF by an
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
164
Gamma-Globulins Patterns in CSF
References 1 Alter, M.: Multiple sclerosis in the Negro. Archs Neurol. 7: 83-91 (1962). 2 Castaigne, P.; Lhermitte, F.; Schuller, E.; Delasnerie, M.; Deloche, G. et Dumas, Y.: Valeur diagnostique de la distribution oligoclonalc des gamma-globulines dans le LCR. Revue cur. Etud. clin. biol. 17: 324-327 (1972).
3 Doutriaux, C.; Clerc, M. et Giordano, C.: Utilisa tion du Cellogel RS triangulaire pour l’étude de la protéinorachie dans la PESS. Rfésultats et per spectives. Clínica chimi. Acta 59: 9 -1 8 (1975). 4 Gallais, H.; Collomb, H. et Miletto, G.: Con ceptions actuelles de la trypanosomiase humaine africaine. Revue prat. 6: 826-836 (1956). 5 Girard, P.L.; Dumas, M.; Oudart, J.L.; Vieillard, J.J. et Collomb, H.: Les protéines du LCR. Etude électrophorétique chez le Noir Africain. Nouv. Presse Méd. 2: 1583-1586 (1973). 6 Laterre, E.C.: Les protéines du LCR à l’état normal et pathologique, vol. 1, 328 pp. (Maloine, Paris 1965). 7 Lemercier, G.; Virieu, R.; Dumas, M. et Collomb, N.: Sclérose en plaques au Sénégal. Acta neurol. belg. 70: 309 - 332 (197 0). 8 Oudart, J.L.; Dufresne, Y.; Girard, P.L. et Dumas, M.: Electrophorèse des protéines du LCR chez le Noir de l’Ouest Africain. Son intérêt dans les parasitoses cérébrales. Méd. afr. noire 23: 25-29 (1976). 9 Schuller, E.: Les méthodes actuelles d’études des protéines du LCR. Revue prat. 26: 1675-1683 (1976). 10 Schuller, E.; Castaigne, P. et Lhermitte, F.: Les réactions immunitaires humorales au cours de la sclérose en plaques. Immunopathologie du système nerveux. Colloque de ITnserm, 1974, vol. 1, p. 319 (Inserm, Paris 1975).
Received: June 21, 1977 Accepted: July 5,1977 Prof. Dr. med. C. Giordano, Department of Neurology, Abidjan University Hospital, Abidjan (Ivory Coast)
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
intense immunologic reaction, qualitatively nor mal, due to the presence of the parasite. This is shown upon electrophoresis by a nonclonal aspect of the 7 -zone, (b) The second stage (with leukoencephalitis caused by an autoimmunologic reaction) shows an abnormal im munologic reaction. An oligoclonal distribution is then apparent. One can mention here that this oligoclonal distribution is found in an extremely marked fashion in MS and SSPE, where the autoimmune processes are also evident. The uniformity of our results can be ex plained by the fact that we have only seen patients with early infestations who have re sponded very well to treatment. On the other hand, we have not seen patients at the terminal, irreversible stage. With this hypothesis, which needs confirmation, the study of the CSF may differentiate the 2 stages of the infection, and the oligoclonal aspect could be a marker for the autoimmunologic reactions in neurological in fections.
165
Gamma-Globulins Patterns in CSF of Inflammatory Neurological Diseases in Tropical Africa C. Giordano, M. Clerc, C. Doutriaux and M. Piquemal Departments of Neurology and Biochemistry, Abidjan University Hospital, Abidjan
Key Words. Cerebrospinal fluid • Electrophoresis • Black African • 7 -Globulins • Multiple sclerosis • Trypanosomiasis Abstract. 400 CSF electrophoreses were performed on Black West Africans (Ivory Coast) with inflammatory infections of the nervous system. In the normal state, the CSF of the Black African contains a higher concentration of 7 -globulins than the European (15.8% compared to 8—10%). This study permits us to confirm indirectly the classical idea of the extreme rarity of MS in tropical areas: an increase in the 7 -globulins of the CSF has been shown in 22% of the cases and the two principal responsible infections are trypanosomiasis (57.3%) and SSPE (16.8%). The oligoclonal distribution described by various authors in trypanosomiases was not found. On the contrary, a nonclonal aspect of 7 -zone was constantly found (49/50). It is possible that the differences are in accordance with the different evolutionary phases of the disease, and that the oligoclonal distribution is a marker of the autoimmune state of the disease.
