title: Cerebrospinal fluid/serum gradient of IgG is associated with disability at acute attacks of neuromyelitis optica.
abstract: Increased blood-brain barrier (BBB) disruption can be found in patients with neuromyelitis optica (NMO); however, its clinical implication and association with disability at acute attack remains obscure. The purpose of the study was to evaluate the clinical significance of BBB disruption and the subsequent cerebrospinal fluid (CSF)/serum IgG gradient in NMO. Retrospective analysis was made of acute-stage CSF samples from NMO (n = 40) and multiple sclerosis (MS; n = 26) patients. The CSF/serum IgG gradient (QIgG), albumin ratio (Qalb), and IgG index were calculated. Multivariate regression analysis was used to identify clinical and CSF variables associated with disability at acute attacks (extended disability scale score, EDSS) in both groups. The EDSS was significantly associated with the QIgG (p < 0.001), Qalb (p = 0.012), and number of cumulative attacks (p = 0.012) in NMO but not in MS with univariate analysis. Length of spinal cord involvement was also associated with EDSS in NMO (p = 0.030). However, multivariate analysis revealed that the QIgG was only significantly associated with EDSS in NMO (0.580; 95% CI -0.257, 0.961; p = 0.002). The QIgG was also highly associated with the Qalb in NMO (p < 0.001). The QIgG may reflect systemic IgG leakage into the CNS and is strongly associated with disability at acute attacks in NMO, suggesting that BBB disruption can aggravate disease activity by facilitating systemic IgG infiltration into the CNS.
authors: Department of Neurology, College of Medicine, Seoul National University, 28 Yon-Gun Dong, Chong-Ro, Seoul, Korea.
authors: Sung-Min
authors: SM
authors: Kim
authors: Patrick
authors: P
authors: Waters
authors: Angela
authors: A
authors: Vincent
authors: Min Jin
authors: MJ
authors: Go
authors: Kyung Seok
authors: KS
authors: Park
authors: Jung-Joon
authors: JJ
authors: Sung
authors: Kwang-Woo
authors: KW
authors: Lee
references: Ann Neurol. 2009 Sep;66(3):425-8
references: 19798642
references: Ann Neurol. 2009 Nov;66(5):617-29
references: 19938104
references: Ann Neurol. 2005 Dec;58(6):840-6
references: 16283615
references: Brain. 2010 Feb;133(Pt 2):349-61
references: 20047900
references: Neurology. 1983 Nov;33(11):1444-52
references: 6685237
references: Brain. 2007 May;130(Pt 5):1206-23
references: 17439988
references: J Neurol Neurosurg Psychiatry. 2008 Oct;79(10):1134-6
references: 18270237
references: J Immunol. 2008 Oct 15;181(8):5730-7
references: 18832732
references: Neurology. 2006 May 23;66(10):1485-9
references: 16717206
references: Arch Neurol. 2008 Jul;65(7):913-9
references: 18625857
references: Ann Neurol. 2009 Nov;66(5):630-43
references: 19937948
references: J Neurol Sci. 2001 Mar 1;184(2):101-22
references: 11239944
references: Lancet Neurol. 2003 Feb;2(2):117-27
references: 12849268
references: Nat Clin Pract Neurol. 2008 Apr;4(4):202-14
references: 18334978
references: Arch Neurol. 2006 Mar;63(3):390-6
references: 16533966