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10 Intrathecal IgM synthesis in children with multiple sclerosis is associated with a slower progression

Published online by Cambridge University Press:  24 June 2014

C. Stauch ,
M. Rauchenzauner ,
D. Pohl ,
F. Hanefeld ,
H. Reiber  and
K.M. Rostásy
C. Stauch
Affiliation:
Department of Pediatrics and Pediatric Neurology, Georg-August University Göttingen, Germany
M. Rauchenzauner
Affiliation:
Department of Pediatrics IV, Division of Pediatric Neurology and Inborn Errors of Metabolism, Medical University of Innsbruck, Austria
D. Pohl
Affiliation:
Department of Neurology, Childrens Hospital of Eastern Ontario, Ottawa, Ontario, Canada, E-mail: Kevin.Rostasy@uki.at
F. Hanefeld
Affiliation:
Department of Pediatrics and Pediatric Neurology, Georg-August University Göttingen, Germany
H. Reiber
Affiliation:
Neurochemistry Laboratory, Department of Neurology, Georg-August University Göttingen, Germany
K.M. Rostásy
Affiliation:
Department of Pediatrics IV, Division of Pediatric Neurology and Inborn Errors of Metabolism, Medical University of Innsbruck, Austria
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Abstract

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Background:

Intrathecal IgM synthesis has been associated with the onset of new relapses and an earlier onset of secondary progressive disease in adult multiple sclerosis patients. Objective: Investigation of the predictive value of intrathecal IgM by correlation of recent interpretations of CSF data with clinical information from pediatric MS patients.

Methods:

Seventy-two children with onset of MS before age of 16y were followed for a mean period of 10.3 years (range: 0.4–22.8 years) evaluated as two groups with (n=44) or without intrathecal IgM synthesis (n=28). Clinical course and EDSS scores at five and 10 years were compared with CSF data interpreted with a non-linear program for statistics of groups in CSF/serum quotient diagrams.

Results:

In general, female gender, total number ofattacks, number of attacks in the first 2 years and the time interval between first and second attack were associated with a worse prognosis. The cohort of children without intrathecal IgM had a significant higher number of relapses in the first 2 years (P = 0.033) with a trend to shorter time intervals between first and second attack and a higher EDSS score after 10 years of MS, though not statistically significant. In the subgroup ofgirls without intrathecal IgM EDSS score after 10 years was significantly higher compared to the group with IgM synthesis (P = 0.023). The contradiction to earlier reports is explained as a bias in the qualitative method or interpretation with a linear IgM Index.

Conclusion:

Intrathecal IgM synthesis at time of first clinical manifestation was associated with a slower progression of disability in pediatric MS.