Richard ARudick, Director, Mellen Center, Cleveland Clinicrudickr@ccf.org
Aaron Miller, New York
Submitted June 21, 2012
We agree with Dr. Diesenhammer that CSF analysis can be very helpful in difficult cases. Results can add to confidence in the diagnosis in patients thought not to have MS, and in atypical MS. However, we would caution against over-reliance on CSF test results, for several reasons: 1) The performance characteristics for CSF oligoclonal bands has been studied more extensively in well-established MS than in patients with clinically or radiologically isolated syndromes. In our experience, CSF may be negative for OCB at initial presentation, and positive at a later time point; 2) There is a large literature demonstrating that OCB are nonspecific. Inflammatory and infectious diseases are commonly accompanied by OCB, and even infarcts or tumors may be accompanied by CSF OCB; and 3) Performance characteristics for OCB are technique dependent. As with other diagnostic tests, specificity declines as sensitivity increases. Similar to MRI, CSF test results should be interpreted for each individual case by a neurologist experienced in diagnosis and management of MS.
For disclosures, contact the editorial office at journal@neurology.org.
We agree with Dr. Diesenhammer that CSF analysis can be very helpful in difficult cases. Results can add to confidence in the diagnosis in patients thought not to have MS, and in atypical MS. However, we would caution against over-reliance on CSF test results, for several reasons: 1) The performance characteristics for CSF oligoclonal bands has been studied more extensively in well-established MS than in patients with clinically or radiologically isolated syndromes. In our experience, CSF may be negative for OCB at initial presentation, and positive at a later time point; 2) There is a large literature demonstrating that OCB are nonspecific. Inflammatory and infectious diseases are commonly accompanied by OCB, and even infarcts or tumors may be accompanied by CSF OCB; and 3) Performance characteristics for OCB are technique dependent. As with other diagnostic tests, specificity declines as sensitivity increases. Similar to MRI, CSF test results should be interpreted for each individual case by a neurologist experienced in diagnosis and management of MS.
For disclosures, contact the editorial office at journal@neurology.org.