Prevalence and clinical features of multiple sclerosis in Latin America

Multiple sclerosis (MS) in Latin America (LA) is considered to have a low to medium prevalence. However, accurate information on MS in LA is scarce. The aim of this study was to compare clinical characteristics among LA patients through a systematic review of the literature. A systematic search (Spanish, Portuguese and English) was done for all clinical studies of MS in humans (MEDLINE, PubMed, Scielo, BIREME, EMBASE and LILACS) up to May 2011 being focused on a well-defined Latin American population (peer-reviewed journal) following the MOOSE guidelines. The search strategy included combinations of different Mesh terms (two independent researchers). Classification of each article by using the Oxford Centre for Evidence-based Medicine – Levels of Evidence was done. The total number of patients per country for each specific characteristic was compiled. Chi-square test was used to compare the characteristics in the studies retrieved per country. There were 38 articles fulfilling the inclusion criteria, accounting for 4524 patients. Relapsing-remitting form was the most frequent in LA patients and the main initial symptom was motor, followed by optic neuritis and sensorial. A mild expanded disability status scale was the most prevalent in all LA countries. Factors accounting for differences in distribution and clinical course across LA countries include genetics, environment, diagnostic techniques, socioeconomic structure and medical facilities.     

Prevalence and incidence of multiple sclerosis in the city of Monreale, Italy

The prevalence and incidence of multiple sclerosis (MS) in the city of Monreale, southern Italy were ascertained 10 years after a preliminary study in the same area. The study was undertaken in a population of 26,256 people. The patients were classified according to Poser’s criteria. The prevalence of MS on 31 December 1991 was 72.4 per 100,000 population. The incidence of MS for the period 1981–1991 was 3.3/100,000 per year. The mean period between onset and diagnosis of MS was 4.9 years for those patients found during this survey and 9.2 years for those in the first study. This study shows an increase of MS prevalence in Monreale city and a high incidence. The findings parallel the reduction of the lag time between onset and diagnosis. Received: 25 March 1997 Received in revised form: 30 June 1997 Accepted: 10 July 1997     

Prevalence of multiple sclerosis in Valladolid, northern Spain

The aim of this study was to ascertain the prevalence of multiple sclerosis (MS) in a northern Spanish region and to compare it with that from the most recent epidemiological studies in the country. MS prevalence was studied for a period of 2 years using multiple sources of information in the province of Valladolid, with a sample comprising a total population of 92,632. Patients were classified according to the Poser criteria. The crude prevalence of definite and probable MS was 58.3 per 100,000 (95% confidence interval: 43.7–75.7). The same methods have been used in ascertaining similar prevalence rates in Vélez-Málaga, Osona, and Gijón and a slightly lower rate in Teruel. Our survey confirms Spain as a high-risk area for MS, with prevalence rates over 50 per 100,000. Received: 4 March 1998 Received in revised form: 13 May 1998 Accepted: 10 June 1998     

Prevalence of multiple sclerosis in the province of Teruel, Spain

There have been few reports about the frequency of multiple sclerosis (MS) in Spain. We undertook a prevalence study in the province of Teruel, which is served by two hospitals as referral centres for a population of 143,680. We found a total of 46 patients who fulfilled Poser’s criteria for clinically definite or probable MS with a prevalence rate of 32/100,000 [95% confidence interval (CI): 22.8–41.3]. The prevalence rates for males and females were 23.5 (95% CI: 12.3– 34.7) and 40.6 (95% CI: 25.8–55.4) respectively. We found an incidence rate of 2.2/year per 100,000 in the last 5 years. The sex ratio (females/ males) was 1.7. The mean age on prevalence day was 40.6 years (range: 15–76). The clinical course was relapsing-remitting in 82% of patients, progressive in 9% and secondary progressive in the other 9%. The mean EDSS score was 3.73 (range: 1–8.5). Our results confirm the hypothesis that Spain is an area at high risk for MS. Received: 7 May 1996 Received in revised form: 17 September 1996 Accepted: 23 September 1996     

