V Kahlmann1, J Roodbol2, N van Leeuwen3, C R B Ramakers4, D van Pelt5, R F Neuteboom6, C E Catsman-Berrevoets7, M C Y de Wit8, B C Jacobs9. 1. Department of Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands; Department of Paediatric Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands. Electronic address: vivienne.kahlmann@gmail.com. 2. Department of Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands; Department of Paediatric Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands. Electronic address: j.roodbol@erasmusmc.nl. 3. Department of Public Health, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands. Electronic address: n.vanleeuwen.1@erasmusmc.nl. 4. Department of Clinical Chemistry, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands. Electronic address: c.ramakers@erasmusmc.nl. 5. Department of Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands; Department of Paediatric Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands. Electronic address: e.vanpelt@erasmusmc.nl. 6. Department of Paediatric Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands. Electronic address: r.neuteboom@erasmusmc.nl. 7. Department of Paediatric Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands. Electronic address: c.catsman@erasmusmc.nl. 8. Department of Paediatric Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands. Electronic address: m.c.y.dewit@erasmusmc.nl. 9. Department of Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands; Department of Immunology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands. Electronic address: b.jacobs@erasmusmc.nl.
Abstract
OBJECTIVE: To define age-specific reference values for cerebrospinal fluid (CSF) total protein levels for children and validate these values in children with Guillain-Barré syndrome (GBS), acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS). METHODS: Reference values for CSF total protein levels were determined in an extensive cohort of diagnostic samples from children (<18 year) evaluated at Erasmus Medical Center/Sophia Children's Hospital. These reference values were confirmed in children diagnosed with disorders unrelated to raised CSF total protein level and validated in children with GBS, ADEM and MS. RESULTS: The test results of 6145 diagnostic CSF samples from 3623 children were used to define reference values. The reference values based on the upper limit of the 95% CI (i.e. upper limit of normal) were for 6 months-2 years 0.25 g/L, 2-6 years 0.25 g/L, 6-12 years 0.28 g/L, 12-18 years 0.34 g/L. These reference values were confirmed in a subgroup of 378 children diagnosed with disorders that are not typically associated with increased CSF total protein. In addition, the CSF total protein levels in these children in the first 6 months after birth were highly variable (median 0.47 g/L, IQR 0.26-0.65). According to these new reference values, CSF total protein level was elevated in 85% of children with GBS, 66% with ADEM and 23% with MS. CONCLUSION: More accurate age-specific reference values for CSF total protein levels in children were determined. These new reference values are more sensitive than currently used values for diagnosing GBS and ADEM in children.
OBJECTIVE: To define age-specific reference values for cerebrospinal fluid (CSF) total protein levels for children and validate these values in children with Guillain-Barré syndrome (GBS), acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS). METHODS: Reference values for CSF total protein levels were determined in an extensive cohort of diagnostic samples from children (<18 year) evaluated at Erasmus Medical Center/Sophia Children's Hospital. These reference values were confirmed in children diagnosed with disorders unrelated to raised CSF total protein level and validated in children with GBS, ADEM and MS. RESULTS: The test results of 6145 diagnostic CSF samples from 3623 children were used to define reference values. The reference values based on the upper limit of the 95% CI (i.e. upper limit of normal) were for 6 months-2 years 0.25 g/L, 2-6 years 0.25 g/L, 6-12 years 0.28 g/L, 12-18 years 0.34 g/L. These reference values were confirmed in a subgroup of 378 children diagnosed with disorders that are not typically associated with increased CSF total protein. In addition, the CSF total protein levels in these children in the first 6 months after birth were highly variable (median 0.47 g/L, IQR 0.26-0.65). According to these new reference values, CSF total protein level was elevated in 85% of children with GBS, 66% with ADEM and 23% with MS. CONCLUSION: More accurate age-specific reference values for CSF total protein levels in children were determined. These new reference values are more sensitive than currently used values for diagnosing GBS and ADEM in children.
Authors: Sven Jarius; Christian Lechner; Eva M Wendel; Matthias Baumann; Markus Breu; Mareike Schimmel; Michael Karenfort; Adela Della Marina; Andreas Merkenschlager; Charlotte Thiels; Astrid Blaschek; Michela Salandin; Steffen Leiz; Frank Leypoldt; Alexander Pschibul; Annette Hackenberg; Andreas Hahn; Steffen Syrbe; Jurgis Strautmanis; Martin Häusler; Peter Krieg; Astrid Eisenkölbl; Johannes Stoffels; Matthias Eckenweiler; Ilya Ayzenberg; Jürgen Haas; Romana Höftberger; Ingo Kleiter; Mirjam Korporal-Kuhnke; Marius Ringelstein; Klemens Ruprecht; Nadja Siebert; Kathrin Schanda; Orhan Aktas; Friedemann Paul; Markus Reindl; Brigitte Wildemann; Kevin Rostásy Journal: J Neuroinflammation Date: 2020-09-03 Impact factor: 8.322
Authors: Maurizio Bruschi; Andrea Petretto; Armando Cama; Marco Pavanello; Martina Bartolucci; Giovanni Morana; Luca Antonio Ramenghi; Maria Luisa Garré; Gian Marco Ghiggeri; Isabella Panfoli; Giovanni Candiano Journal: Sci Rep Date: 2021-01-19 Impact factor: 4.379