BACKGROUND: Isoelectrofocusing (IEF) to detect oligoclonal bands (OBCs) in cerebrospinal fluid (CSF) is the gold standard approach for evaluating intrathecal immunoglobulin synthesis in multiple sclerosis (MS) but the kappa free light chain index (KFLCi) is emerging as an alternative marker, and the combined/sequential uses of IEF and KFLCi have never been challenged. METHODS: CSF and serum albumin, IgG, kFLC and lFLC were measured by nephelometry; albumin, IgG and kFLC quotients as well as Link and kFLC indexes were calculated; OCBs were evaluated by immunofixation. A total of 150 consecutive patients: 48 with MS, 32 with other neurological inflammatory diseases (NID), 62 with neurological non-inflammatory diseases (NNID), and 8 without any detectable neurological disease (NND) were investigated. RESULTS: Both IEF and KFLCi showed a similar accuracy as diagnostic tests for multiple sclerosis. The high sensitivity and specificity associated with the lower cost of KFLCi suggested to use this test first, followed by IEF as a confirmative procedure. The sequential use of IEF and KFLCi showed high diagnostic efficiency with cost reduction of 43 and 21%, if compared to the contemporary use of both tests, or the unique use of IEF in all patients. CONCLUSIONS: The "sequential testing" using KFLCi followed by IEF in MS represents an optimal procedure with accurate performance and lower costs.
BACKGROUND: Isoelectrofocusing (IEF) to detect oligoclonal bands (OBCs) in cerebrospinal fluid (CSF) is the gold standard approach for evaluating intrathecal immunoglobulin synthesis in multiple sclerosis (MS) but the kappa free light chain index (KFLCi) is emerging as an alternative marker, and the combined/sequential uses of IEF and KFLCi have never been challenged. METHODS: CSF and serum albumin, IgG, kFLC and lFLC were measured by nephelometry; albumin, IgG and kFLC quotients as well as Link and kFLC indexes were calculated; OCBs were evaluated by immunofixation. A total of 150 consecutive patients: 48 with MS, 32 with other neurological inflammatory diseases (NID), 62 with neurological non-inflammatory diseases (NNID), and 8 without any detectable neurological disease (NND) were investigated. RESULTS: Both IEF and KFLCi showed a similar accuracy as diagnostic tests for multiple sclerosis. The high sensitivity and specificity associated with the lower cost of KFLCi suggested to use this test first, followed by IEF as a confirmative procedure. The sequential use of IEF and KFLCi showed high diagnostic efficiency with cost reduction of 43 and 21%, if compared to the contemporary use of both tests, or the unique use of IEF in all patients. CONCLUSIONS: The "sequential testing" using KFLCi followed by IEF in MS represents an optimal procedure with accurate performance and lower costs.
Authors: Philipp Schwenkenbecher; Franz Felix Konen; Ulrich Wurster; Konstantin Fritz Jendretzky; Stefan Gingele; Kurt-Wolfram Sühs; Refik Pul; Torsten Witte; Martin Stangel; Thomas Skripuletz Journal: Int J Mol Sci Date: 2018-11-29 Impact factor: 5.923
Authors: Frida Duell; Björn Evertsson; Faiez Al Nimer; Åsa Sandin; Daniel Olsson; Tomas Olsson; Mohsen Khademi; Max Albert Hietala; Fredrik Piehl; Magnus Hansson Journal: Neurol Neuroimmunol Neuroinflamm Date: 2020-06-11
Authors: Franz Felix Konen; Philipp Schwenkenbecher; Konstantin Fritz Jendretzky; Stefan Gingele; Kurt-Wolfram Sühs; Hayrettin Tumani; Marie Süße; Thomas Skripuletz Journal: Cells Date: 2021-11-06 Impact factor: 6.600
Authors: Franz Felix Konen; Philipp Schwenkenbecher; Konstantin Fritz Jendretzky; Stefan Gingele; Torsten Witte; Kurt-Wolfram Sühs; Matthias Grothe; Malte Johannes Hannich; Marie Süße; Thomas Skripuletz Journal: Brain Sci Date: 2022-04-03