Materials and Methods
Material Firstly, the electrophoretic profile of normal CSF was determined with 30 control subjects (hospitalized patients or volunteers) with the following criteria: clinical examination, normal level of blood consti tuents, normal fundus oculi, and less than 3 cells/mm3 in the CSF. Finally, electrophoreses of the CSF proteins of 400 subjects with certain or supposed inflammatory neuro logical infections were performed. Thereby, cerebro vascular disease, tumors, degenerative, and toxic diseases were eliminated.
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
The increase in the 7 -globulins of cerebro spinal fluid (CSF) with a slight increase or a normal level of total CSF proteins is charac teristic of certain subacute or chronic inflam matory states of the nervous system. — In the temperate zone, the most common infection is multiple sclerosis (MS). — In the tropical areas, this disease is very rare. In view of these facts, the goal of this preliminary research in a group of patients with neurological diseases was to determine the principal inflammatory infec tions which could provoke quantitative and qual itative changes in the 7 -globulins of the CSF.
Gamma-Globulins Patterns in CSF
161
For this study, only the patients with inflam matory CSF according to the definition of l.aterre (6) and Schuller (9) were used: their definition indicates an inflammatory CSF as being ‘an increase of the 7-globulins occurring with a normal or slightly in creased level of total CSF proteins, which were always less than 1 g/l\ These CSF are characterized by a cell-mediated local immunologic reaction, where there exists in intrathecal synthesis of 7-globulins from plasmocytes and from lymphocytes which have crossed the meninges to enter the CSF and eventually the CNS. With an increase, therefore, in the total proteins of the CSF, this would be due solely to the 7-globulins.
Methods The CSF was obtained by lumbar puncture. The total CSF proteins were measured by the method of Lowry. The needed concentration for electrophoresis was effected by dialysis in vacuo at + 4 °C. Electro phoresis was performed using Cellogel RS triangular, according to a method already described (3). This is a cellulose acetate gel with a high resolving power which permits a multiple fractioning of the proteins.
Results
Protein Electrophoresis o f Normal CSF Table I gives the relative and absolute mean values, the SD, and permits a comparison with the values obtained with Europeans. Similar studies done at Dakar in 1975 (5 ,8 ) give similar results. Pathological Aspects 7 -Globulins are considered as elevated when they are superior both to 26.6% and to 107 mg/1 which would be twice the SD of the normal sample. Accordingly, a hypergammaglobulinemia of the CSF with total protein less than 1 g/1 has been found in 89 cases, 22% of the 400 electro phoreses performed. The principal neurological infections re sponsible for this rise can be divided into 2 groups: ( l ) a very important homogeneous
Table I. CSF proteins on cellulose acetate foils
Total protein
White Europeans (Paris) 28 cases (Schuller, 1976)
rel. %
mg/1
rel. %
mg/1
5.8 ± 2.7 50.5 ± 8 4.7 ± 1.6 4.5 ± 1.4 10.4 ± 2.3 6.8 ± 1.8 15.8 ± 5.4 1.5
17 165 15 15 33 21 53
6±2 58.5 ± 7 4.7 ± 1.5 4.5 t 1.4 10 ± 3.2 6 ± 2.5 9.5 ± 2.4
24 239 18 19 42 26 39
324
408
1 With bovine albumin as a reference substance, giving about 8% too high values compared with the real human protein composition.
