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The reason you should get a spinal tap at diagnosis

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  • The reason you should get a spinal tap at diagnosis

    Sure, lumbar punctures generally suck. But they can give critical information, especially around diagnosis. I had so much oligoclonal banding that I joke there was a Lollapalooza in my spine. That was in 2006 when there were few DMT options, and the full impact of OCBs were unclear. If I were diagnosed today, you bet I would get on a high-efficacy DMT stat. -D

    Oligoclonal IgM bands in the cerebrospinal fluid of patients with relapsing MS to inform long-term MS disability

    Rocco Capuano*, Irati Zubizarreta*, Salut Alba-Arbalat, ...
    First Published January 12, 2021


    Prognostic markers are needed to guide multiple sclerosis (MS) management in the context of large availability of disease-modifying drugs (DMDs).

    To investigate the role of cerebrospinal fluid (CSF) markers to inform long-term MS outcomes.

    Demographic features, IgM index, oligoclonal IgM bands (OCMB), lipid-specific OCMB, CSF neurofilament light chain protein levels, expanded disability status scale (EDSS), relapses and DMD use over the study period and peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell plus inner plexiform layer (GCIPL) thicknesses in non-optic neuritis eyes (end of follow-up) were collected from relapsing MS (RMS) patients with CSF obtained ⩽2 years after MS onset prospectively followed at the Hospital Clinic of Barcelona. We assessed associations between CSF markers and MS outcomes using multivariable models.

    A total of 89 patients (71 females; median 32.9 years of age) followed over a median of 9.6 years were included. OCMB were associated with a 33% increase in the annualized relapse rate (ARR; p = 0.06), higher odds for high-efficacy DMDs use (OR = 4.8; 95% CI = (1.5, 16.1)), thinner pRNFL (β = −4.4; 95% CI = (−8.6, −0.2)) and GCIPL (β = −2.9; 95% CI = (−5.9, +0.05)), and higher rates to EDSS ⩾ 3.0 (HR = 4.4; 95% CI = (1.6, 11.8)) and EDSS ⩾ 4.0 (HR = 5.4; 95% CI = (1.1, 27.1)). No overall associations were found for other CSF markers.

    The presence of OCMB was associated with unfavorable long-term outcomes. OCMB should be determined in RMS to inform long-term prognosis.
    Dave Bexfield