Clinical Study: A Comparative Study Testing Utility of CSF Biomarkers in the Diagnosis and Follow-Up of Multiple Sclerosis
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- Category: Vol. 81, December 2013
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Clinical Study: A Comparative Study Testing Utility of CSF Biomarkers in the Diagnosis and Follow-Up of Multiple Sclerosis, ASMAA A. EL-REWENY, NEHAD MOSAAD and ADEL HASANEEN
Abstract
Objective: The aim of current study was to compare CSF Myelin Basic Protein (MBP), IgG index and Oligoclonal Banding (OCB) as biomarkers for diagnosis of Multiple Sclerosis (MS), follow-up of disease activity and for monitoring of treatment.
Methods: The study included 30 cases with definite MS from Neurology Department in Faculty of Medicine of Cairo University, 22 patients in relapsing remitting stage (15 cases during relapse and 7 in remission) and 8 cases in progressive stage. The mean of ages of cases was 31.07±8.96 years and male/female ratio was 2/3. These cases were compared with age and sex matched 20 control subjects. The CSF MBP, IgG index and OCB were measured for both cases and controls.
Results: The mean MBP was significantly higher in cases than control. It was also significantly higher in relapse when compared with remitting and progressive stages. IgG index was higher in cases compared to control with a p-value <0.01. There was no significant difference between MBP mean values in relapse, remission and progressive stages. OCB was present in 56.7% of MS cases and absent in all controls. When comparing cases with controls, the specificity of OCB was 100% and sensitivity was 56.7%. The sensitivity of IgG index at cut off value 0.54 was 100% and specificity was 95%. The sensitivity of MBP at cut off value 0.8ng/ml was 96.7% and specificity was 100%. But on comparing active cases with inactive ones, the specificity of OCB was 57. 1 % and sensitivity was 60.9%. The sensitivity of IgG index at cut off value 0.7 was 56.5% and specificity was 71.4%. The sensitivity of MBP at a cut off value of 2ng/ml was 52.2% and specificity was 71.4%. At p<0.0 1, the mean values of MBP and IgG index were significantly higher in cases who did not receive Methyl Prednisone when compared with treated cases. The IgG index is of good practicability as it is simple, rapid and does need certain skills as the case in OCB and it is cheaper than MBP.
Conclusion: The CSF MBP and IgG index were better than OCB in diagnosing and differentiating MS cases as regards sensitivity. The MBP could be used for follow-up of activity of the disease in the relapse remission stage and both MBP and IgG index could be used for follow-up of treatment. The IgG index is of good practicability and could be adopted as initial tests in all routine laboratories.