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
Pre-albumin Albumin o^-Globulin dj-Globulin (3,-Globulin /3j-Globulin 7-Globulin Post 7-Globulin
Black African 30 cases
Giordano/Clerc/Doutriaux/Piquemal
162
Table II. Main inflammatory neurological diseases causing changes in the CSF 7-globulins in the tropical zone Number Total of CSF cases protein mg/i
Number of cells found in CSF by first LP cells/pl
Quantitative aspects
Qualitative aspects
7-globulin % (mean)
7-globulin mg/1 (mean)
nonclonal aspect
31.5
236
1
38
347
4
oligoclonal with more than 2 fractions
Acute meningoencephalitis with probable viral cause
4
700
120
Chronic meningoencephalitis with unknown origin
4
895
92
Subacute myelitis with unknown origin
4
680
6
35.7
240
-
4
Neuro-syphilis
3
590
42
33.6
195
3
-
SSPE
15
549
2
49.6
307
-
13
Confirmed trypanosomiasis
44
919
385
48.7
457
43
1
Suspected trypanosomiasis
6
403
16
30.2
169
6
—
Cerebral cysticercosis
1
430
2
28.8
115
1
-
58
21
Total
81
group comprising the inflammatory syndromes throughout the CNS: encephalitis, meningo encephalitis, meningomyelitis, meningoencephalomyelitis and myelitis = 81 cases (table 11), and ( 2 ) a smaller heterogeneous group: neuro logical complications of acute myeloblastic leukemia (1 case), metastatic polyra diculoneuritis (1 case), dementia (3 cases), and others (3 cases). The different qualitative aspects found: one
3
notes the homogeneity or the heterogeneity of the 7 -zone (fig. 1), 3 aspects are described ( 6 , 9): (l ) The monoclonal aspect: a sharp peak with a narrow base, caused by myeloma and other Ig. Paraproteinemias. (2) The nonclonal aspect: a broad, irregular, but not really subfractional aspect, caused by the fusion of many clones as in normal serum. This aspect was found in 62 cases of the 89 cases of 7 -globulins increase in the CSF. (3) The oligoclonal aspect,
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
Diseases
Fig. 1. Qualitative aspects of the 7-zones, a Normal aspect, b High increase of nonclonal aspect in try panosomiasis. c Oligoclonal aspect in SSPE.
or oligoclonal distribution: characterized by the appearance of 2—5 7 -fractions and evoked by an abnormal immunologic reaction, due, most often if not always, to the continuance of an infectious aggression. This aspect was found 27 times, with 23 cases having more than 2 7 fractions. The difference between the nonclonal and oligoclonal aspects according to the etiologies is given on the right side of table II.
Discussion
The normal CSF of the West African is characterized by an elevated percentage of the 7 -globulins, superior to that of the European. The results of Dakar and Abidjan are in ac cordance. Because of the African immigration to Europe, this is a point to keep in mind. Among the limits defined by us (exclusive augmentation of the 7 -globulins, with total CSF
163
proteins found between 0.50 and 0.90 g/1), an increase in CSF 7 -globulins appears less fre quent among Africans: 22% of the performed examinations. The two principal causes in our study are: trypanosomiasis at the meningoencephalitic stages, 50 cases among 89 (57.3%), and subacute sclerosing panencephalitis (SSPE), 15 cases among 89 (16.8%). We believe that this study is a confirmation of the rarity of MS in tropical zones. Already, clinically, this rarity has been confirmed a long time ago by global studies ( 1 ) and local studies in Senegal (7) and South Africa (7). Among 2,000 patients hospitalized during a 5-year period at the Neurological Department in Abidjan, and 5,000 seen in outpatient con sultation, a diagnosis of MS has never been confirmed with certainty. During the same period, 6 Europeans with MS were confirmed. The study of the 7 -globulins gives an indirect confirmation. It is known that in MS 80% of the cases are accompanied by an increased concentration of the 7 -globulins of the CSF and that this is the most frequent cause of this
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
Gamma-Globulins Patterns in CSF
Giordano/Clerc/Doutriaux/Piquemal
Fig. 2. Oligoelonal aspect in 4 cases with subacute sclerosing panencephalitis (anode to the left).
Fig. 3. Nonclonal aspect in 4 cases of try panosomiasis (anode to the left, arrows indicating the 7-rcgion).
