Contributions
Abstract: EP1283
Type: ePoster
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Introduction: The MRZ reaction (MRZR), composed of the three respective antibody indices (AI) against measles, rubella and varicella zoster virus, has been found positive almost exclusively in patients with multiple sclerosis (MS)1-2. Rheumatological disorders with involvement of the central nervous system (RDwCNS) and primary CNS lymphoma (PCNSL) can display similar symptoms, MRI findings and cerebrospinal fluid (CSF) routine results compared to MS and thus may be difficult to distinguish from MS but require a different therapy.
Methods: MRZR-2 (defined as positive by at least two AI ≥ 1.5) was assessed in patients with RDwCNS (n = 23), PCNSL (n = 37), MS (n = 203) and patients with a schizophreniform or bipolar disorder (n = 76). MRZR-2 results were compared using the Fisher's exact test (two-tailed) with p < 0.05 for statistical significance.
Results: Demographic data of all study cohorts are shown in Table 1. MRZR-2 results are presented in Figure 1. A positive MRZR-2 was statistically significantly more frequent in MS patients (48.8%) compared to RDwCNS (8.7%), PCNSL (8.1%) and psychiatric patients (2.6%; p < 0.001 for all comparisons with the MS group).
Discussion: These MRZR-2 results confirm the comparable high specificity for MS also in the context of RDwCNS and PCNSL and thus indicate its potential as a diagnostic tool to differentiate these diagnoses from MS. Nevertheless, a brain biopsy remains the diagnostic gold standard for PCNSL. In respect of rheumatological disorders detection of extractable nuclear antigens (ENA) is helpful in case of present antinuclear antibodies (ANA), because MS patients show slightly elevated unspecific ANA titers in around 30% as well3.
References:
- Jarius S, Eichhorn P, Franciotta D et al. The MRZ reaction as a highly specific marker of multiple sclerosis: re-evaluation and structured review of the literature. J Neurol 2016;doi:10.1007/s00415-016-8360-4.
- Hottenrott T, Dersch R, Berger B, et al. The intrathecal, polyspecific antiviral immune response in neurosarcoidosis, acute disseminated encephalomyelitis and autoimmune encephalitis compared to multiple sclerosis in a tertiary hospital cohort. Fluids Barriers CNS 2015;12:27.
- Barned S, Goodman AD, Mattson DH. Frequency of anti-nuclear antibodies in multiple sclerosis. Neurology. 1995;45:384-5.
Disclosure:
Conflicts of interest:
TH, RD, and DE: nothing to disclose.
SR and OS have received consulting and lecture fees and grant and research support from Baxter, Bayer Vital GmbH, Biogen Idec, Genzyme, Merck Serono, Novartis, RG, Sanofi-Aventis and Teva. NV has served on advisory boards of, has participated in lectures for, and/or received research or travel grants from AbbVie, GSK, Janssen-Cilag, Lilly, Medac, Novartis, Pfizer, and Roche.
We report no funding of this project.
Abstract: EP1283
Type: ePoster
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Introduction: The MRZ reaction (MRZR), composed of the three respective antibody indices (AI) against measles, rubella and varicella zoster virus, has been found positive almost exclusively in patients with multiple sclerosis (MS)1-2. Rheumatological disorders with involvement of the central nervous system (RDwCNS) and primary CNS lymphoma (PCNSL) can display similar symptoms, MRI findings and cerebrospinal fluid (CSF) routine results compared to MS and thus may be difficult to distinguish from MS but require a different therapy.
Methods: MRZR-2 (defined as positive by at least two AI ≥ 1.5) was assessed in patients with RDwCNS (n = 23), PCNSL (n = 37), MS (n = 203) and patients with a schizophreniform or bipolar disorder (n = 76). MRZR-2 results were compared using the Fisher's exact test (two-tailed) with p < 0.05 for statistical significance.
Results: Demographic data of all study cohorts are shown in Table 1. MRZR-2 results are presented in Figure 1. A positive MRZR-2 was statistically significantly more frequent in MS patients (48.8%) compared to RDwCNS (8.7%), PCNSL (8.1%) and psychiatric patients (2.6%; p < 0.001 for all comparisons with the MS group).
Discussion: These MRZR-2 results confirm the comparable high specificity for MS also in the context of RDwCNS and PCNSL and thus indicate its potential as a diagnostic tool to differentiate these diagnoses from MS. Nevertheless, a brain biopsy remains the diagnostic gold standard for PCNSL. In respect of rheumatological disorders detection of extractable nuclear antigens (ENA) is helpful in case of present antinuclear antibodies (ANA), because MS patients show slightly elevated unspecific ANA titers in around 30% as well3.
References:
- Jarius S, Eichhorn P, Franciotta D et al. The MRZ reaction as a highly specific marker of multiple sclerosis: re-evaluation and structured review of the literature. J Neurol 2016;doi:10.1007/s00415-016-8360-4.
- Hottenrott T, Dersch R, Berger B, et al. The intrathecal, polyspecific antiviral immune response in neurosarcoidosis, acute disseminated encephalomyelitis and autoimmune encephalitis compared to multiple sclerosis in a tertiary hospital cohort. Fluids Barriers CNS 2015;12:27.
- Barned S, Goodman AD, Mattson DH. Frequency of anti-nuclear antibodies in multiple sclerosis. Neurology. 1995;45:384-5.
Disclosure:
Conflicts of interest:
TH, RD, and DE: nothing to disclose.
SR and OS have received consulting and lecture fees and grant and research support from Baxter, Bayer Vital GmbH, Biogen Idec, Genzyme, Merck Serono, Novartis, RG, Sanofi-Aventis and Teva. NV has served on advisory boards of, has participated in lectures for, and/or received research or travel grants from AbbVie, GSK, Janssen-Cilag, Lilly, Medac, Novartis, Pfizer, and Roche.
We report no funding of this project.