CSF lymphocytic pleocytosis does not predict a less favourable long-term prognosis in MS
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Updated: Aug 16, 2025
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Published on: March 29, 2024
Lauren Astbury1, Seema Kalra2, Radu Tanasescu1
1Academic Unit of Mental Health and Clinical Neuroscience, Section of Clinical Neurology, University of Nottingham, Nottingham Centre for MS and Neuroinflammation, Nottingham University Hospitals QMC, Nottingham, NG7 2UH, UK.
Objective:
The role of CSF lymphocytic pleocytosis in predicting the clinical outcome of multiple sclerosis is unclear. We explored the impact of CSF pleocytosis at diagnosis on long-term disease progression in a large UK cohort.
Methods:
We extracted demographic, clinical and CSF data of people with MS attending the MS clinics between 1996 and 2014 at two MS centres from the English Midlands. We compared EDSS at onset, follow up EDSS and progression indices Multiple Sclerosis Severity Score (MSSS), annualized change in EDSS and transition to secondary progression in the presence/absence of pleocytosis. Two-tailed student t-test, Mann-Whitney U test, Chi-Square or Fisher's exact tests were used for detecting the differences.
Results:
A total of 247 patients with MS (178 females; mean age 42.4; 217 with relapsing onset) were followed up for an average of 13.56 years (median 12 years). Almost 18% had lymphocytic CSF ≥ 5 per microliter. CSF pleocytosis was not associated with higher EDSS at the time of LP or at follow up, and other progression indices like MSSS, annualized change in EDSS or transition to secondary progression.
Discussion:
CSF pleocytosis at MS diagnosis does not predict higher long-term disability and has no long-term prognostic value in routine clinical circumstances. Differences between MS populations and potential differences in disease activity at the time of CSF analysis may account for differences between studies.
Insights
Cerebrospinal fluid (CSF) lymphocytic pleocytosis at multiple sclerosis (MS) diagnosis does not predict long-term disability. This finding suggests CSF pleocytosis lacks prognostic value in routine clinical practice for MS progression.
Area of Science:
- Neurology
- Immunology
- Clinical Research
Background:
- The prognostic value of cerebrospinal fluid (CSF) lymphocytic pleocytosis in multiple sclerosis (MS) remains uncertain.
- Understanding predictors of long-term disease progression is crucial for managing MS.
Purpose of the Study:
- To investigate the impact of CSF pleocytosis at the time of diagnosis on the long-term clinical progression of MS.
- To determine if CSF pleocytosis has prognostic value in predicting disability and disease progression in a large UK cohort.
Main Methods:
- Retrospective analysis of demographic, clinical, and CSF data from 247 patients with MS diagnosed between 1996 and 2014.
- Comparison of Expanded Disability Status Scale (EDSS) scores at onset and follow-up, Multiple Sclerosis Severity Score (MSSS), and transition to secondary progressive MS in patients with and without CSF pleocytosis.
- Statistical analysis using t-tests, Mann-Whitney U, Chi-Square, and Fisher's exact tests.
Main Results:
- Approximately 18% of the cohort exhibited lymphocytic CSF pleocytosis (≥5 cells/µL).
- CSF pleocytosis was not associated with higher EDSS at diagnosis or follow-up.
- No significant association was found between CSF pleocytosis and other progression indices, including MSSS, annualized EDSS change, or time to secondary progression.
Conclusions:
- CSF pleocytosis at the time of MS diagnosis does not predict increased long-term disability.
- CSF pleocytosis does not appear to have significant long-term prognostic value in routine clinical settings for MS.
- Variations in MS populations and disease activity at CSF analysis may explain differing study results.
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