increase in the temperate zones (2, 6 ,9 , 10). In our 89 cases, our exact diagnoses were able to completely exclude MS in 84 of them. Only the cases of subacute myelitis could be caused by a demyelinating process in presenting considerable differences in the clinical evolu tion. Even by accepting this diagnosis, these four cases out of a total of 2,000 patients cannot justify contradicting the fact that MS is very rare in the tropical zone, at least in Abidjan. For many authors ( 6 , 8 ), the modifications of the 7 -zone have more importance than the quantitative variations. One would point out in using this term the homogeneous or hetero geneous aspects of the 7 -zone. The oligoelonal aspect is a rare anomaly: 6% of the electrophoreses performed in Europe (2), and is characteristic of four infections: MS, SSPE, neuro-syphilis, and trypanosomiasis, which are responsible for 87% of the oligoclonal distributions with more than 2 7 -frac tions. Our results are completely in agreement for the SSPE: 15 oligoelonal distributions for 15
cases of which 13 have over 2 7 -fractions (fig. 2). On the other hand, for trypanosomiasis out of the 50 cases we have found a nonclonal aspect (fig. 3) 49 times. Our results can be explained by an assump tion: our patients and those of the above authors were examined at different periods of the evolution of the disease. It is well known that in meningoencephalitis of trypanosomiasis there are 2 stages: Stage I: Characterized by mesenchymal and perivascular lesions caused by the dissemination and penetration of the parasite reversible with specific treatment. Stage II: Not always occurring, with a varying evolution, characterized by diffuse, ir reversible parenchymal lesions, leading to leu koencephalitis with demyelinization probably due to an autoimmune mechanism. With the parasite no longer being the cause, specific treatment is without effect. Because of the known etiopathology (4), one can, from our first results, put forward the following working hypothesis: (a) The first stage of meningoence phalitis is characterized in the CSF by an
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
164
Gamma-Globulins Patterns in CSF
References 1 Alter, M.: Multiple sclerosis in the Negro. Archs Neurol. 7: 83-91 (1962). 2 Castaigne, P.; Lhermitte, F.; Schuller, E.; Delasnerie, M.; Deloche, G. et Dumas, Y.: Valeur diagnostique de la distribution oligoclonalc des gamma-globulines dans le LCR. Revue cur. Etud. clin. biol. 17: 324-327 (1972).
3 Doutriaux, C.; Clerc, M. et Giordano, C.: Utilisa tion du Cellogel RS triangulaire pour l’étude de la protéinorachie dans la PESS. Rfésultats et per spectives. Clínica chimi. Acta 59: 9 -1 8 (1975). 4 Gallais, H.; Collomb, H. et Miletto, G.: Con ceptions actuelles de la trypanosomiase humaine africaine. Revue prat. 6: 826-836 (1956). 5 Girard, P.L.; Dumas, M.; Oudart, J.L.; Vieillard, J.J. et Collomb, H.: Les protéines du LCR. Etude électrophorétique chez le Noir Africain. Nouv. Presse Méd. 2: 1583-1586 (1973). 6 Laterre, E.C.: Les protéines du LCR à l’état normal et pathologique, vol. 1, 328 pp. (Maloine, Paris 1965). 7 Lemercier, G.; Virieu, R.; Dumas, M. et Collomb, N.: Sclérose en plaques au Sénégal. Acta neurol. belg. 70: 309 - 332 (197 0). 8 Oudart, J.L.; Dufresne, Y.; Girard, P.L. et Dumas, M.: Electrophorèse des protéines du LCR chez le Noir de l’Ouest Africain. Son intérêt dans les parasitoses cérébrales. Méd. afr. noire 23: 25-29 (1976). 9 Schuller, E.: Les méthodes actuelles d’études des protéines du LCR. Revue prat. 26: 1675-1683 (1976). 10 Schuller, E.; Castaigne, P. et Lhermitte, F.: Les réactions immunitaires humorales au cours de la sclérose en plaques. Immunopathologie du système nerveux. Colloque de ITnserm, 1974, vol. 1, p. 319 (Inserm, Paris 1975).
Received: June 21, 1977 Accepted: July 5,1977 Prof. Dr. med. C. Giordano, Department of Neurology, Abidjan University Hospital, Abidjan (Ivory Coast)
Downloaded by: UCL 144.82.238.225 - 4/28/2018 5:18:03 PM
intense immunologic reaction, qualitatively nor mal, due to the presence of the parasite. This is shown upon electrophoresis by a nonclonal aspect of the 7 -zone, (b) The second stage (with leukoencephalitis caused by an autoimmunologic reaction) shows an abnormal im munologic reaction. An oligoclonal distribution is then apparent. One can mention here that this oligoclonal distribution is found in an extremely marked fashion in MS and SSPE, where the autoimmune processes are also evident. The uniformity of our results can be ex plained by the fact that we have only seen patients with early infestations who have re sponded very well to treatment. On the other hand, we have not seen patients at the terminal, irreversible stage. With this hypothesis, which needs confirmation, the study of the CSF may differentiate the 2 stages of the infection, and the oligoclonal aspect could be a marker for the autoimmunologic reactions in neurological in fections.
165
