title: Importance of cerebrospinal fluid analysis in the era of McDonald 2010 criteria: a German-Austrian retrospective multicenter study in patients with a clinically isolated syndrome.
abstract: The majority of patients presenting with a first clinical symptom suggestive of multiple sclerosis (MS) do not fulfill the MRI criteria for dissemination in space and time according to the 2010 revision of the McDonald diagnostic criteria for MS and are thus classified as clinically isolated syndrome (CIS). To re-evaluate the utility of cerebrospinal fluid (CSF) analysis in the context of the revised McDonald criteria from 2010, we conducted a retrospective multicenter study aimed at determining the prevalence and predictive value of oligoclonal IgG bands (OCBs) in patients with CIS. Patients were recruited from ten specialized MS centers in Germany and Austria. We collected data from 406 patients; at disease onset, 44/406 (11 %) fulfilled the McDonald 2010 criteria for MS. Intrathecal IgG OCBs were detected in 310/362 (86 %) of CIS patients. Those patients were twice as likely to convert to MS according to McDonald 2010 criteria as OCB-negative individuals (hazard ratio = 2.1, p = 0.0014) and in a shorter time period of 25 months (95 % CI 21-34) compared to 47 months in OCB-negative individuals (95 % CI 36-85). In patients without brain lesions at first attack and presence of intrathecal OCBs (30/44), conversion rate to MS was 60 % (18/30), whereas it was only 21 % (3/14) in those without OCBs. Our data confirm that in patients with CIS the risk of conversion to MS substantially increases if OCBs are present at onset. CSF analysis definitely helps to evaluate the prognosis in patients who do not have MS according to the revised McDonald criteria.
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: André M
authors.initials: AM
authors.lastname: Huss
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Halbgebauer
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Öckl
authors.affiliation: Hannover Medical School, Hannover, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Trebst
authors.affiliation: University of Göttingen, Göttingen, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Spreer
authors.affiliation: NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.|Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Nadja
authors.initials: N
authors.lastname: Borisow
authors.affiliation: Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Harrer
authors.affiliation: University of Würzburg, Würzburg, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Brecht
authors.affiliation: University of Heidelberg, Heidelberg, Germany.|UCL Institute of Neurology, London, UK.
authors.forename: Bettina
authors.initials: B
authors.lastname: Balint
authors.affiliation: University of Freiburg, Freiburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Stich
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Schlegel
authors.affiliation: Neuroimmunological Section, Department of Neurology, University of Rostock, Rostock, Germany.
authors.forename: Nele
authors.initials: N
authors.lastname: Retzlaff
authors.affiliation: Neuroimmunological Section, Department of Neurology, University of Rostock, Rostock, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Winkelmann
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: Romy
authors.initials: R
authors.lastname: Roesler
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Lauda
authors.affiliation: Hannover Medical School, Hannover, Germany.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Yildiz
authors.affiliation: Hannover Medical School, Hannover, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Voß
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Muche
authors.affiliation: University of Freiburg, Freiburg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rauer
authors.affiliation: University of Leipzig, Leipzig, Germany.
authors.forename: Florian Then
authors.initials: FT
authors.lastname: Bergh
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Otto
authors.affiliation: NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.|Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.|Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Friedemann
authors.initials: F
authors.lastname: Paul
authors.affiliation: University of Heidelberg, Heidelberg, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Wildemann
authors.affiliation: Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.|University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Kraus
authors.affiliation: Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Klemens
authors.initials: K
authors.lastname: Ruprecht
authors.affiliation: Hannover Medical School, Hannover, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Stangel
authors.affiliation: University of Würzburg, Würzburg, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Buttmann
authors.affiliation: Neuroimmunological Section, Department of Neurology, University of Rostock, Rostock, Germany.
authors.forename: Uwe K
authors.initials: UK
authors.lastname: Zettl
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany. hayrettin.tumani@uni-ulm.de.
authors.forename: Hayrettin
authors.initials: H
authors.lastname: Tumani
mesh_terms: D000328:Adult; D001317:Austria / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000401:mortality; D043025:Oligoclonal Bands / Q000134:cerebrospinal fluid*; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D043025:Oligoclonal Bands
keywords: Biomarker; CSF; Multiple sclerosis; OCB