Contributions
Abstract: P431
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - Immunology
Introduction: The finding of a single cerebrospinal fluid (CSF) Immunoglobulin G (IgG) band is rare and only few studies have explored its frequency and diagnostic significance.
Objective: To establish
1) the diagnoses associated with the finding of a single CSF IgG band,
2) the proportion of patients with a single IgG band who will be diagnosed with Multiple Sclerosis (MS) within the following 2 years and 3) whether there are differences in the CSF characteristics of patients subsequently diagnosed with MS compared to those with alternative diagnoses, in a multicenter study.
Methods: We collected clinical and CSF data of patients who showed a single CSF-restricted IgG band, with or without an associated “mirror pattern”, at CSF isoelectric focusing (IEF) analysis, carried out for any reason, from 2005 onwards.
Results: Out of 8156 CSF IEF analyses, 113 showed a single CSF IgG band (1.4%). In another cohort of 500 CSF analyses carried out for suspected MS, only 2 showed a single CSF IgG band (0.4%). A definite diagnosis was established in 98 patients. MS was diagnosed in 26 (27%) patients, other central nervous system (CNS) demyelinating diseases in 20 (20%), CNS infections in 7 (7%), inflammatory peripheral nervous system (PNS) diseases in 6 (6%), CNS autoimmune/paraneoplastic diseases in 5 (5%), cerebral tumours in 3 (3%), and other diagnoses in 31 (32%), including CNS/PNS degenerative diseases (6%), spondylomyelopathy (3%), idiopathic intracranial hypertension (2%), headache (2%), Tolosa-Hunt syndrome, reversible cerebral vasoconstriction syndrome, hereditary spastic paraparesis, DYT1-positive dystonia and cerebral venous thrombosis. Patients who acquired a diagnosis of MS were significantly younger (38±13 versus 46±18 years; p=0.03) than those with other diagnoses. There were no differences in CSF data (cell number and type, proteins, Link"s Index, CSF/serum albumin ratio, presence of additional “mirror pattern”) between the two groups.
Conclusion: MS was the single most frequent diagnosis in patients with a single CSF IgG band. Nevertheless, the majority of patients with a single CSF IgG band have neurological diseases other than MS or CNS demyelinating diseases, the most frequent being CNS infections, inflammatory PNS diseases, CNS autoimmune/paraneoplastic diseases and cerebral tumours. Patients with a subsequent diagnosis of MS are significantly younger than those with other neurological diseases.
Disclosure:
Ferraro D has nothing to disclose.
Simone AM has nothing to disclose
Cocco E has nothing to disclose
Santangelo M has nothing to disclose
Immovilli P has nothing to disclose
Calabrese M has nothing to disclose
Di Filippo M has nothing to disclose
Orlandi R has nothing to disclose
Bedin R has nothing to disclose
Vitetta F has nothing to disclose
Gallina A has nothing to disclose
Solaro C has nothing to disclose
Gasperini C has nothing to disclose
Rodegher ME has nothing to disclose
Sola P has nothing to disclose
Abstract: P431
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - Immunology
Introduction: The finding of a single cerebrospinal fluid (CSF) Immunoglobulin G (IgG) band is rare and only few studies have explored its frequency and diagnostic significance.
Objective: To establish
1) the diagnoses associated with the finding of a single CSF IgG band,
2) the proportion of patients with a single IgG band who will be diagnosed with Multiple Sclerosis (MS) within the following 2 years and 3) whether there are differences in the CSF characteristics of patients subsequently diagnosed with MS compared to those with alternative diagnoses, in a multicenter study.
Methods: We collected clinical and CSF data of patients who showed a single CSF-restricted IgG band, with or without an associated “mirror pattern”, at CSF isoelectric focusing (IEF) analysis, carried out for any reason, from 2005 onwards.
Results: Out of 8156 CSF IEF analyses, 113 showed a single CSF IgG band (1.4%). In another cohort of 500 CSF analyses carried out for suspected MS, only 2 showed a single CSF IgG band (0.4%). A definite diagnosis was established in 98 patients. MS was diagnosed in 26 (27%) patients, other central nervous system (CNS) demyelinating diseases in 20 (20%), CNS infections in 7 (7%), inflammatory peripheral nervous system (PNS) diseases in 6 (6%), CNS autoimmune/paraneoplastic diseases in 5 (5%), cerebral tumours in 3 (3%), and other diagnoses in 31 (32%), including CNS/PNS degenerative diseases (6%), spondylomyelopathy (3%), idiopathic intracranial hypertension (2%), headache (2%), Tolosa-Hunt syndrome, reversible cerebral vasoconstriction syndrome, hereditary spastic paraparesis, DYT1-positive dystonia and cerebral venous thrombosis. Patients who acquired a diagnosis of MS were significantly younger (38±13 versus 46±18 years; p=0.03) than those with other diagnoses. There were no differences in CSF data (cell number and type, proteins, Link"s Index, CSF/serum albumin ratio, presence of additional “mirror pattern”) between the two groups.
Conclusion: MS was the single most frequent diagnosis in patients with a single CSF IgG band. Nevertheless, the majority of patients with a single CSF IgG band have neurological diseases other than MS or CNS demyelinating diseases, the most frequent being CNS infections, inflammatory PNS diseases, CNS autoimmune/paraneoplastic diseases and cerebral tumours. Patients with a subsequent diagnosis of MS are significantly younger than those with other neurological diseases.
Disclosure:
Ferraro D has nothing to disclose.
Simone AM has nothing to disclose
Cocco E has nothing to disclose
Santangelo M has nothing to disclose
Immovilli P has nothing to disclose
Calabrese M has nothing to disclose
Di Filippo M has nothing to disclose
Orlandi R has nothing to disclose
Bedin R has nothing to disclose
Vitetta F has nothing to disclose
Gallina A has nothing to disclose
Solaro C has nothing to disclose
Gasperini C has nothing to disclose
Rodegher ME has nothing to disclose
Sola P has nothing to disclose