title: The intrathecal, polyspecific antiviral immune response in neurosarcoidosis, acute disseminated encephalomyelitis and autoimmune encephalitis compared to multiple sclerosis in a tertiary hospital cohort.
abstract: BACKGROUND
  A polyspecific, intrathecal humoral immune response against the neurotropic viruses, measles, rubella and varicella zoster virus, called "MRZ reaction" (MRZR), is present in the majority of patients with multiple sclerosis (MS). Neurosarcoidosis (NS) and acute disseminated encephalomyelitis (ADEM) are important clinical differential diagnoses of MS. Autoimmune encephalitis (AIE) represents a well characterized autoimmune CNS disorder with intrathecal antibody synthesis. The aim of this study was to investigate the specificity of MRZR for MS in patients with NS, ADEM and AIE for the first time, and to compare it with the diagnostic value of oligoclonal bands (OCB).
  
  
  METHODS
  Twenty-two patients with NS, 17 with AIE, 8 with ADEM and 33 with MS serving as controls were analyzed for OCB and MRZR by calculation of the antibody index (AI) for each virus. MRZR was considered as positive if at least two AIs were ≥1.5.
  
  
  RESULTS
  A positive MRZR was statistically significantly less frequent in NS (9%), AIE (11%) and ADEM (0%) compared to MS patients (70%; p < 0.001 each). The specificity of MRZR for MS was 92% in the study cohort. In comparison to MRZR, the OCB showed a higher sensitivity (100%), but a lower specificity (69%) for MS.
  
  
  CONCLUSIONS
  These results indicate that MRZR seems to be the most specific available CSF marker of MS.
authors.affiliation: Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. tilman.hottenrott@uniklinik-freiburg.de.
authors.forename: Tilman
authors.initials: T
authors.lastname: Hottenrott
authors.affiliation: Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. rick.dersch@uniklinik-freiburg.de.
authors.forename: Rick
authors.initials: R
authors.lastname: Dersch
authors.affiliation: Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. benjamin.berger@uniklinik-freiburg.de.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berger
authors.affiliation: Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. sebastian.rauer@uniklinik-freiburg.de.|ravo Diagnostika GmbH, Oltmannsstrasse 5, 79100, Freiburg, Germany. sebastian.rauer@uniklinik-freiburg.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rauer
authors.affiliation: Department of Neuropediatrics and Muscle Disorders, University Medical Center Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany. matthias.eckenweiler@uniklinik-freiburg.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Eckenweiler
authors.affiliation: Institute of Virology, University Medical Center Freiburg, Hermann-Herder-Strasse 11, 79104, Freiburg, Germany. daniela.huzly@uniklinik-freiburg.de.
authors.forename: Daniela
authors.initials: D
authors.lastname: Huzly
authors.affiliation: Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. oliver.stich@uniklinik-freiburg.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Stich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000175:diagnosis / Q000276:immunology*; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis / Q000276:immunology*; D005260:Female; D050031:Hashimoto Disease / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D056724:Immunity, Humoral / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000276:immunology*; D043025:Oligoclonal Bands / Q000276:immunology; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis / Q000276:immunology*; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D043025:Oligoclonal Bands