The prevalence of multiple sclerosis in the world: an update

The systematic study of multiple sclerosis (MS) in populations, started in 1929 by Sydney Allison, now consists of over 400 publications dealing with the prevalence of MS throughout the world. However, any attempt to redefine the pattern of geographical differences in MS frequency remains as difficult as ever. The comparison of prevalence studies carried out in different areas and times is made difficult by the variability in surveyed population sizes, age structures, ethnic origins and composition, and the difficult quantification of numerators, especially regarding the recognition of benign and very early cases. Additionally, complete case ascertainment depends on access to medical care, local medical expertise, number of neurologists, accessibility and availability of new diagnostic procedures, the degree of public awareness about MS, and the investigators' zeal and resources. Critical examination of the more recent data on MS prevalence leads to some revisions of previously held concepts, the most interesting of which is the appreciation of the greater influence of genetic factors on disease acquisition. The rarity of MS among Samis, Turkmen, Uzbeks, Kazakhs, Kyrgyzis, native Siberians, North and South Amerindians, Chinese, Japanese, African blacks and New Zealand Maoris, as well as the high risk among Sardinians, Parsis and Palestinians, clearly indicate that the different susceptibilities of distinct racial and ethnic groups are an important determinant of the uneven geographic distribution of the disease. The updated distribution of MS in Europe, showing many exceptions to the previously described north-south gradient, requires more explanation than simply a prevalence-latitude relationship. Prevalence data imply that racial and ethnic differences are important in influencing the worldwide distribution of MS and that its geography must be interpreted in terms of the probable discontinuous distribution of genetic susceptibility alleles, which can however be modified by environment. Because the environmental and genetic determinants of geographic gradients are by no means mutually exclusive, the race versus place controversy is, to some extent, a useless and sterile debate.     

Epidemiological and Clinical Study of Epilepsy in Benghazi, Libya

An epidemiologic study of adult patients (aged greater than 15 years) with epilepsy was made over a 2-year period, through the policlinics, EEG laboratory, and university hospitals in Benghazi, northeastern Libya. Based on a total of 568 patients (310 male and 258 female), the prevalence rate on 31 December 1984 was 2.3/1,000 in the population above the age of 15 years (1.9, if age standardized). The age-specific prevalence per 1,000 population decreased from 3.6 in the 15-24 year age group to 1 in the greater than 60-year age group. For 70.8% of the patients the onset of epilepsy occurred in the first 2 decades of life, and for 7.6% it commenced after the age of 40. The duration of epilepsy when first seen in the study period was less than 1 year in 14.6%, and greater than 10 years in 25.7%. The percentages of primary generalized, partial seizures secondarily generalized, simple partial, and partial complex seizures were 55.6, 18.8, 10.4, and 14.6%, respectively. Antecedents that could be considered potential causes of epilepsy were found in 17.5% of cases. Fifty-five patients had status epilepticus, 24 of whom had symptomatic epilepsy and eight recurrent status. EEG revealed generalized epileptic activity in 199 cases and focal seizure activity in 118. Computerized tomography (CT) scan, done in 219 patients, disclosed abnormal results in 50. Among those with abnormal CT scans, 84% had partial seizures. Monotherapy with carbamazepine or phenytoin was used in the majority of cases. The influence of social, cultural, and religious factors in the diagnosis and management of epilepsy as seen in Benghazi are discussed.     

Dysphagia in multiple sclerosis

Objectives: (1) To determine the prevalence of swallowing problems in MS patients and its relation to the overall disability. (2) To define the most frequent symptoms suggestive of dysphagia. (3) To describe the abnormalities on manofluoroscopy (MFS). Methods: Three hundred and eight consecutive MS patients were asked whether they ever had swallowing problems. If so the questionnaire of the Johns Hopkins Swallowing Centre was applied to qualify the dysphagia. A MFS was performed in 30 patients with dysphagia covering the entire spectrum of MS. Overall disability was assessed using the Expanded Disability Status Scale (EDSS). Results: Seventy-three of our 309 patients had permanent dysphagia (24%). Another 5% had a history of transitory swallowing problems only. Permanent dysphagia started to be a problem in mildly impaired patients (EDSS 2–3). Prevalence increased together with rising disability to reach 65% in the most severely disabled subjects (EDSS 8–9). Two alarming symptoms of patients with swallowing problems, coughing or choking during the meal and a history of pneumonia were present in 59%, respectively, 12% of these patients. MFS showed deficiency of the oral phase in all patients, while only the patients with an EDSS higher than 7.5 showed abnormalities of the pharyngeal phase. Conclusions: Permanent dysphagia may already develop in mildly impaired MS patients but becomes a rather frequent finding in MS patients with moderate or severe disability. MFS is a sensitive and useful ancillary examination. Important qualitative changes of the pharyngeal phase on MFS are seen in patients with an EDSS higher than 7.5.     

