The conditions of 5 patients with untreated lymphocytic meningoradiculitis (Bannwarth's syndrome, probably equivalent to Lyme disease) with serologically confirmed infection resulting from Borrelia spirochetes were followed with repetitive lumbar punctures up to 221 days after the onset of symptoms. Using a protein A plaque assay, high numbers of IgG-, IgM-, and IgA-producing cells were found in the cerebrospinal fluid (CSF), whereas there were mostly normal numbers of immunoglobulin-producing cells in peripheral blood. A markedly increased CSF IgM index and an elevated IgG index were observed in all patients during the early phase, reflecting production of these immunoglobulins within the central nervous system. All patients had oligoclonal IgG bands in the CSF that persisted during follow-up; in the 2 patients tested, the bands contained Borrelia antibodies. Most serum immunoglobulin concentrations were normal and in only 1 patient was it possible to detect in serum some of the oligoclonal IgG bands present in CSF. Declining numbers of CSF cells producing immunoglobulin and decreasing immunoglobulin index values were observed during follow-up, but 3 patients had an elevated CSF IgM index in the presence of normal IgG and IgA indices when examined during the later phases of disease. An intense and prolonged IgM response within the central nervous system seems to be a characteristic of the disease.
SUMMARY. Seven different formulae and agarose isoelectrofocusing (AIF) using immunolabelIing for IgG were compared for their ability to discriminate between intrathecally produced IgG and transudated IgG in cerebrospinal fluid. All reference limits were set to a specificity of 97' 5070 (reference group, n = 211). The probability of a positive test (p+) was evaluated for 112 patients with multiple sclerosis (MS), 42 with meningitis, 114 with noninflammatory diseases affecting the central nervous system (CNS), 23 with Guillairi-Barre syndrome, and 56 with various diseases not affecting the CNS. Agarose isoelectrofocusing had the best diagnostic sensitivity (93%) for MS, combined with a low p+ (0-19070) for other diseases. Among the formulae, the IgG extended index and Reiber's hyperbolic formula were equivalent, giving high (75-79%) diagnostic sensitivity for MS combined with low p ; (4-22%) for other diseases. All other formulae, although sensitive for MS, had a higher rate of false positive results.
Immunoglobulin M (IgM) concentrations were determined in cerebrospinal fluid (CSF) and serum (S) by enzyme-linked immunosorbent assay (ELISA). In 52 reference subjects, the upper reference limit was 0.46 mg/l for CSF-IgM, 0.32 X 10(-3) for CSF-IgM/S-IgM ratio, and 0.061 for IgM index equal to CSF-IgM X S-albumin/S-IgM X CSF-albumin ratio. No correlation to age over 15-85 years was found for any of these variables. Among 22 patients with aseptic meningoencephalitis (AM) elevated values of CSF-IgM were found in 68%, CSF-IgM/S-IgM ratio in 73%, and IgM index in 73%. The corresponding values among 35 patients with multiple sclerosis (MS) were 66%, 60% and 63%. The differences in diagnostic sensitivities for the three IgM variables were not significant. Eleven of 16 AM patients and two of 22 with MS had elevated IgM index in the presence of normal IgG and IgA indices. Determination of IgM index should therefore be performed in suspected inflammatory nervous system disorders.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.