The diagnosis and classification of multiple sclerosis: evoked responses and spinal fluid electrophoresis.

Multimodality evoked responses (including visual, brainstem auditory, and somatosensory) and CSF analysis were evaluated in 123 patients grouped into definite, probable, and possible MS according to the McAlpine criteria. The evoked responses (ERs) were very sensitive in detecting asymptomatic lesions and can therefore be used in conjunction with clinical data to provide evidence of multiple lesions. The CSF abnormalities also have high sensitivity and specificity in MS. ER and CSF findings, therefore, should be considered in addition to the clinical data in any classification of MS.

Multiple sclerosis: magnetic resonance imaging, evoked responses, and spinal fluid electrophoresis.

Magnetic resonance images (MRI), evoked responses (ER), and CSF findings were compared in 39 patients with possible, probable, or definite MS. MRI disclosed multiple lesions (72%) more often than ERs (55%) in the total group of patients. In possible MS, MRI showed multiple lesions in 71%, and ER abnormalities were found in 41%. MRI is the preferred test for patients with suspected MS, but ERs are useful when MRI is normal and in the evaluation of optic nerve or spinal cord lesions.

Magnetic resonance imaging in multiple sclerosis: analysis of correlations to peripheral blood and spinal fluid abnormalities.

MRI of the brain, peripheral blood (PB) T cell subsets and B cells, CSF T cell subsets, CSF IgG concentration and incidence of CSF oligoclonal bands (OB), and plasma cells were studied in 32 clinically suspected MS patients. The CSF in MS patients with MRI lesions showed increased IgG concentration and higher incidence of plasma cells and OB compared with those without MRI lesions. In PB, the percentage of kappa light-chain positive B cells was significantly increased in patients with abnormal MRI as compared with controls. The correlation of MRI of the head and immunologic studies in MS will be helpful in better understanding the pathogenesis and dynamics of the disease.

Cerebrospinal fluid immunoelectrophoresis in multiple sclerosis.

In 95 patients with definite multiple sclerosis (MS) cerebrospinal fluid (CSF) cytomorphology, protein electrophoresis and immunoelectrophoresis using antisera to human serum, Fab fragments of immunoglobulin G(IgG) and to kappa and lambda light chains and the CSF IgG concentration were examined. In the CSF diagnosis of MS, the set of the examinations used is considered to be superior to any individual laboratory technique currently applied in the diagnostic process of MS. In the set of the CSF examinations, CSF immunoelectrophoresis revealed abnormal findings in patients with MS in whom presence of bands (oligoclonal gammopathy) in the gamma-globulin field of the CSF electropherogram and/or increased concentration of CSF IgG were not demonstrated.

Serum immunologic markers in multiple sclerosis patients on continuous combined therapy with beta-interferon 1a, prednisone and azathioprine.

Break-through symptoms (BTS) in multiple sclerosis (MS) patients on beta-interferon (beta-IFN) monotherapy are most frequently treated with a brief administration of steroids. Here, we report the results of monitoring serum immunologic markers recorded at three-month intervals for 1.5 years in responders to beta-INF 1a (Avonex) monotherapy (n =21) and MS patients placed on Avonex with prednisone (n =83) and Avonex, prednisone and azathioprine (AZA) (n =21) because of BTS. Compared to 23 healthy controls, patients on Avonex monotherapy and Avonex with prednisone, in individuals on Avonex, prednisone and AZA, a significant decrease in serum concentration of soluble intercellular adhesion molecule-1 (sICAM-1) (P=0.001) was established. Combined therapy with Avonex, prednisone and AZA was associated with a significant increase in the serum level of interleukin (IL)10 (P <0.001). Compared to Avonex monotherapy, combined therapy suppressed the serum level of IL12p40, antagonized elevation in the serum concentration of soluble IL2 receptor (sIL2R) and inhibited an increase in the serum soluble CD95 (sCD95) molecule. In patients studied, no significant differences in the serum level of IL18 and tumor necrosis factor-alpha (TNF-alpha) were established. These findings are important in understanding some of the immunoregulatory mechanisms induced by combined therapy in MS.

Differential diagnostic aspects in malignant lymphomas involving the central nervous system.

Neoplastic cells were found in the cerebrospinal fluid (CSF) cytograms in 57% of patients with lymphocytic leukemia and reticulum cell sarcoma. Tumor cells may be observed in CSF specimens showing normal cell count and total proteins. Quantitative and/or qualitative changes in CSF proteins in absence of corresponding abnormalities in serum may indicate a malignant lymphorproliferative process involving the central nervous system even in absence of neoplastic cells.

Neurosyphilis.

In patients with abnormal neuropsychiatric symptoms and a reactive fluorescent treponemal antibody absoption (FTA-ABS) test in the cerebrospinal fluid (CSF) or serum, a normal CSF cell count and total protein concentration does not exlude late syphilis involving the central nervous system. In these patients, the presence of plasma cells in the CSF cytogram, increased concentration of CSF immunoglobulin G (IgG), immunoelectrophoretic abnormalities in the precipitates of the IgG and of the Fab fragments of IgG in the CSF immunoelectropherogram, and an increased serum level of immunoglobulin M (IgM) suggest an active, potentially treatable neurosyphilis.