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Nervenheilkunde 2005; 24(04): 271-278
DOI: 10.1055/s-0038-1629962
Geist & Gehirn
Schattauer GmbH

Die Bedeutung des Liquorbefundes in der Diagnostik der Multiplen Sklerose

The relevance of cerebrospinal findings in diagnosis of MS
H. Tumani
1   Neurologische Klinik im RKU, Universität Ulm
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
31. Januar 2018 (online)

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Zusammenfassung

Die Liquordiagnostik ist ein wesentlicher Bestandteil der Diagnose „Multiple Sklerose“ (MS), insbesondere um differenzialdiagnostisch andere Erkrankungen des ZNS auszuschließen. Mit Ausnahme der Hirnbiopsie kann nur die Liquordiagnostik den entzündlichen Charakter der Erkrankung beweisen. Durch einen „positiven Liquorbefund“ kann die Diagnose MS nach den McDonald-Kriterien in vielen Fällen deutlich früher gestellt werden.

Das MS-typische Liquorprofil besteht aus 1. oligoklonalen IgG-Banden, 2. lymphomonozytärem Zellbild (normal bis leicht erhöhte Zellzahl), 3. intakter bis leicht gestörter Blut-Liquorschrankenfunktion und 4. dem Nachweis einer polyspezifischen Immunantwort („MRZ-Reaktion“). Ähnlich dem MRT hat der MS-typische Liquorbefund einen hohen prädiktiven Wert hinsichtlich der Entwicklung einer MS nach einem klinischen Erstereignis.

Keiner der genannten Liquorparameter ist jedoch pathognomonisch. Auch ist das Liquorprofil im Verlauf der MS nahezu konstant, es erlaubt keine Aussage über die Krankheitsaktivität beziehungsweise Schwere der Behinderung und differenziert nicht zwischen Verlaufstypen. Unter der Therapie mit Kortikosteroiden und immunmodulatorischen Substanzen ist keine Änderung dieses diagnostischen Liquorprofils zu beobachten.

Gegenstand der Forschung ist die Identifizierung Prozessspezifischer Surrogatmarker (Zytokine, Adhäsionsmoleküle, Myelinabbauprodukte, gliale und neuronale Proteine), die unterschiedliche Aspekte der MS-Pathologie reflektieren und zum Teil eine Erfassung von Krankheitsaktivität und Therapieerfolg ermöglichen.

Summary

Analysis of cerebrospinal fluid (CSF) is highly important to establish the diagnosis of MS, especially by recognizing or ruling out non-MS diseases. Except for brain biopsy, only CSF findings may confirm the inflammatory nature of MS. Moreover, a typical CSF pattern improves the probability of an early diagnosis of MS according to the McDonald criteria. The MS-typical CSF profile consists of 1. presence of oligoclonal IgG bands, 2. mononuclear cells (normal or mildly elevated leukocyte count), 3. normal or mildly disturbed blood-CSF barrier function and 4. presence of polyspecific humoral immune response („MRZ-reaction”). As for MRI, CSF findings show high predictivity with regard to conversion to definite MS following a first clinical event.

None of the single CSF parameters is pathognomonic for MS. Furthermore, the CSF profile remains constant over disease course without correlation to disease activity or severity, it does not allow differentiation of disease subtypes, and it is not influenced by treatment with corticosteroids or immunmodulatory drugs.

It is subject of ongoing research to identify process-specific surrogate markers (cytokines, adhesion molecules, myelin degradation products, glial and neuronal proteins) related to different aspects of MS pathology. Such markers correlate in part with disease activity and treatment response.

Schlüsselwörter

Liquor cerebrospinalis - Multiple Sklerose - Prozesspezifische Surrogatmarker

Keywords

Cerebrospinal fluid - multiple sclerosis - process-specific surrogates
 

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