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Recommended Standard of Cerebrospinal Fluid Analysis in the Diagnosis of Multiple Sclerosis: A Consensus Statement
Abstract
New criteria for the diagnosis of multiple sclerosis (MS) were published as the result of an internationally formed committee. To increase the specificity of diagnosis and to minimize the number of false diagnoses, the committee recommended the use of both clinical and paraclinical criteria, the latter involving information obtained from magnetic resonance imaging, evoked potentials, and cerebrospinal fluid (CSF) analysis. Although rigorous magnetic resonance imaging requirements were provided, the "new criteria paper" fell short in terms of guidelines as to how the CSF analysis should be performed and simply equated the IgG index with isoelectric focusing, without any justification. The spectrum of parameters analyzed and methods for CSF analysis differ worldwide and often yield variable results in terms of sensitivity, specificity, accuracy, and reliability, with no decided "optimal" CSF test for the diagnosis of MS. To address this question specifically, an international panel of experts in MS and CSF diagnostic techniques was convened and the result was this article, representing a consensus of all the participants. These recommendations for establishing a standard for the evaluation of CSF in patients suspected of having MS should greatly complement the new criteria in ensuring that a correct diagnosis of MS is being made.
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“Multiple studies provide evidence that in adult patients with CIS, CSF OCBs are an independent predictor of the risk of a second attack when controlling for demographic, clinical, treatment, and MRI variables. 61-69”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [64]
In the citing paper
“but in some patients, further supportive information can be obtained from cerebrospinal fluid examination and neurophysiological testing.”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [14]
In the citing paper
“Qualitative assessment of IgG using isoelectric focusing and immunofixation is the optimal method for detection of OCBs.14”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [14]
In the citing paper
“CSF findings in MS include a normal or mildly raised white cell count (<25 cells/cm 3 , predominantly lymphocytes) and protein (usually <1g/L), a raised IgG index and IgG oligoclonal bands (OCBs) not present in serum.14”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [14]
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Metadata
- Authors
- Freedman, M. S., Thompson, E. J., Deisenhammer, F., Giovannoni, G., Grimsley, G., Keir, G., Öhman, S., Racke, M. K., Sharief, M., Sindic, C. J. M., Sellebjerg, F., & Tourtellotte, W. W.
- Affiliations
- University of Ottawa (CA)
- Venue
- Archives of Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2005-06-01
- Volume
- 62
- Issue
- 6
- ISSN
- 0003-9942 (ISSN-L)
- OpenAlex
- W2123646700
- Cited by
- 41
- References
- 34
- Citations by year
- 2023: 1 · 2020: 3 · 2018: 2 · 2017: 2 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 3 · 2012: 5
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Neurology (publishedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Clinical Neurology › Peripheral Neuropathies and Disorders
- Health Sciences › Medicine › Infectious Diseases › Infectious Diseases and Tuberculosis
- Keywords
- multiple sclerosis, cerebrospinal fluid analysis, diagnostic criteria, IgG index, isoelectric focusing, magnetic resonance imaging, evoked potentials, diagnostic standardization, false diagnosis
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