Skip to main content
Erschienen in: Der Nervenarzt 12/2016

20.09.2016 | Multiple Sklerose | Leitthema

Liquordiagnostik bei Multipler Sklerose

Erschienen in: Der Nervenarzt | Ausgabe 12/2016

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Multiple Sklerose (MS) geht als chronisch-entzündliche Erkrankung des zentralen Nervensystems (ZNS) mit typischen Veränderungen im Liquor einher. In der Diagnostik der MS ist die Liquoruntersuchung daher neben der Magnetresonanztomographie ein zentrales Verfahren, welches einerseits die Diagnose einer MS untermauern und andererseits hilfreich in der Abgrenzung von Differenzialdiagnosen sein kann. Der wichtigste Liquorbefund bei der MS ist der Nachweis einer persistierenden polyspezifischen intrathekalen Immunglobulinsynthese. Diese Übersichtsarbeit gibt einen Überblick über Liquorbefunde bei der MS, weist auf praxisrelevante Aspekte und diagnostische Fallstricke hin und stellt neue Entwicklungen in der Liquordiagnostik bei der MS dar.
Literatur
1.
Zurück zum Zitat Andersson M, Alvarez-Cermeno J, Bernardi G et al (1994) Cerebrospinal fluid in the diagnosis of multiple sclerosis: A consensus report. J Neurol Neurosurg Psychiatr 57:897–902CrossRefPubMedPubMedCentral Andersson M, Alvarez-Cermeno J, Bernardi G et al (1994) Cerebrospinal fluid in the diagnosis of multiple sclerosis: A consensus report. J Neurol Neurosurg Psychiatr 57:897–902CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Brecht I, Weissbrich B, Braun J et al (2012) Intrathecal, polyspecific antiviral immune response in oligoclonal band negative multiple sclerosis. PLOS ONE 7:e40431CrossRefPubMedPubMedCentral Brecht I, Weissbrich B, Braun J et al (2012) Intrathecal, polyspecific antiviral immune response in oligoclonal band negative multiple sclerosis. PLOS ONE 7:e40431CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Brettschneider J, Petzold A, Junker A et al (2006) Axonal damage markers in the cerebrospinal fluid of patients with clinically isolated syndrome improve predicting conversion to definite multiple sclerosis. Mult Scler 12:143–148CrossRefPubMed Brettschneider J, Petzold A, Junker A et al (2006) Axonal damage markers in the cerebrospinal fluid of patients with clinically isolated syndrome improve predicting conversion to definite multiple sclerosis. Mult Scler 12:143–148CrossRefPubMed
4.
Zurück zum Zitat Canto E, Tintore M, Lm V et al (2015) Chitinase 3‑like 1: Prognostic biomarker in clinically isolated syndromes. Brain 138:918–931CrossRefPubMed Canto E, Tintore M, Lm V et al (2015) Chitinase 3‑like 1: Prognostic biomarker in clinically isolated syndromes. Brain 138:918–931CrossRefPubMed
5.
Zurück zum Zitat Dobson R, Ramagopalan S, Davis A et al (2013) Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: A meta-analysis of prevalence, prognosis and effect of latitude. J Neurol Neurosurg Psychiatr 84:909–914CrossRefPubMed Dobson R, Ramagopalan S, Davis A et al (2013) Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: A meta-analysis of prevalence, prognosis and effect of latitude. J Neurol Neurosurg Psychiatr 84:909–914CrossRefPubMed
6.
Zurück zum Zitat Gunnarsson M, Malmestrom C, Axelsson M et al (2011) Axonal damage in relapsing multiple sclerosis is markedly reduced by natalizumab. Ann Neurol 69:83–89CrossRefPubMed Gunnarsson M, Malmestrom C, Axelsson M et al (2011) Axonal damage in relapsing multiple sclerosis is markedly reduced by natalizumab. Ann Neurol 69:83–89CrossRefPubMed
7.
Zurück zum Zitat Halbgebauer S, Huss A, Buttmann M et al (2016) Detection of intrathecal immunoglobulin G synthesis by capillary isoelectric focusing immunoassay in oligoclonal band negative multiple sclerosis. J Neurol 263:954–960CrossRefPubMed Halbgebauer S, Huss A, Buttmann M et al (2016) Detection of intrathecal immunoglobulin G synthesis by capillary isoelectric focusing immunoassay in oligoclonal band negative multiple sclerosis. J Neurol 263:954–960CrossRefPubMed
