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Intrathecal immunoglobulin synthesis: The potential value of an adjunct test

Andreja Emersic1, Vanesa Anadolli2, Mladen Krsnik3

  • 1Department of Neurology, University Medical Centre Ljubljana, Zaloska c. 2, SI-1525 Ljubljana, Slovenia.

Clinica Chimica Acta; International Journal of Clinical Chemistry
|December 12, 2018
PubMed

Insights

Quantifying kappa free light chains (KFLC) in cerebrospinal fluid (CSF) offers a convenient alternative to oligoclonal bands (OCB) for diagnosing multiple sclerosis (MS). Combining KFLC and OCB tests enhances diagnostic accuracy in MS detection.

Area of Science:

  • Neurology
  • Immunology
  • Biochemistry

Background:

  • Diagnosis of multiple sclerosis (MS) often relies on detecting cerebrospinal fluid (CSF) specific oligoclonal bands (OCB).
  • Current OCB detection methods are technically demanding and provide only qualitative data.
  • Quantification of kappa free light chains (KFLC) presents a potentially more convenient diagnostic alternative.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of OCB and KFLC in a cohort of patients.
  • To assess the added diagnostic value of combining KFLC and OCB testing for MS diagnosis.

Main Methods:

  • KFLC levels were measured in paired serum and CSF samples from 80 MS patients and 50 controls.
  • OCB were detected using an in-house alkaline phosphatase assay.
  • Likelihood ratio analysis was employed to determine the benefit of combined testing.

Main Results:

  • KFLC index and intrathecal KFLC fraction demonstrated high sensitivity (96% and 95%) and specificity (96%).
  • OCB assay showed comparable sensitivity (91%) and higher specificity (98%).
  • Concurrent normal KFLC and absent OCB significantly reduced the probability of MS.

Conclusions:

  • Normal KFLC parameters reliably exclude intrathecal inflammation.
  • Positive OCB results increase the probability of MS.
  • KFLC testing may be beneficial as an adjunct in specialized centers with high pretest MS probability.
Abstract

Keywords:
Cerebrospinal fluidDiagnostic performanceKappa free light chainsMultiple sclerosisOligoclonal bands

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