Epidemiology of multiple sclerosis in Sicily

From epidemiological data obtained over more than 20 years by surveys conducted in different parts of Sicily, it is evident that Sicily is a high-risk area for multiple sclerosis (MS). This is in sharp contrast with the gradient hypothesis. High frequencies have been found in different parts of the island having different geoclimatic features, but at least two cities (Monreale and Enna) had had a prolonged Norman domination. This is in agreement with the hypothesis that MS originated in Northern Europe and spread around the world throughout the raids of the northern peoples. The increase in frequency estimated by follow-up and incidence studies is well established and is only in part linked to the improvement in diagnostic techniques. Finally, it is noteworthy that in the islands of Malta, a few sea miles away from Sicily, the MS prevalence rates are in the range of 4–8 cases per 100 000 persons. This occurrence represents a natural model to investigate MS etiology through analytic studies and genetic analyses.     

Incidence of multiple sclerosis in Bagheria City, Sicily, Italy

We investigated the incidence of multiple sclerosis (MS) in a Sicilian community located a sea level. The study was a retrospective search for MS patients. Incidence was studied in the period from 1 January 1985 to 31 December 1994. We searched for definite MS patients, according to Poser's criteria, among the population resident in Bagheria (Palermo province). There were 25 subjects affected by MS, of which 20 were incident MS patients. The average annual incidence was 4.4 per 100 000 persons (n = 453 385 person-years). The incidence increased over time (1985–1989 = 3.5, 1990–1994 = 5.3). A parallel decrease of the interval between onset and diagnosis of MS was observed (1985–1989, 3.7 years, 95% CI = 1.6–7.3; 1990–1994, 1.9 years, 95% CI = 1.0–3.3). These results confirm that MS is frequent in Sicily. Received: 19 October 2000 / Accepted in revised form: 18 December 2000     

A prospective study of the incidence, prevalence and mortality of multiple sclerosis in Leeds

Objective: To establish the prospective incidence of multiple sclerosis and mortality rates of people with multiple sclerosis in Leeds Health Authority and an updated prevalence of multiple sclerosis on 31 October 1999. Methods A population based prevalence register established on 30 April 1996 was maintained by prospectively registering all new cases of multiple sclerosis, flagging all cases with the National Health Service Central Register for notification of deaths and by registering all new clinical events. General practitioners notified patients with multiple sclerosis moving into or out of the area. Results 136 incident cases were prospectively registered from 30 April 1996 living in Leeds Health Authority (with an estimated resident population of 728 840). 57 deaths were notified. 792 people with multiple sclerosis were identified living in Leeds on 31 October 1999. The mean annual incidence rate for the three-year period 1996–1998 was 6.1/10⁵ (95 % CI: 5.1–7.2). The sex ratio of incident cases was 2.3 to 1 women to men. On 31 October 1999 the prevalence of multiple sclerosis in the Leeds Health Authority was 108.7/10⁵ (95 % CI: 101.2–116.5). This compares with a prevalence of 97.3/10⁵ (95 % CI: 90.3 –104.7) on 30 April 1996. The prevalence of definite and probable multiple sclerosis was 93.3/10⁵ (95 % CI: 86.4–100.6) and of suspected multiple sclerosis was 15.4/10⁵ (95 % CI 12.7 –18.5). Crude annual mortality rates of people with multiple sclerosis for 1997 and 1998 were 1.9/10⁵ (95 % CI: 1.1 to 3.2) and 3.2/10⁵ (95 % CI: 2.0 to 4.7). Multiple sclerosis was noted as the underlying cause of death in 8 (14 %) cases. Conclusion The incidence of multiple sclerosis in the Leeds Health Authority is similar to that in the south of the United Kingdom. The difference in successive prevalence figures is less than that published in other serial studies. Multiple sclerosis was notified as the underlying cause of death in a minority of deaths in people with multiple sclerosis. Received: 5 December 2000, Received in revised form: 23 March 2001, Accepted: 10 July 2001     

Frequency of reported European ancestry among multiple sclerosis patients from four cities in the southern and southeastern regions of Brazil

Recent reports on the prevalence of multiple sclerosis (MS) have described discrepancies between the rates in cities in the northeastern and southeastern regions of Brazil, representing a north–south gradient. European immigrants settled in southeastern and southern Brazil at the beginning of the twentieth century. In this study, we report the frequency of European ancestors among Brazilian MS patients in four cities in the southern and southeastern regions of Brazil.     

