• Cathérine Dekeyser, Matthias Hautekeete, Melissa Cambron, Vincent Van Pesch, Francesco Patti, Jens Kuhle, Samia Khoury, Jeanette Lechner Scott, Oliver Gerlach, Alessandra Lugaresi, Davide Maimone, Andrea Surcinelli, Pierre Grammond, Tomas Kalincik, Mario Habek, Barbara Willekens, Richard Macdonell, Patrice Lalive, Tunde Csepany, Helmut Butzkueven, Cavit Boz, Valentina Tomassini, Matteo Foschi, José Luis Sánchez-Menoyo, Ayse Altintas, Saloua Mrabet, Gerardo Iuliano, Maria Jose Sa, Raed Alroughani, Rana Karabudak, Eduardo Aguera-Morales, Orla Gray, Koen de Gans, Anneke van der Walt, Pamela A McCombe, Norma Deri, Justin Garber, Abdullah Al-Asmi, Olga Skibina, Pierre Duquette, Elisabetta Cartechini, Daniele Spitaleri, Riadh Gouider, Aysun Soysal, Liesbeth Van Hijfte, Mark Slee, Maria Pia Amato, Katherine Buzzard, and Guy Laureys.
• Neurology, University Hospital Ghent, Gent, Belgium catherine.dekeyser@uzgent.be.
• J. Neurol. Neurosurg. Psychiatr. 2024 Oct 16; 95 (11): 102110311021-1031.

BackgroundIt remains unclear whether routine cerebrospinal fluid (CSF) parameters can serve as predictors of multiple sclerosis (MS) disease course.MethodsThis large-scale cohort study included persons with MS with CSF data documented in the MSBase registry. CSF parameters to predict time to reach confirmed Expanded Disability Status Scale (EDSS) scores 4, 6 and 7 and annualised relapse rate in the first 2 years after diagnosis (ARR2) were assessed using (cox) regression analysis.ResultsIn total, 11 245 participants were included of which 93.7% (n=10 533) were persons with relapsing-remitting MS (RRMS). In RRMS, the presence of CSF oligoclonal bands (OCBs) was associated with shorter time to disability milestones EDSS 4 (adjusted HR=1.272 (95% CI, 1.089 to 1.485), p=0.002), EDSS 6 (HR=1.314 (95% CI, 1.062 to 1.626), p=0.012) and EDSS 7 (HR=1.686 (95% CI, 1.111 to 2.558), p=0.014). On the other hand, the presence of CSF pleocytosis (≥5 cells/µL) increased time to moderate disability (EDSS 4) in RRMS (HR=0.774 (95% CI, 0.632 to 0.948), p=0.013). None of the CSF variables were associated with time to disability milestones in persons with primary progressive MS (PPMS). The presence of CSF pleocytosis increased ARR2 in RRMS (adjusted R2=0.036, p=0.015).ConclusionsIn RRMS, the presence of CSF OCBs predicts shorter time to disability milestones, whereas CSF pleocytosis could be protective. This could however not be found in PPMS. CSF pleocytosis is associated with short-term inflammatory disease activity in RRMS. CSF analysis provides prognostic information which could aid in clinical and therapeutic decision-making.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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