Does CSF pleocytosis have a predictive value for disease course in MS?

Area of Science:

• Neurology
• Immunology
• Clinical Medicine

Background:

• Multiple sclerosis (MS) is a central nervous system demyelinating disorder with variable clinical presentations and prognoses.
• Current prognostic factors for MS are limited, lacking specific biological markers to guide treatment.
• The impact of cerebrospinal fluid (CSF) pleocytosis on MS clinical course and prognosis remains unclear.

Purpose of the Study:

• To investigate the association between CSF pleocytosis at initial presentation and the clinical course of MS.
• To determine if CSF pleocytosis serves as a predictive marker for MS disease progression.

Main Methods:

• Retrospective evaluation of 114 MS patients who underwent lumbar puncture at diagnosis.
• Analysis included CSF cell count, clinical diagnosis (CIS/RRMS), annualized relapse rate (ARR), and Expanded Disability Status Scale (EDSS) progression.
• Comparison of outcomes between patients with and without CSF pleocytosis (≥5 cells/μL vs. <4 cells/μL).

Main Results:

• Forty-six patients (40%) presented with CSF pleocytosis.
• Patients with CSF pleocytosis exhibited a significantly higher ARR (0.60 vs. 0.48, p=0.0267).
• Pleocytosis was associated with a steeper EDSS score increase over the follow-up period (r²=0.04, p=0.0251).

Conclusions:

• CSF pleocytosis at initial MS presentation is linked to a more aggressive disease course.
• Elevated CSF cell counts may serve as an unfavorable biological predictive factor in MS.
• These findings highlight the prognostic value of CSF analysis in managing MS patients.