8.
Zurück zum Zitat Hassan-Smith G, Durant L, Tsentemeidou A et al (2014) High sensitivity and specificity of elevated cerebrospinal fluid kappa free light chains in suspected multiple sclerosis. J Neuroimmunol 276:175–179CrossRefPubMed Hassan-Smith G, Durant L, Tsentemeidou A et al (2014) High sensitivity and specificity of elevated cerebrospinal fluid kappa free light chains in suspected multiple sclerosis. J Neuroimmunol 276:175–179CrossRefPubMed
9.
Zurück zum Zitat Hottenrott T, Dersch R, Berger B et al (2015) The intrathecal, polyspecific antiviral immune response in neurosarcoidosis, acute disseminated encephalomyelitis and autoimmune encephalitis compared to multiple sclerosis in a tertiary hospital cohort. Fluids Barriers CNS 12:27CrossRefPubMedPubMedCentral Hottenrott T, Dersch R, Berger B et al (2015) The intrathecal, polyspecific antiviral immune response in neurosarcoidosis, acute disseminated encephalomyelitis and autoimmune encephalitis compared to multiple sclerosis in a tertiary hospital cohort. Fluids Barriers CNS 12:27CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Jacobi C, Lange P, Reiber H (2007) Quantitation of intrathecal antibodies in cerebrospinal fluid of subacute sclerosing panencephalitis, herpes simplex encephalitis and multiple sclerosis: discrimination between microorganism-driven and polyspecific immune response. J Neuroimmunol 187:139–146CrossRefPubMed Jacobi C, Lange P, Reiber H (2007) Quantitation of intrathecal antibodies in cerebrospinal fluid of subacute sclerosing panencephalitis, herpes simplex encephalitis and multiple sclerosis: discrimination between microorganism-driven and polyspecific immune response. J Neuroimmunol 187:139–146CrossRefPubMed
11.
Zurück zum Zitat Jarius S, Eichhorn P, Jacobi C et al (2009) The intrathecal, polyspecific antiviral immune response: Specific for MS or a general marker of CNS autoimmunity? J Neurol Sci 280:98–100CrossRefPubMed Jarius S, Eichhorn P, Jacobi C et al (2009) The intrathecal, polyspecific antiviral immune response: Specific for MS or a general marker of CNS autoimmunity? J Neurol Sci 280:98–100CrossRefPubMed
12.
Zurück zum Zitat Jarius S, Paul F, Franciotta D et al (2011) Cerebrospinal fluid findings in aquaporin-4 antibody positive neuromyelitis optica: results from 211 lumbar punctures. J Neurol Sci 306:82–90CrossRefPubMed Jarius S, Paul F, Franciotta D et al (2011) Cerebrospinal fluid findings in aquaporin-4 antibody positive neuromyelitis optica: results from 211 lumbar punctures. J Neurol Sci 306:82–90CrossRefPubMed
13.
Zurück zum Zitat Kuhle J, Barro C, Disanto G et al (2016) Serum neurofilament light chain in early relapsing remitting MS is increased and correlates with CSF levels and with MRI measures of disease severity. Mult Scler 2016(Jan 11):pii:1352458515623365 (Epub ahead of print) Kuhle J, Barro C, Disanto G et al (2016) Serum neurofilament light chain in early relapsing remitting MS is increased and correlates with CSF levels and with MRI measures of disease severity. Mult Scler 2016(Jan 11):pii:1352458515623365 (Epub ahead of print)
14.
Zurück zum Zitat Kuhle J, Disanto G, Dobson R et al (2015) Conversion from clinically isolated syndrome to multiple sclerosis: A large multicentre study. Mult Scler. doi:10.1177/1352458514568827 Kuhle J, Disanto G, Dobson R et al (2015) Conversion from clinically isolated syndrome to multiple sclerosis: A large multicentre study. Mult Scler. doi:10.​1177/​1352458514568827​
15.
Zurück zum Zitat Kuhle J, Plattner K, Bestwick JP et al (2013) A comparative study of CSF neurofilament light and heavy chain protein in MS. Mult Scler 19:1597–1603CrossRefPubMed Kuhle J, Plattner K, Bestwick JP et al (2013) A comparative study of CSF neurofilament light and heavy chain protein in MS. Mult Scler 19:1597–1603CrossRefPubMed
16.
