Neurológia pre prax 5/2009

Intrathecal synthesis of specific antiviral antibodies in relapsing-remitting and primary chronic progressive courses of multiple sclerosis

The relapsing-remitting and primary chronic progressive courses are distinguished in cerebrospinal multiple sclerosis. Both these types differ in the pathogenesis, immunology, therapeutic response, and prognosis. No laboratory diagnostic marker to distinguish these two disease subentities has been available to date. Our aim was to assess the intrathecal synthesis of specific IgG antibodies against the neurotropic measles, rubella, and herpes zoster viruses (the MRZ reaction) in the relapsing-remitting course and primary chronic progressive course and to establish its differential diagnostic significance. A cohort of 35 patients (n = 35) was investigated. The intrathecal synthesis of specific antibodies was expressed by the antibody index using Reiber‘s formula. The MRZ reaction was positive in 14 out of 25 patients with the relapsing-remitting course and in 2 out of 10 patients with the primary chronic progressive course of multiple sclerosis with sensitivities of 56 % and 20 %, respectively. The difference in the positivity of the MRZ reaction in both the courses supports the hypothesis of different pathogeneses, suggesting that the MRZ reaction may be used as a complementary marker in differential diagnosis.

Keywords: cerebrospinal multiple sclerosis, relapsing-remitting course, primary chronic progressive course, intrathecal synthesis, MRZ reaction.