The Protein Fractions in Cerebrospinal Fluid in the Various States of Multiple Sclerosis

摘要

(1) Agar gel electrophoresis was performed on the CSF of 139 patients with multiple sclerosis of both the intermittent and chronic type, and in the early and late stages of the disease. In most cases a serum electrophoresis was performed with the purpose of determining γ-quotient. (2) The following criteria were determined: The relation of the γ-globulins (GG), the quotients γ CSF/S and CSF γ/β, the discontinuity of the γ-region, the total protein content (TP), the mastic reaction, the cell-count, and the GG sub-fractions with their mutual relationship. The effects of age, sex, location of the lesion and the duration of an attack were given particular attention. (3) Pathological results were found most frequently in the exacerbations of advanced cases of the intermittent form. The average number of pathological values in chronic cases is not significantly less than in the intermittent form. The frequency of pathological values generally decreases with time. A pleocytosis is rarely found in the chronic form. The smallest number of pathological results was found in the so-called ''burnt out'' cases. (4) The TP is frequently high at the beginning of an attack, but the GG and the cell-count increase later. (5) The increase in GG is more frequent in cerebral than spinal attacks, and in older patients suffering their first attack than in the younger ones. (6) In contrast to the TP, the GG of the CSF is significantly higher in women than in men. In the serum a similar but less marked difference is found. (7) Patients with multiple sclerosis have approximately double the normal values for GG. (8) The γ-sub-fractions varied only slightly in the various diagnostic categories. In the earlier stages of the disease γsis the highest, later γf. Basic proteins appear only in insignificant amounts. (9) The GG content is dependent upon the stage of the attack at which the determination is made. The values are more frequently normal at the beginning of an attack than later in the active phase of the disease. (10) The determination of the GG content is less useful for early diagnosis of multiple sclerosis than for differential diagnosis of the advanced disease. The earlier in the course of the disease or an attack that the tests are made and the fewer the symptoms, the more frequent are findings normal. (11) The determination of the γ-quotients (CSF/SER or γ/β) is of little additional value. By means of electrophoretic criteria 60 to 70 of the patients can be satisfactorily diagnosed as pathological. By means of the cell-count, the mastic reaction and the TP one can diagnose a further 10 to 20 , but 10 to 30 are left with no