Laboratory parameters of the 1st order – obligatory laboratory tests.
- Small blood count
- Differential blood count*
- Inflammatory parameters – CRP (C-reactive protein) or ESR* (erythrocyte sedimentation rate).
- Electrolytes (blood salts)* – calcium, sodium, potassium.
- Fasting glucose* (fasting blood glucose).
- Alanine aminotransferase* (ALT, GPT)
- Creatinine kinase (CK)*
- LDL*
- Uric acid*
- Vitamin B12*
- CSF examinations* (examination of cerebrospinal fluid from the spinal canal) due toMS diagnostics (for first-time typical optic neuritis, diagnostic CSF puncture is a relative indication).
- Cell count, protein, sugar, lactate.
- Oligoclonal immunoglobulins in CSF (detectable in >95% of pediatric MS patients), albumin, and IgG, IgA, and IgM in serum and CSF Indications: CSF examination is important in cases of unclear MRI findings, atypical clinical findings, or atypical age of onset of disease. [No longer necessary for diagnosis according to current diagnostic criteria; however, continues to be part of the diagnosis at the first relapse].
- MRZ reaction – Parameters: Measles virus antibody (IgG, CSF/serum), rubella virus antibody (IgG, CSF/serum), varicella zoster virus antibody (IgG, CSF/serum; additionally necessary: Albumin quotient (CSF/serum), IgG quotient (CSF/serum).
- MOG antibodies* (MOG-Ak; antibodies against myelin sheath protein myelin oligodendrocyte glycoprotein) – determination after first episode in children/DD unique acute demyelinating encephalomyelitis (ADEM) [if MOG-positive: Optic neuritis (optic neuritis) twice as often and encephalomyelitis (inflammation of the brain (encephalitis) and spinal cord (myelitis) three times as often as MOG-negative patients; one in four MOG-positive children developed a relapsing course of disease, and this occurred primarily in those who remained seropositive
2nd order laboratory parameters – depending on the results of the history, physical examination, etc. – for differential diagnosis (in case of atypical presentation of optic neuritis and unknown underlying disease)
- Rheumatoid diagnostics – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate); rheumatoid factor (RF), CCP-AK (cyclic citrulline peptide antibodies), ANA* (antinuclear antibodies).
- Antiphospholipid antibodies – autoreactive antibodies.
- Aquaporin-4 antibody* (in natural steric conformation) – highly specific for neurodermatitis optica (NMO, Devic syndrome), an inflammatory demyelinating disease of the central nervous system.
- Lupus anticoagulant – antibodies that occur in 30% of patients with systemic lupus erythematosus (SLE).
- ANCA (anti-neutrophil cytoplasmic antibodies) – antibodies against structures of granulocytes (immune defense cells).
- ENA (extractable nuclear antigens).
- Von Willebrand factor* – in vasculitis affecting only the small vessels.
- Metabolic screening* – in cases of clinical suspicion, depending on the clinical phenotype.
- Borrelia serology* – examination of the blood to find any Borrelia (causative agent of Lyme disease) present.
- Infection parameters (measles, rubella, varicella) in serum and cerebrospinal fluid.
- HIV serology
- HTLV-1 serology (human T-cell leukemia virus) – viruses that can infect T lymphocytes (cells of disease defense) in humans.
- TPHA (Treponema pallidum hemagglutination) – test performed when syphilis (sexually transmitted infectious disease) is suspected.
- Long chain fatty acids
- Methylmalony excretion in urine
- Neurofilament light chain proteins (NFL; Engl.Neurofilament light chain) in CSF and serum – serum marker of MS activity [Untreated MS patients: serum NFL levels median around 50 ng/l; one year after therapy initiation: 30 ng/l; patients on escalation therapy: 15-20 ng/l (level of healthy participants].
* S1 guideline: pediatric multiple sclerosis [see below].
