Modification of CSF findings in multiple sclerosis in the era of rapidly expanding treatment options

Abstract

ABSTRACTBackground: The detection of cerebrospinal fluid (CSF)-specific oligoclonal bands (OCB) as well as an elevated antibody production directed against neurotrophic viruses remain hallmark findings in multiple sclerosis (MS). In general, individual patients show a unique pattern of OCB, which is believed to persist over time. Here, the authors revisited this assumption and investigated to what extent common anti-inflammatory MS medications can alter the level of immunoglobulins produced within the CSF.Methods: The authors analyzed three patients and compared CSF findings longitudinally. Two of these patients received corticosteroids, either systemically or intrathecally, the third patient was treated continuously with natalizumab.Results: In line with reports from other groups, the authors observed that continuous natalizumab treatment dampened the intrathecal immunoglobulin production in our patient. Exceeding this anticipated scenario, the authors detected that the continued administration of corticosteroids similarly reduced the production of CSF immunoglobulins, down to a level at which these parameters are considered normal.Conclusion: These observations suggest that inflammatory CSF findings are more accessible to immunomodulatory MS treatment than previously thought, and that accordingly, their significance may transition from a sole diagnostic finding to a valuable therapeutic biomarker which may help to assess effective targeting of CNS-established inflammation in MS.