BackgroundWe aimed to determine the association of clinical and routine cerebrospinal fluid biochemical markers (total protein, IgG index and oligoclonal bands) with disability in multiple sclerosis and whether these biomarkers assessed at diagnosis add prognostic value.MethodsWe followed a cohort of patients included in the Multiple Sclerosis Lorraine Register (eastern France) who had a diagnosis of multiple sclerosis for at least 5 years, as well as biological markers values and MRI findings (Barkhof’s criteria). In a Cox regression model, endpoint was time to score of 4 on the Expanded Disability Status Scale (EDSS) (i.e., limited time walking without aid or rest for more than 500 m).ResultsFor 407 patients included, the median time from multiple sclerosis onset to EDSS score 4 was 4.5 years [2.2–7.2]. Cerebrospinal fluid total protein factor < 500 mg/L was associated with EDSS score 4 on bivariate analysis (hazard ratio 0.66, 95% confidence interval 0.46–0.95, p = 0.02). On multivariate analysis, older age at disease onset (≥50 years) and initial primary progressive course of MS but not biological markers predicted worse prognosis.ConclusionRoutine cerebrospinal fluid biological markers at diagnosis were not prognostic factors of multiple sclerosis progression.

Used in the treatment of spasticity at low doses, baclofen is also prescribed off-label at high doses for the treatment of alcohol dependence. Several cases of baclofen intoxication have been reported, but only 1 case deals with the treatment of alcohol dependence. Thus, we report the first death in the context of baclofen off-label use of an alcohol-dependent patient with a high blood baclofen concentration after intentional drug intoxication. The safety profile of baclofen in the treatment of alcohol dependence is reviewed and discussed, underlining the obligatory caution that may support any prescription of high doses of baclofen in this off-label indication and especially in patients with concomitant psychiatric disorders.

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Le criblage toxicologique est une approche spécifique de la toxicologie analytique qui fait appel à des outils analytiques tels que la CG-SM, la CL-UV (barrette de diodes) ou la CL-SM. Le criblage toxicologique permet la détection et l'identification simultanées d'un grand nombre de composés. Les résultats peuvent être basés sur l'emploi d'une ou de plusieurs techniques. Dans le cadre du processus d'accréditation des examens de biologie médicale selon la norme NF EN ISO 15189, le groupe issu des sociétés savantes SFTA et SFBC recommande une démarche pour accréditer le criblage toxicologique. En effet, la complexité de l'accréditation de cette analyse provient en particulier du nombre élevé de composés susceptibles d'être détectés. Les paramètres de validation sont discutés dans le cadre spécifique du criblage toxicologique en considérant deux approches distinctes : l'identification des composés, ou l'identification et l'estimation d'une zone de concentration.

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