Multiple Sclerosis Journal - October 2017 - 1499

MM Voortman, T Stojakovic et al.
Table 1. Demographic, clinical and MRI data of study subjects.

n female
Age at LP (years)
Age at disease onset (years)
Duration of disease at LP (years)
EDSS at LP
n with corticosteroids at LPa
n with DMT at LP
n with DMT at FU
T2LL (cm3) at LP
T2LL (cm3) at FU
T2LL change LP-FU (cm3)
T2LL change rate LP-FU (cm3/year)
PBVC LP-FU (%)
PBVC rate LP-FU (%/year)

CIS/MS (n = 48/n = 13)

Controls (n = 60)

46 (75.4)
28.8 (23.2-36.9)
27.1 (21.8-36.9)
0.1 (0.0-0.3)
2.0 (1.0-3.0)
14 (23.0)
0 (0)
37 (60.7)
1.2 (0.4-3.3)
1.0 (0.5-3.4)
−0.09 (−0.58 to 0.34)
−0.03 (−0.29 to 0.09)
−0.96 (−2.32 to −0.40
−0.56 (−0.80 to −0.21)

40 (66.7)
30.5 (25.4-44.9)
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA

MRI: magnetic resonance imaging; CIS: clinically isolated syndrome; DMT: disease-modifying treatment; EDSS: Expanded Disability Status Scale; FU: follow-up; LL: lesion load; LP: lumbar puncture; MS: multiple sclerosis; n: number of subjects; NA: not
applicable; PBVC: percentage brain volume change.
Values are given as number (%) or as median (interquartile range).
aNumber of patients who received intravenous corticosteroids within 30 days prior to LP. Differences between CIS/MS and controls
regarding gender and age were not significant.

Table 2. CSF routine diagnostic parameters in CIS/MS patients and controls.

CSF white cell count (nr/µL, ref. ⩽4)
Quotient albumin (×103)
Index IgG
Index IgA
Index IgM
n OCB positive

CIS/MS (n = 48/n = 13)

Controls (n = 60)

p-value

10 (5-19)
4.67 (4.02-6.73)
0.89 (0.66-1.39)
0.35 (0.29-0.42)
0.18 (0.10-0.36)
61 (100)

2 (1-3)
5.10 (4.19-5.84)
0.49 (0.45-0.54)
0.28 (0.23-0.32)
0.09 (0.06-0.13)
NA

<0.001
NS
<0.001
<0.001
<0.001
NA

CIS: clinically isolated syndrome; CSF: cerebrospinal fluid; Ig: immunoglobulin; MS: multiple sclerosis; n: number of subjects; NA:
not applicable; nr: number of cells; NS: not significant; OCB: oligoclonal bands; ref.: reference value.
Values are given as number (%) or as median (interquartile range).

samples of both patients and controls are given in
Table 2. All diagnostic variables of the controls were
within the normal range.

FLC in CSF and serum - group differences
Levels, quotients and indices of KFLC and LFLC, and
the KFLC/LFLC ratio in serum and CSF of patients
and controls are given in Table 3. KFLC and LFLC
levels and KFLC/LFLC ratio were significantly
increased in CSF of CIS/MS patients compared to
controls (all p < 0.001, see Figure 1), but no differences
were seen in serum. Quotients and indices of KFLC
and LFLC were significantly increased in patients
compared to controls. In addition, FLC concentrations
did not differ significantly between men and women.
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Serum and CSF levels of KFLC and LFLC did not
differ between CIS and MS subgroups (Figure 1). The
index KFLC was significantly lower (p < 0.05) in
patients with active disease (median, 50.8; IQR, 23.5-
100.4) compared to those with non-active disease
(median, 106.4; IQR, 28.4-232.3), but the actual levels of KFLC or LFLC were not different in regard to
disease activity. There were no significant differences
in KFLC and LFLC levels between active and nonactive patients, neither within CIS-CDMS converters
nor non-converters.

FLC and diagnostic value in MS
Applying the previously published threshold for index
KFLC on our data of CIS/MS compared to controls
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