title: Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis.
abstract: OBJECTIVE
  The presence of lipid-specific immunoglobulin M bands in the cerebrospinal fluid (CSF) predicts an aggressive course in patients with relapsing-remitting multiple sclerosis (MS) during early stages of the disease. This study examined whether it is also a predictor of long-term prognosis in MS.
  
  
  METHODS
  Eighty-one patients with MS and 22 headache controls were analyzed for anti-lipid IgM reactivity in CSF samples. The correlation between the presence of lipid-specific immunoglobulin M bands in CSF and disease progression was assessed in patients with MS who had been followed longitudinally for, on average, more than 11 years.
  
  
  RESULTS
  Lipid-specific immunoglobulin M bands were detected in the CSF of 24 of 81 patients with MS and were absent in the CSF of all headache controls. Median time to conversion to a secondary progressive course was 11 years in patients with bands and 22 years in patients without bands. Median time to an Expanded Disability Status Scale score of 4 was 14 years in patients with bands and 24 years in patients without bands.
  
  
  CONCLUSIONS
  The presence of lipid-specific immunoglobulin M bands in CSF predicts a more adverse long-term outcome in patients with MS; it may thus define a subset of patients who might benefit from aggressive treatment during the early phase of the disease.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Thangarajh
authors.forename: J
authors.initials: J
authors.lastname: Gomez-Rial
authors.forename: A K
authors.initials: AK
authors.lastname: Hedström
authors.forename: J
authors.initials: J
authors.lastname: Hillert
authors.forename: J C
authors.initials: JC
authors.lastname: Alvarez-Cermeño
authors.forename: T
authors.initials: T
authors.lastname: Masterman
authors.forename: L M
authors.initials: LM
authors.lastname: Villar