CSF diagnostics in multiple sclerosis
To diagnose multiple sclerosis, cerebral fluid (liquor) is taken from the patient’s brain during a lumbar puncture and examined in the laboratory. For this purpose, the doctor pierces the cerebral membrane with a needle in the area of the lumbar spine and thus reaches your external cerebrospinal fluid space. The procedure is painful and is therefore performed under local anesthesia.Since the disease is an inflammation of the central nervous system, an increased number of white blood cells (leukocytes) is to be expected.
In addition, the concentration of proteins, such as antibodies, is increased. Thus, in CSF diagnostics, special attention is paid to so-called oligoclonal antibody bands of the IgG type. These are an expression of increased antibody formation in the area of the central nervous system, often in the meninges.
These antibodies are produced by B-lymphocytes and enter the cerebrospinal fluid, but not the blood. Thus, in multiple sclerosis patients, a blood sample may be inconspicuous, while a lumbar puncture shows clear signs of inflammation. However, it should be noted that antibody bands are not a specific proof of multiple sclerosis.
Antibody formation is also stimulated in other chronic inflammations of the brain and is visible in CSF diagnostics. These include, for example, inflammations of the brain after viral infections such as rubella, measles or certain herpes viruses. According to this, only a lumbar puncture is not sufficient to confirm the diagnosis.
In addition, there are imaging procedures of the brain such as MRI of the head or MRI of the brain. With the help of a contrast medium, an attempt is made to detect the individual centres of inflammation in the brain. Typical for MS is the occurrence of individual inflammations, which, however, are not dependent on each other in terms of time and place.
This means that in multiple sclerosis, inflammation develops spontaneously in different areas of the brain and becomes increasingly worse over time. In CSF diagnostics, this leads to constantly increased cell and protein numbers, which would not be expected in reversible inflammations, for example. An MRI examination differs in the administration of contrast medium and the objective of the MRI ́s.
Since MS multiple sclerosis is still incurable today, the goal of the treating physician should be to keep the patient’s quality of life as high as possible for as long as possible. This is usually attempted with several medications that demonstrably reduce neurological disorders and pain, but are unable to slow them down for a long time.
