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High performance of cerebrospinal fluid immunoglobulin G analysis for diagnosis of multiple sclerosis

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Abstract

Background

The 2017 revision of the McDonald criteria highlights the usefulness of cerebrospinal fluid (CSF) immunoglobulin G (IgG) analysis to diagnose multiple sclerosis (MS). The objective of this study was to assess the diagnostic performances of CSF IgG analysis in the absence of a gold standard.

Methods

All patients who underwent CSF IgG analysis for events suggestive of MS in Nancy University Hospital (France) from 2008 to 2011 were retrospectively included. A latent class analysis with Bayesian approach was used to infer MS prevalence (latent variable) as well as the diagnostic properties of the 2005 and 2010 McDonald criteria and CSF IgG analysis (observed variables).

Results

Data from 673 patients were analysed. For CSF IgG analysis, the Bayesian latent class analysis estimated sensitivity of 0.93 (95% CrI 0.89–0.96) and specificity of 0.81 (95% CrI 0.77–0.85). The true prevalence estimate was 36% (95% CrI 0.33–0.40). Sensitivity and specificity estimates for patients with events suggestive of remitting-onset MS were similar to those for the whole sample—0.92 (95% CrI 0.85–0.96) and 0.80 (95% CrI 0.76–0.84), respectively—but higher for patients with signs of progressive-onset MS—0.95 (95% CrI 0.84–0.99) and 0.88 (95% CrI 0.78–0.94), respectively.

Conclusions

In the absence of a gold standard, latent class analysis indicates good diagnostic properties of CSF IgG analysis for MS. This test could thus be useful, especially for patients who tested negative for the 2005 and 2010 McDonald criteria. These findings deserve to be confirmed prospectively.

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Funding

Study Funded by the National Institutes for Health and Medical Research (INSERM) and the Nancy university hospital (CHRU). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Inserm CIC-EC 1433, Nancy University Hospital, Université de Lorraine, 54 000, Nancy, France

    Simon Gamraoui, Marc Debouverie, Francis Guillemin & Jonathan Epstein

  2. Department of Neurology, Nancy University Hospital, 54 000, Nancy, France

    Guillaume Mathey & Marc Debouverie

  3. Université de Lorraine, EA 4360 Apemac, 54 000, Nancy, France

    Guillaume Mathey, Marc Debouverie, Francis Guillemin & Jonathan Epstein

  4. Department of Biochemistry, Molecular Biology and Nutrition, Nancy University Hospital, 54 000, Nancy, France

    Catherine Malaplate

  5. Department of Neuroradiology, Nancy University Hospital, 54 000, Nancy, France

    René Anxionnat

  6. CHRU de Nancy-Hôpitaux de Brabois, Allée du Morvan 54511, Vandœuvre-les-Nancy Cedex, 54511, Nancy, France

    Simon Gamraoui

Authors
  1. Simon Gamraoui
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  2. Guillaume Mathey
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Corresponding author

Correspondence to Simon Gamraoui.

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Conflicts of interest

All authors declare that they have no conflict of interest.

Ethical standards

The study was approved by the institutional review board and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Gamraoui, S., Mathey, G., Debouverie, M. et al. High performance of cerebrospinal fluid immunoglobulin G analysis for diagnosis of multiple sclerosis. J Neurol 266, 902–909 (2019). https://doi.org/10.1007/s00415-019-09212-4

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  • DOI: https://doi.org/10.1007/s00415-019-09212-4

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