Clinical Chemistry
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Clinical Chemistry 50: 1721-1722, 2004; 10.1373/clinchem.2004.038083
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(Clinical Chemistry. 2004;50:1721-1722.)
© 2004 American Association for Clinical Chemistry, Inc.

Editorials

Quality versus Quantity: Which Is Better for Cerebrospinal Fluid IgG?

Edward J. Thompson

1 Department of Neuroimmunology, National Hospital for Neurology & Neurosurgery, Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom, Fax 44-207-837-8553, E-mail e.thompson@ion.ucl.ac.uk

The first 20% of the full text of this article appears below.

An article in this issue (1) reopens an old question: Is qualitative or quantitative testing of immunoglobulins in cerebrospinal fluid (CSF) more diagnostically useful? The short answer is that each has pros and cons. In the diagnosis of multiple sclerosis, it can be misleading to perform only quantitative analysis, but it is much less problematic to perform only qualitative analysis (2). To detect IgG synthesis within the brain/CSF, a recent International Consensus has reaffirmed that qualitative is better than quantitative analysis and has gone further to state that there must be isoelectric focusing followed by immunofixation (Freedman et al., submitted for publication).

The study of "free" light chains (Bence Jones proteins) has been rekindled by the report by Fischer et al. (1) in this issue, in which the authors examine commercially available antibodies in the hope that they will provide a better test for intrathecal antibody synthesis. Several specific issues can be considered as individual questions, although some may be rhetorical. I will examine clinical aspects before chemical issues.

Is the assertion by Consensus neurologists, that isoelectric focusing is equivalent to the IgG index (3), correct? Yes and no. The latter (quantitative) test is not sufficient to make the diagnosis because it is only ~75% sensitive vs >95% for the focusing (qualitative) test (3).

How often should we repeat the lumbar puncture to get the correct diagnosis? It would be best to get the right answer on the first (and thus the only) occasion. However, there . . . [Full Text of this Article]


issues on separation


issues in qualitative/quantitative analysis


issues in sensitivity


issues in specificity






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