Zurück zum Zitat Liebsch R, Kornhuber ME, Dietl D et al (1996) Blood-CSF barrier integrity in multiple sclerosis. Acta Neurol Scand 94:404–410CrossRefPubMed Liebsch R, Kornhuber ME, Dietl D et al (1996) Blood-CSF barrier integrity in multiple sclerosis. Acta Neurol Scand 94:404–410CrossRefPubMed
17.
Zurück zum Zitat Link H, Ym H (2006) Oligoclonal bands in multiple sclerosis cerebrospinal fluid: An update on methodology and clinical usefulness. J Neuroimmunol 180:17–28CrossRefPubMed Link H, Ym H (2006) Oligoclonal bands in multiple sclerosis cerebrospinal fluid: An update on methodology and clinical usefulness. J Neuroimmunol 180:17–28CrossRefPubMed
18.
Zurück zum Zitat Otto C, Hofmann J, Finke C et al (2014) The fraction of varicella zoster virus-specific antibodies among all intrathecally-produced antibodies discriminates between patients with varicella zoster virus reactivation and multiple sclerosis. Fluids Barriers CNS 11:3. doi:10.1186/2045-8118-11-3 CrossRefPubMedPubMedCentral Otto C, Hofmann J, Finke C et al (2014) The fraction of varicella zoster virus-specific antibodies among all intrathecally-produced antibodies discriminates between patients with varicella zoster virus reactivation and multiple sclerosis. Fluids Barriers CNS 11:3. doi:10.​1186/​2045-8118-11-3 CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Otto C, Hofmann J, Ruprecht K (2016) Antibody producing B lineage cells invade the central nervous system predominantly at the time of and triggered by acute Epstein-Barr virus infection: A hypothesis on the origin of intrathecal immunoglobulin synthesis in multiple sclerosis. Med Hypotheses 91:109–113CrossRefPubMed Otto C, Hofmann J, Ruprecht K (2016) Antibody producing B lineage cells invade the central nervous system predominantly at the time of and triggered by acute Epstein-Barr virus infection: A hypothesis on the origin of intrathecal immunoglobulin synthesis in multiple sclerosis. Med Hypotheses 91:109–113CrossRefPubMed
20.
Zurück zum Zitat Otto C, Oltmann A, Stein A et al (2011) Intrathecal EBV antibodies are part of the polyspecific immune response in multiple sclerosis. Neurology 76:1316–1321CrossRefPubMed Otto C, Oltmann A, Stein A et al (2011) Intrathecal EBV antibodies are part of the polyspecific immune response in multiple sclerosis. Neurology 76:1316–1321CrossRefPubMed
22.
Zurück zum Zitat Pohl D, Rostasy K, Jacobi C et al (2009) Intrathecal antibody production against Epstein-Barr and other neurotropic viruses in pediatric and adult onset multiple sclerosis. J Neurol 257:212–216CrossRefPubMedPubMedCentral Pohl D, Rostasy K, Jacobi C et al (2009) Intrathecal antibody production against Epstein-Barr and other neurotropic viruses in pediatric and adult onset multiple sclerosis. J Neurol 257:212–216CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Polman CH, Reingold SC, Banwell B et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302CrossRefPubMedPubMedCentral Polman CH, Reingold SC, Banwell B et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Presslauer S, Milosavljevic D, Huebl W et al (2016) Validation of kappa free light chains as a diagnostic biomarker in multiple sclerosis and clinically isolated syndrome: A multicenter study. Mult Scler 22:502–510CrossRefPubMed Presslauer S, Milosavljevic D, Huebl W et al (2016) Validation of kappa free light chains as a diagnostic biomarker in multiple sclerosis and clinically isolated syndrome: A multicenter study. Mult Scler 22:502–510CrossRefPubMed
25.
Zurück zum Zitat Reiber H, Lange P (1991) Quantification of virus-specific antibodies in cerebrospinal fluid and serum: Sensitive and specific detection of antibody synthesis in brain. Clin Chem 37:1153–1160PubMed Reiber H, Lange P (1991) Quantification of virus-specific antibodies in cerebrospinal fluid and serum: Sensitive and specific detection of antibody synthesis in brain. Clin Chem 37:1153–1160PubMed
26.
