Top

Published in:

Open Access 01-12-2016 | Original Communication

Importance of cerebrospinal fluid analysis in the era of McDonald 2010 criteria: a German–Austrian retrospective multicenter study in patients with a clinically isolated syndrome

Authors: André M. Huss, Steffen Halbgebauer, Patrick Öckl, Corinna Trebst, Annette Spreer, Nadja Borisow, Andrea Harrer, Isabel Brecht, Bettina Balint, Oliver Stich, Sabine Schlegel, Nele Retzlaff, Alexander Winkelmann, Romy Roesler, Florian Lauda, Özlem Yildiz, Elke Voß, Rainer Muche, Sebastian Rauer, Florian Then Bergh, Markus Otto, Friedemann Paul, Brigitte Wildemann, Jörg Kraus, Klemens Ruprecht, Martin Stangel, Mathias Buttmann, Uwe K. Zettl, Hayrettin Tumani

Published in: Journal of Neurology | Issue 12/2016

Abstract

The majority of patients presenting with a first clinical symptom suggestive of multiple sclerosis (MS) do not fulfill the MRI criteria for dissemination in space and time according to the 2010 revision of the McDonald diagnostic criteria for MS and are thus classified as clinically isolated syndrome (CIS). To re-evaluate the utility of cerebrospinal fluid (CSF) analysis in the context of the revised McDonald criteria from 2010, we conducted a retrospective multicenter study aimed at determining the prevalence and predictive value of oligoclonal IgG bands (OCBs) in patients with CIS. Patients were recruited from ten specialized MS centers in Germany and Austria. We collected data from 406 patients; at disease onset, 44/406 (11 %) fulfilled the McDonald 2010 criteria for MS. Intrathecal IgG OCBs were detected in 310/362 (86 %) of CIS patients. Those patients were twice as likely to convert to MS according to McDonald 2010 criteria as OCB-negative individuals (hazard ratio = 2.1, p = 0.0014) and in a shorter time period of 25 months (95 % CI 21–34) compared to 47 months in OCB-negative individuals (95 % CI 36–85). In patients without brain lesions at first attack and presence of intrathecal OCBs (30/44), conversion rate to MS was 60 % (18/30), whereas it was only 21 % (3/14) in those without OCBs. Our data confirm that in patients with CIS the risk of conversion to MS substantially increases if OCBs are present at onset. CSF analysis definitely helps to evaluate the prognosis in patients who do not have MS according to the revised McDonald criteria.

Compston A, Coles A (2002) Multiple sclerosis. Lancet 359(9313):1221–1231. doi:10.1016/S0140-6736(02)08220-X CrossRefPubMed

Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O’Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302. doi:10.1002/ana.22366 CrossRefPubMedPubMedCentral

Tumani H, Deisenhammer F, Giovannoni G, Gold R, Hartung HP, Hemmer B, Hohlfeld R, Otto M, Stangel M, Wildemann B, Zettl UK (2011) Revised McDonald criteria: the persisting importance of cerebrospinal fluid analysis. Ann Neurol 70(3):520. doi:10.1002/ana.22508 CrossRefPubMed

Zettl UK, Stuve O, Patejdl R (2012) Immune-mediated CNS diseases: a review on nosological classification and clinical features. Autoimmun Rev 11(3):167–173. doi:10.1016/j.autrev.2011.05.008 CrossRefPubMed

Weisfeld-Adams JD, Katz Sand IB, Honce JM, Lublin FD (2015) Differential diagnosis of Mendelian and mitochondrial disorders in patients with suspected multiple sclerosis. Brain J Neurol 138(Pt 3):517–539. doi:10.1093/brain/awu397 CrossRef

Solomon AJ, Klein EP, Bourdette D (2012) “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS. Neurology 78(24):1986–1991. doi:10.1212/WNL.0b013e318259e1b2 CrossRefPubMedPubMedCentral

Solomon A, Bourdette D, Cross A, Applebee A, Skidd P, Howard D, Spain R, Cameron M, Kim E, Mass M, Yadav V, Whitham R, Longbrake E, Naismith R, Wu G, Parks B, Wingerchuk D, Rabin B, Toledano M, Tobin W, Kantarci O, Carter J, Keegan B, Weinshenker B (2016) The spectrum of multiple sclerosis misdiagnosis in the era of McDonald criteria: a multicenter study (PL01.003). Neurology 86(16 Supplement):PL01–003

Miller DH, Chard DT, Ciccarelli O (2012) Clinically isolated syndromes. Lancet Neurol 11(2):157–169. doi:10.1016/S1474-4422(11)70274-5 CrossRefPubMed

Comabella M, Fernandez M, Martin R, Rivera-Vallve S, Borras E, Chiva C, Julia E, Rovira A, Canto E, Alvarez-Cermeno JC, Villar LM, Tintore M, Montalban X (2010) Cerebrospinal fluid chitinase 3-like 1 levels are associated with conversion to multiple sclerosis. Brain J Neurol 133(Pt 4):1082–1093. doi:10.1093/brain/awq035 CrossRef

10.

