The kappa free light chains index is an accurate diagnostic biomarker for paediatric multiple sclerosis
Aurélie Sarthou1, Pascale Chrétien1,2, Laetitia Giorgi3,4
1Clinical Immunology Laboratory, Groupe Hospitalier Universitaire Paris Saclay, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
Insights
The kappa free light chain (KFLC) index effectively diagnoses paediatric multiple sclerosis (PedMS). This biomarker distinguishes PedMS from other central nervous system inflammatory disorders in children, aiding accurate diagnosis.
Area of Science:
- Neurology
- Immunology
- Biomarker Discovery
Background:
- Paediatric multiple sclerosis (PedMS) diagnosis is challenging, often confused with other demyelinating syndromes (ODSs).
- The kappa free light chain (KFLC) index is a validated marker for intrathecal immunoglobulin (Ig) synthesis in adult MS.
Purpose of the Study:
- To evaluate the diagnostic utility of the KFLC index in paediatric-onset central nervous system (CNS) inflammatory disorders.
- To determine if the KFLC index can differentiate PedMS from ODSs and other inflammatory conditions in children.
Main Methods:
- A cohort of 73 paediatric patients was analyzed, categorized into PedMS, ODS, encephalitis/epilepsy (EE), and control groups.
- The KFLC index was calculated for all participants and compared with oligoclonal band (OCB) results.
Main Results:
- The KFLC index was significantly elevated in the PedMS group compared to ODS, EE, and control groups.
- A KFLC index cut-off of 6.83 demonstrated high sensitivity (100%) and specificity (92%) for distinguishing PedMS from controls.
- A KFLC index above 93.77 strongly suggested a PedMS diagnosis with 68% sensitivity and 100% specificity.
Conclusions:
- The KFLC index is a reliable and effective biomarker for diagnosing multiple sclerosis in paediatric patients.
- This index aids in differentiating PedMS from other inflammatory CNS conditions in children, improving diagnostic accuracy.
Background:
Multiple sclerosis (MS) may occur before the age of 18. Differentiation between paediatric MS (PedMS) and other demyelinating syndromes (ODSs) is challenging. In adult with MS, the kappa free light chain (KFLC) index has proven to be a reliable marker of intrathecal Ig synthesis.
Objective:
To assess the diagnostic value of the KFLC index in a cohort of patients with paediatric-onset, inflammatory disorders of the CNS.
Methods:
We included 73 patients and divided them into four groups: PedMS (n = 16), ODS (n = 17), encephalitis and/or inflammatory epilepsy (EE, n = 15), and controls without inflammatory CNS diseases (n = 25). The KFLC index was calculated and compared with the results of the oligoclonal bands determination.
Results:
The KFLC index was higher in the PedMS group (median (interquartile range (IQR)): 150.9 (41.02-310.6)) than in the ODS (3.37 (2.22-8.11)), the EE (5.53 (2.31-25.81)) and the control group (3.41 (2.27-5.08)), respectively. The best KFLC index cut-off for differentiating between patients with PedMS and controls was 6.83 (sensitivity: 100%; specificity: 92%). A KFLC index over 93.77 indicated that the patient is very likely to have PedMS (sensitivity: 68%; specificity: 100%).
Conclusion:
The KFLC index is a reliable tool for the diagnosis of MS in a paediatric population.
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