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Cited by 54Multiple Sclerosis Research StudiesPolyomavirus and related diseasesPeripheral Neuropathies and Disorders

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

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Huss, André M., Halbgebauer, Steffen, Öckl, Patrick, Trebst, Corinna, Spreer, Annette, Borisow, Nadja, Harrer, Andrea, Brecht, Isabel +21 more·2016·Journal of Neurology
DOI 10.1007/s00415-016-8302-1PMC PMC5110610
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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.

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  • Recent studies showed that inclusion of symptomatic lesions in the MRI determination of DIS or DIT increases MS diagnostic sensitivity with little or no reduction in specificity.

    “Recent studies showed that inclusion of symptomatic lesions in the MRI determination of DIS or DIT increases MS diagnostic sensitivity with little or no reduction in specificity 70,71 and was proposed in the 2016 MAGNIMS Criteria. 7,72”

    From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [71]

    The Methods describe MRI criteria for dissemination in space and time, and the Results report sensitivity and specificity for those criteria in patients with clinically isolated syndrome. Neither passage compares criteria that include versus exclude symptomatic lesions, so our copy does not establish the claimed increase in sensitivity or its effect on specificity (searched: symptomatic lesions and MRI diagnostic sensitivity and specificity). (LLM, conf=0.74)

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Authors
Huss, A. M., Halbgebauer, S., Öckl, P., Trebst, C., Spreer, A., Borisow, N., Harrer, A., Brecht, I., Balint, B., Stich, O., Schlegel, S., Retzlaff, N., Winkelmann, A., Roesler, R., Lauda, F., Yildiz, Ö., Voß, E., Muche, R., Rauer, S., Bergh, F. T., Otto, M., Paul, F., Wildemann, B., Kraus, J., Ruprecht, K., Stangel, M., Buttmann, M., Zettl, U. K., & Tumani, H.
Affiliations
  • Universität Ulm (DE)
  • Medizinische Hochschule Hannover (DE)
  • University of Göttingen (DE)
  • Charité – Universitätsmedizin Berlin (DE)
  • Paracelsus Medical University (AT)
  • University of Würzburg (DE)
  • Heidelberg University (DE)
  • University of Freiburg (DE)
  • University of Rostock (DE)
  • Leipzig University (DE)
  • Max Delbrück Center (DE)
Corresponding author
Tumani, Hayrettin
ORCID
Venue
Journal of Neurology
Publisher
Springer Science and Business Media LLC
Published
2016-10-11
Volume
263
Issue
12
Pages
2499-2504
ISSN
  • 0012-1037 (ISSN-L)
  • 0340-5354
  • 1432-1459
DOI
10.1007/s00415-016-8302-1
PMC
PMC5110610
OpenAlex
W2530971761
Cited by
54
References
3
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 5 · 2019: 10 · 2018: 17 · 2017: 5 · 2015: 1
FWCI
9.70
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Neurology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • MDC Repository (Max-Delbrueck-Center for Molecular Medicine) (acceptedVersion)
  • GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
  • Online Publication Service of Würzburg University (Würzburg University) (submittedVersion, cc-by)
  • GRO (submittedVersion, cc-by)
Funders
Bundesministerium für Bildung und Forschung (01GI1208A)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Oncology › Polyomavirus and related diseases
  • Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
Keywords
clinically isolated syndrome, multiple sclerosis, cerebrospinal fluid analysis, oligoclonal bands, intrathecal IgG, conversion to multiple sclerosis, prognosis, disease onset
MeSH terms
Adult, Austria, Female, Germany, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Retrospective Studies, Severity of Illness Index, Disease Progression, Oligoclonal Bands, Kaplan-Meier Estimate

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