Canto E, Tintore M, Villar LM, Costa C, Nurtdinov R, Alvarez-Cermeno JC, Arrambide G, Reverter F, Deisenhammer F, Hegen H, Khademi M, Olsson T, Tumani H, Rodriguez-Martin E, Piehl F, Bartos A, Zimova D, Kotoucova J, Kuhle J, Kappos L, Garcia-Merino JA, Sanchez AJ, Saiz A, Blanco Y, Hintzen R, Jafari N, Brassat D, Lauda F, Roesler R, Rejdak K, Papuc E, de Andres C, Rauch S, Khalil M, Enzinger C, Galimberti D, Scarpini E, Teunissen C, Sanchez A, Rovira A, Montalban X, Comabella M (2015) Chitinase 3-like 1: prognostic biomarker in clinically isolated syndromes. Brain J Neurol 138(Pt 4):918–931. doi:10.1093/brain/awv017 CrossRef

11.

Kuhle J, Disanto G, Dobson R, Adiutori R, Bianchi L, Topping J, Bestwick JP, Meier UC, Marta M, Costa GD, Runia T, Evdoshenko E, Lazareva N, Thouvenot E, Iaffaldano P, Direnzo V, Khademi M, Piehl F, Comabella M, Sombekke M, Killestein J, Hegen H, Rauch S, D’Alfonso S, Alvarez-Cermeno JC, Kleinova P, Horakova D, Roesler R, Lauda F, Llufriu S, Avsar T, Uygunoglu U, Altintas A, Saip S, Menge T, Rajda C, Bergamaschi R, Moll N, Khalil M, Marignier R, Dujmovic I, Larsson H, Malmestrom C, Scarpini E, Fenoglio C, Wergeland S, Laroni A, Annibali V, Romano S, Martinez AD, Carra A, Salvetti M, Uccelli A, Torkildsen O, Myhr KM, Galimberti D, Rejdak K, Lycke J, Frederiksen JL, Drulovic J, Confavreux C, Brassat D, Enzinger C, Fuchs S, Bosca I, Pelletier J, Picard C, Colombo E, Franciotta D, Derfuss T, Lindberg R, Yaldizli O, Vecsei L, Kieseier BC, Hartung HP, Villoslada P, Siva A, Saiz A, Tumani H, Havrdova E, Villar LM, Leone M, Barizzone N, Deisenhammer F, Teunissen C, Montalban X, Tintore M, Olsson T, Trojano M, Lehmann S, Castelnovo G, Lapin S, Hintzen R, Kappos L, Furlan R, Martinelli V, Comi G, Ramagopalan SV, Giovannoni G (2015) Conversion from clinically isolated syndrome to multiple sclerosis: a large multicentre study. Mult Scler 21(8):1013–1024. doi:10.1177/1352458514568827 CrossRefPubMed

12.

Brettschneider J, Czerwoniak A, Senel M, Fang L, Kassubek J, Pinkhardt E, Lauda F, Kapfer T, Jesse S, Lehmensiek V, Ludolph AC, Otto M, Tumani H (2010) The chemokine CXCL13 is a prognostic marker in clinically isolated syndrome (CIS). PLoS One 5(8):e11986. doi:10.1371/journal.pone.0011986 CrossRefPubMedPubMedCentral

13.

Brettschneider J, Tumani H, Kiechle U, Muche R, Richards G, Lehmensiek V, Ludolph AC, Otto M (2009) IgG antibodies against measles, rubella, and varicella zoster virus predict conversion to multiple sclerosis in clinically isolated syndrome. PLoS One 4(11):e7638. doi:10.1371/journal.pone.0007638 CrossRefPubMedPubMedCentral

14.

Fisniku LK, Brex PA, Altmann DR, Miszkiel KA, Benton CE, Lanyon R, Thompson AJ, Miller DH (2008) Disability and T2 MRI lesions: a 20-year follow-up of patients with relapse onset of multiple sclerosis. Brain J Neurol 131(Pt 3):808–817. doi:10.1093/brain/awm329 CrossRef

15.

Tintore M, Rovira A, Rio J, Tur C, Pelayo R, Nos C, Tellez N, Perkal H, Comabella M, Sastre-Garriga J, Montalban X (2008) Do oligoclonal bands add information to MRI in first attacks of multiple sclerosis? Neurology 70(13 Pt 2):1079–1083. doi:10.1212/01.wnl.0000280576.73609.c6 CrossRefPubMed

16.

