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September 2019; 6 (5) ArticleOpen Access

Does CSF pleocytosis have a predictive value for disease course in MS?

Itay Lotan, View ORCID ProfileFelix Benninger, Rom Mendel, Mark A. Hellmann, Israel Steiner
First published June 18, 2019, DOI: https://doi.org/10.1212/NXI.0000000000000584
Itay Lotan
From the Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel.
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Felix Benninger
From the Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel.
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  • ORCID record for Felix Benninger
Rom Mendel
From the Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel.
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Mark A. Hellmann
From the Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel.
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Israel Steiner
From the Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel.
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Citation
Does CSF pleocytosis have a predictive value for disease course in MS?
Itay Lotan, Felix Benninger, Rom Mendel, Mark A. Hellmann, Israel Steiner
Neurol Neuroimmunol Neuroinflamm Sep 2019, 6 (5) e584; DOI: 10.1212/NXI.0000000000000584

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Abstract

Objective MS is a demyelinating CNS disorder with a spectrum of clinical patterns regarding course and prognosis. Although several prognostic factors are considered in the initial evaluation of patients, biological markers defining the disease course and guiding treatments are currently lacking. It is unknown whether patients with CSF pleocytosis differ in regard to symptoms, disease course, and prognosis from those without. The aim of this study was to evaluate whether CSF pleocytosis during the initial presentation has an impact on the clinical course and progression of MS.

Methods We retrospectively evaluated patients attending the MS Clinic at Rabin Medical Center between January 1999 and January 2016 who underwent lumbar puncture (LP) at disease presentation, considering CSF cell count, clinical diagnosis (clinically isolated syndrome [CIS] and relapsing-remitting MS [RRMS]), annualized relapse rate (ARR), paraclinical findings (imaging, CSF oligoclonal bands, and evoked potentials), and disease progression, expressed by the Expanded Disability Status Scale (EDSS).

Results One hundred fourteen patients (72 females) underwent LP at disease presentation (RRMS: n = 100, CIS: n = 14). Age at diagnosis was 32.4 ± 12.2 years, and the follow-up time was 9.4 ± 3.8 years. Forty-six patients showed a pleocytic CSF (≥5 cells per μL). Compared with patients with <4 cells per μL, patients with pleocytosis had a higher ARR (0.60 ± 0.09 vs 0.48 ± 0.04; p = 0.0267) and a steeper increase (slope) in the EDSS score throughout the follow-up period (correlation coefficient: r2 = 0.04; p = 0.0251).

Conclusions CSF pleocytosis may be considered a biological unfavorable predictive factor regarding disease course and progression in MS.

Glossary

ARR=
annualized relapse rate;
CDMS=
clinically definite MS;
CIS=
clinically isolated syndrome;
DMT=
disease-modifying therapy;
EDSS=
Expanded Disability Status Scale;
EP=
evoked potential;
EPS=
evoked potential study;
LP=
lumbar puncture;
OCB=
oligoclonal band;
RRMS=
relapsing-remitting MS;
WBC=
white blood cell

Footnotes

  • Go to Neurology.org/NN for full disclosures. Funding information is provided at the end of the article.

  • ↵* Equal contribution first author.

  • The Article Processing Charge was funded by the authors.

  • Received March 26, 2019.
  • Accepted in final form April 26, 2019.
  • Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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