Zurück zum Zitat Reiber H, Ungefehr S, Jacobi C (1998) The intrathecal, polyspecific and oligoclonal immune response in multiple sclerosis. Mult Scler 4:111–117CrossRefPubMed Reiber H, Ungefehr S, Jacobi C (1998) The intrathecal, polyspecific and oligoclonal immune response in multiple sclerosis. Mult Scler 4:111–117CrossRefPubMed
27.
Zurück zum Zitat Senel M, Tumani H, Lauda F et al (2014) Cerebrospinal fluid immunoglobulin kappa light chain in clinically isolated syndrome and multiple sclerosis. PLOS ONE 9:e88680CrossRefPubMedPubMedCentral Senel M, Tumani H, Lauda F et al (2014) Cerebrospinal fluid immunoglobulin kappa light chain in clinically isolated syndrome and multiple sclerosis. PLOS ONE 9:e88680CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Storch-Hagenlocher B, Oschmann P, Wildemann B (2006) Nicht erregerbedingte Entzündungen vom Autoimmuntyp. In: Wildemann B, Oschmann P, Reiber H (Hrsg) Neurologische Labordiagnostik. Thieme, Stuttgart, New York, S 142–145 Storch-Hagenlocher B, Oschmann P, Wildemann B (2006) Nicht erregerbedingte Entzündungen vom Autoimmuntyp. In: Wildemann B, Oschmann P, Reiber H (Hrsg) Neurologische Labordiagnostik. Thieme, Stuttgart, New York, S 142–145
29.
Zurück zum Zitat Storch-Hagenlocher B, Reiber H, Wildemann B et al (2006) Liquordiagnostik. In: Wildemann B, Oschmann P, Reiber H (Hrsg) Neurologische Labordiagnostik. Thieme, Stuttgart, New York, S 45–54 Storch-Hagenlocher B, Reiber H, Wildemann B et al (2006) Liquordiagnostik. In: Wildemann B, Oschmann P, Reiber H (Hrsg) Neurologische Labordiagnostik. Thieme, Stuttgart, New York, S 45–54
30.
Zurück zum Zitat Tintore M, Rovira A, Rio J et al (2008) Do oligoclonal bands add information to MRI in first attacks of multiple sclerosis? Neurology 70:1079–1083CrossRefPubMed Tintore M, Rovira A, Rio J et al (2008) Do oligoclonal bands add information to MRI in first attacks of multiple sclerosis? Neurology 70:1079–1083CrossRefPubMed
31.
Zurück zum Zitat Tumani H, Deisenhammer F, Giovannoni G et al (2011) Revised McDonald criteria: the persisting importance of cerebrospinal fluid analysis. Ann Neurol 70:520 (author reply 521)CrossRefPubMed Tumani H, Deisenhammer F, Giovannoni G et al (2011) Revised McDonald criteria: the persisting importance of cerebrospinal fluid analysis. Ann Neurol 70:520 (author reply 521)CrossRefPubMed
32.
Zurück zum Zitat Walsh MJ, Tourtellotte WW (1986) Temporal invariance and clonal uniformity of brain and cerebrospinal IgG, IgA, and IgM in multiple sclerosis. J Exp Med 163:41–53CrossRefPubMed Walsh MJ, Tourtellotte WW (1986) Temporal invariance and clonal uniformity of brain and cerebrospinal IgG, IgA, and IgM in multiple sclerosis. J Exp Med 163:41–53CrossRefPubMed
33.
Zurück zum Zitat Wengert O, Rothenfusser-Korber E, Vollrath B et al (2013) Neurosarcoidosis: Correlation of cerebrospinal fluid findings with diffuse leptomeningeal gadolinium enhancement on MRI and clinical disease activity. J Neurol Sci 335:124–130CrossRefPubMed Wengert O, Rothenfusser-Korber E, Vollrath B et al (2013) Neurosarcoidosis: Correlation of cerebrospinal fluid findings with diffuse leptomeningeal gadolinium enhancement on MRI and clinical disease activity. J Neurol Sci 335:124–130CrossRefPubMed
34.
Metadaten
Titel
Liquordiagnostik bei Multipler Sklerose
Publikationsdatum
20.09.2016
Schlagwort
Multiple Sklerose
Erschienen in
Der Nervenarzt / Ausgabe 12/2016
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI
https://doi.org/10.1007/s00115-016-0220-z

Weitere Artikel der Ausgabe 12/2016

Der Nervenarzt 12/2016 Zur Ausgabe

Passend zum Thema

ANZEIGE
OnSite Advertorial Multiple Sklerose
Service mit Mehrwert

Services in der MS-Therapie für Neurolog*innen und Betroffene

Diagnose und Therapie der MS können für Patient*innen und Neurolog*innen mit Herausforderungen einhergehen [1,2]. Mit umfangreichen Servicemaßnahmen klärt Biogen Ärztinnen und Ärzte über mögliche Therapieoptionen auf und unterstützt diese bei der Fortbildung sowie Betroffene im Alltag.