Heussinger N, Kontopantelis E, Gburek-Augustat J, Jenke A, Vollrath G, Korinthenberg R, Hofstetter P, Meyer S, Brecht I, Kornek B, Herkenrath P, Schimmel M, Wenner K, Hausler M, Lutz S, Karenfort M, Blaschek A, Smitka M, Karch S, Piepkorn M, Rostasy K, Lucke T, Weber P, Trollmann R, Klepper J, Haussler M, Hofmann R, Weissert R, Merkenschlager A, Buttmann M (2015) Oligoclonal bands predict multiple sclerosis in children with optic neuritis. Ann Neurol 77(6):1076–1082. doi:10.1002/ana.24409 CrossRefPubMed

17.

Swanton JK, Fernando K, Dalton CM, Miszkiel KA, Thompson AJ, Plant GT, Miller DH (2006) Modification of MRI criteria for multiple sclerosis in patients with clinically isolated syndromes. J Neurol Neurosurg Psychiatry 77(7):830–833. doi:10.1136/jnnp.2005.073247 CrossRefPubMed

18.

Montalban X, Tintore M, Swanton J, Barkhof F, Fazekas F, Filippi M, Frederiksen J, Kappos L, Palace J, Polman C, Rovaris M, de Stefano N, Thompson A, Yousry T, Rovira A, Miller DH (2010) MRI criteria for MS in patients with clinically isolated syndromes. Neurology 74(5):427–434. doi:10.1212/WNL.0b013e3181cec45c CrossRefPubMed

19.

Teunissen CE, Petzold A, Bennett JL, Berven FS, Brundin L, Comabella M, Franciotta D, Frederiksen JL, Fleming JO, Furlan R, Hintzen RQ, Hughes SG, Johnson MH, Krasulova E, Kuhle J, Magnone MC, Rajda C, Rejdak K, Schmidt HK, van Pesch V, Waubant E, Wolf C, Giovannoni G, Hemmer B, Tumani H, Deisenhammer F (2009) A consensus protocol for the standardization of cerebrospinal fluid collection and biobanking. Neurology 73(22):1914–1922. doi:10.1212/WNL.0b013e3181c47cc2 CrossRefPubMedPubMedCentral

20.

Disanto G, Morahan JM, Barnett MH, Giovannoni G, Ramagopalan SV (2012) The evidence for a role of B cells in multiple sclerosis. Neurology 78(11):823–832. doi:10.1212/WNL.0b013e318249f6f0 CrossRefPubMedPubMedCentral

21.

Tintore M, Rovira A, Rio J, Otero-Romero S, Arrambide G, Tur C, Comabella M, Nos C, Arevalo MJ, Negrotto L, Galan I, Vidal-Jordana A, Castillo J, Palavra F, Simon E, Mitjana R, Auger C, Sastre-Garriga J, Montalban X (2015) Defining high, medium and low impact prognostic factors for developing multiple sclerosis. Brain J Neurol 138(Pt 7):1863–1874. doi:10.1093/brain/awv105 CrossRef

Title: Importance of cerebrospinal fluid analysis in the era of McDonald 2010 criteria: a German–Austrian retrospective multicenter study in patients with a clinically isolated syndrome
Authors: André M. Huss
Steffen Halbgebauer
Patrick Öckl
Corinna Trebst
Annette Spreer
Nadja Borisow
Andrea Harrer
Isabel Brecht
Bettina Balint
Oliver Stich
Sabine Schlegel
Nele Retzlaff
Alexander Winkelmann
Romy Roesler
Florian Lauda
Özlem Yildiz
Elke Voß
Rainer Muche
Sebastian Rauer
Florian Then Bergh
Markus Otto
Friedemann Paul
Brigitte Wildemann
Jörg Kraus
Klemens Ruprecht
Martin Stangel
Mathias Buttmann
Uwe K. Zettl
Hayrettin Tumani
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 12/2016
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-016-8302-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Importance of cerebrospinal fluid analysis in the era of McDonald 2010 criteria: a German–Austrian retrospective multicenter study in patients with a clinically isolated syndrome

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2016

Posterior fossa involvement in the diagnosis of adult-onset inherited leukoencephalopathies

High incidence of carpal tunnel syndrome after deep brain stimulation in Parkinson’s disease

External validation of a 3-step falls prediction model in mild Parkinson’s disease

Vascular comorbidities in multiple sclerosis: a nationwide study from Denmark

Hartwig Kuhlenbeck (1897–1984)

The clinical spectrum and natural history of pure akinesia with gait freezing