Abstract
In the absence of a specific test for the diagnosis of multiple sclerosis (MS), cerebrospinal fluid analysis (CSF) remains discussed. There are robust evidences which demonstrated that an early diagnosis of MS must be done, due to the availability of disease-modifying drugs that could influence the natural history of the disease. However, several arguments can be put forward to assert that CSF analysis is not useful for the diagnosis of MS and thus should not be realized in a systematic way. First, MRI remains the most sensitive and specific marker to validate dissemination in space and in time and CSF analysis is not recommended by the 2010 McDonald criteria. The second argument is related to the low sensitivity and specificity of abnormalities detected in CSF analysis to confirm the diagnosis of MS. Moreover, there is currently no evidence that the presence of oligoclonal bands could represent a surrogate marker on an individual prognostic way. Furthermore, lumbar puncture could be traumatic, may entail some infrequent risks and represents unnecessary expense. Thus, there are strong reasons to not recommend systematic CSF examination to diagnose MS.
References
Aug 1, 1994·Journal of Neurology, Neurosurgery, and Psychiatry·M AnderssonM Grønning
Jan 12, 2001·Neurosurgical Review·E ReihsausW Seeling
Jul 18, 2001·Annals of Neurology·W I McDonaldJ S Wolinsky
Jan 22, 2003·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·N VandenbergheM Weber
Jan 31, 2003·Annals of Neurology·Luisa M VillarJosé C Alvarez-Cermeño
Jul 27, 2004·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·A BourahouiP Vermersch
Nov 12, 2005·Annals of Neurology·Chris H PolmanJerry S Wolinsky
Jul 10, 2007·Lancet Neurology·Josephine K SwantonDavid H Miller
Sep 21, 2007·Neurology·M TintoréX Montalban
Sep 22, 2007·Lancet Neurology·David H Miller, Siobhan M Leary
Mar 10, 2011·Annals of Neurology·Chris H PolmanJerry S Wolinsky
Dec 22, 2011·Multiple Sclerosis : Clinical and Laboratory Research·J Lechner-ScottUNKNOWN MSBase study group
May 15, 2012·Neurology·Andrew J SolomonDennis Bourdette
Feb 20, 2013·Neurology·Florian Deisenhammer
Feb 23, 2013·Journal of Neurology, Neurosurgery, and Psychiatry·Ruth DobsonGavin Giovannoni
Mar 9, 2013·PloS One·Inger-Lise MeroHanne F Harbo
Jan 23, 2014·Journal of Neurology·M HaertleM Linnebank
Feb 8, 2014·Journal of Thrombosis and Haemostasis : JTH·P J H L PeetersF de Vries