title: Primary progressive versus relapsing-onset multiple sclerosis: presence and prognostic value of cerebrospinal fluid oligoclonal IgM.
abstract: BACKGROUND
  There is increasing evidence on cerebrospinal fluid (CSF) oligoclonal IgM (OCIgM) predicting a more aggressive disease course in relapsing-remitting Multiple Sclerosis (MS), while there is a scarcity of data for primary progressive MS (PPMS).
  
  
  OBJECTIVE
  Our aim was to investigate the presence and possible prognostic value of CSF OCIgM in a group of PPMS and in a group of relapsing-onset MS patients. The possible prognostic role of other clinical and biological factors was also evaluated.
  
  
  METHODS
  We calculated the impact of single clinical and biological factors, including CSF OCIgM at onset, on the probability of reaching an Expanded Disability Status Scale of 3 and 4 in 45 PPMS and 104 relapsing-onset MS patients.
  
  
  RESULTS
  CSF OCIgM were found in only 13% of PPMS patients and did not influence the time taken to reach an Expanded Disability Status Scale of 3 and 4. Conversely, they were present in 46% of relapsing-onset MS patients and increased the risk of reaching an Expanded Disability Status Scale of 4. Clinical factors with a negative prognostic value in PPMS were age at onset <30 years and onset with pyramidal symptoms, while onset with sensory symptoms in relapsing-onset MS predicted a more favourable course.
  
  
  CONCLUSIONS
  This study confirms that, in relapsing-onset MS patients, the presence of CSF OCIgM at onset predicts a worse disease course. In the cohort of PPMS patients, however, CSF OCIgM were rare, suggesting that heterogeneous pathogenetic mechanisms may be involved in the different MS forms.
authors.affiliation: Department of Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile Sant'Agostino Estense, Italy. p.sola@ausl.mo.it
authors.forename: Patrizia
authors.initials: P
authors.lastname: Sola
authors.forename: Jessica
authors.initials: J
authors.lastname: Mandrioli
authors.forename: Anna M
authors.initials: AM
authors.lastname: Simone
authors.forename: Diana
authors.initials: D
authors.lastname: Ferraro
authors.forename: Roberta
authors.initials: R
authors.lastname: Bedin
authors.forename: Rosanna
authors.initials: R
authors.lastname: Annecca
authors.forename: Maria G
authors.initials: MG
authors.lastname: Venneri
authors.forename: Paolo F
authors.initials: PF
authors.lastname: Nichelli
authors.forename: Elisa
authors.initials: E
authors.lastname: Merelli
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000134:cerebrospinal fluid; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality; D016017:Odds Ratio; D043025:Oligoclonal Bands / Q000134:cerebrospinal fluid*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors
chemical_list: D015415:Biomarkers; D043025:Oligoclonal Bands