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Recommended Standard of Cerebrospinal Fluid Analysis in the Diagnosis of Multiple Sclerosis
A Consensus Statement
Mark S. Freedman, MSc, MD, FRCPC;
Edward J. Thompson, DSc;
Florian Deisenhammer, MD;
Gavin Giovannoni, PhD;
Guy Grimsley, PhD;
Geoffrey Keir, PhD;
Sten Öhman, PhD;
Michael K. Racke, MD;
Mohammad Sharief, PhD;
Christian J. M. Sindic, MD, PhD;
Finn Sellebjerg, MD, PhD, DMSci;
Wallace W. Tourtellotte, MD, PhD
Arch Neurol. 2005;62:865-870.
New criteria for the diagnosis of multiple sclerosis (MS) were published as the result of an internationally formed committee. To increase the specificity of diagnosis and to minimize the number of false diagnoses, the committee recommended the use of both clinical and paraclinical criteria, the latter involving information obtained from magnetic resonance imaging, evoked potentials, and cerebrospinal fluid (CSF) analysis. Although rigorous magnetic resonance imaging requirements were provided, the "new criteria paper" fell short in terms of guidelines as to how the CSF analysis should be performed and simply equated the IgG index with isoelectric focusing, without any justification. The spectrum of parameters analyzed and methods for CSF analysis differ worldwide and often yield variable results in terms of sensitivity, specificity, accuracy, and reliability, with no decided "optimal" CSF test for the diagnosis of MS. To address this question specifically, an international panel of experts in MS and CSF diagnostic techniques was convened and the result was this article, representing a consensus of all the participants. These recommendations for establishing a standard for the evaluation of CSF in patients suspected of having MS should greatly complement the new criteria in ensuring that a correct diagnosis of MS is being made.
Author Affiliations: Department of Medicine (Neurology), University of Ottawa, Multiple Sclerosis Research Clinic, The Ottawa Hospital–General Campus, Ottawa, Ontario (Dr Freedman); Department of Neuroimmunology, National Hospital for Neurology (Drs Thompson, Giovannoni, and Keir) and Guy's Hospital (Dr Sharief), London, United Kingdom; Department of Neurology, University of Innsbruck, Innsbruck, Austria (Dr Deisenhammer); Specialty Laboratories, Valencia, Calif (Dr Grimsley); Antivenena AB, Ljungsbro, Sweden (Dr Öhman); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (Dr Racke); Service de Neurologie, Université Catholique de Louvain, Brussels, Belgium (Dr Sindic); Department of Neurology, University of Copenhagen, Copenhagen, Denmark (Dr Sellebjerg); Veterans Administration West Los Angeles Healthcare Center, UCLA, Los Angeles, Calif (Dr Tourtellotte).
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