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Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis

Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden

J Gomez-Rial

Departments of Immunology and Neurology, Hospital Ramón y Cajal, Madrid, Spain

AK Hedström

Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden

J Hillert

Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden

JC Alvarez-Cermeño

Departments of Immunology and Neurology, Hospital Ramón y Cajal, Madrid, Spain

T Masterman

Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden thomas.masterman{at}ki.se

LM Villar

Departments of Immunology and Neurology, Hospital Ramón y Cajal, Madrid, Spain

Background and Objective

The presence of lipid-specific immunoglobulin M bands in the cerebrospinal fluid (CSF) predicts an aggressive course in patients with relapsing–remitting multiple sclerosis (MS) during early stages of the disease. This study examined whether it is also a predictor of long-term prognosis in MS.

Methods

Eighty-one patients with MS and 22 headache controls were analyzed for anti-lipid IgM reactivity in CSF samples. The correlation between the presence of lipid-specific immunoglobulin M bands in CSF and disease progression was assessed in patients with MS who had been followed longitudinally for, on average, more than 11 years.

Results

Lipid-specific immunoglobulin M bands were detected in the CSF of 24 of 81 patients with MS and were absent in the CSF of all headache controls. Median time to conversion to a secondary progressive course was 11 years in patients with bands and 22 years in patients without bands. Median time to an Expanded Disability Status Scale score of 4 was 14 years in patients with bands and 24 years in patients without bands.

Conclusion

The presence of lipid-specific immunoglobulin M bands in CSF predicts a more adverse long-term outcome in patients with MS; it may thus define a subset of patients who might benefit from aggressive treatment during the early phase of the disease.

Key Words: biological markers • cerebrospinal fluid • immunoglobulin M • multiple sclerosis • prognosis • survival analysis

This version was published on November 1, 2008

Multiple Sclerosis, Vol. 14, No. 9, 1208-1213 (2008)
DOI: 10.1177/1352458508095729


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