Incidence and prevalence of multiple sclerosis in southeastern Iran

Background

Based on data available, Iran is located in a low risk area for multiple sclerosis (MS). The objective of the current study is to determine the age and sex adjusted prevalence and incidence of MS in southeastern Iran.

Methods

This cross-sectional case register study was conducted from January to August 2010. Considering that MS affects people aged between 16 and 50 years, we intended to find the incidence and prevalence of MS during this age range. Since all cases in this area are referred to our university hospital for confirmation of diagnosis, misdiagnosis is rare. Population data, based on the censuses carried out in 1996 and 2006, were obtained from the Iranian Bureau of Statistics to determine the number of people at risk.

Results

Totally 206 patients were identified according to the McDonald criteria. In 2009 the age-adjusted prevalence and incidence rates of MS for 16–50 year-old adults were 13.96 and 2.67 per 100,000 persons, respectively. Based on those values; the female to male ratio was 2.18. Between 2006 and 2009, the incidence rates increased 2.4 and 2.7 times in women and men, respectively. In 2009, the prevalence rates among the age ranges of <15, 16–35, 36–50 and ≥51 years were 1.44, 14.34, 12.24 and 1.45 per 100,000 persons, respectively, and the relapsing-remitting type of MS was the most prevalent form (65.8%).

Conclusion

According to the Kurtzke geographical distribution, the authors conclude that the prevalence of MS in southeastern Iran is in the intermediate range, and the incidence rate is showing a faster growth rate, compared to previous years.     

The epidemiology of multiple sclerosis in Queensland, Australia

An epidemiological survey of multiple sclerosis (MS) in the State of Queensland was undertaken with its prevalence day being the national census day on June 30th, 1981, 20 years after a regional survey within the State. The relationship between increasing prevalence of MS and increasing south latitude within the State of Queensland which was suggested by the 1961 study was confirmed in the present study. The prevalence rate had increased significantly over the 20-year period between the studies but the State remained a medium frequency zone for MS (prevalence rate between 5 and 29 per 100 000 of population). Although a real increase in disease frequency could not be excluded as a contributing factor to the rise in prevalence, it was most likely due predominantly to an increase in life expectancy amongst the MS population and also in differential migration of a population at a greater risk of developing MS than the indigenous population. The proportions of Australian-born patients who had migrated to Queensland from the higher risk southern regions of Australia or travelled overseas to countries known to be high-risk for MS prior to disease onset, had fallen between the two surveys thus exerting, if anything, a negative influence on the change in prevalence. Analysis of MS prevalence rates amongst migrant populations in Queensland as compared to the more southerly city of Perth in Western Australia, suggested that the risk of acquisition of MS may extend over a wider age range than is generally accepted. Finally, there was an absence of MS cases amongst the Aboriginal population in Queensland but it can only cautiously be concluded from this study that the disease is rare in these peoples.     

Genetics for understanding and predicting clinical progression in multiple sclerosis

Introduction

Multiple sclerosis (MS) is a dys-immune disease of the central nervous system with highly variable and unpredictable long-term outcome.

State of the art

In the early 1970s association between HLA alleles and MS was established. Very recently, the power of Genome Wide Association Studies (GWAS) enabled the identification of several loci involved in immune functions as genetic risk factors in MS. Recent data suggest that common genetic variations might modulate the clinical phenotype of MS through a regulation of key pathophysiological pathways.

Perspectives

Identification of modifier genes might offer an opportunity to explore new relevant therapeutic targets and early prognostic markers. To date, studies of modifier genes in MS are numerous but results are still unclear. This research field may now benefit from large cohorts of patients available for association studies.

Conclusion

In this context, we propose a review of epidemiological and association studies of genetic modifying effect in MS.     

Epilepsy and multiple sclerosis in Sicily: a population-based study

PURPOSE: To evaluate the association between epilepsy and multiple sclerosis (MS), we analyzed the incidence of epilepsy in a population-based incidence cohort of MS in Catania, Sicily. METHODS: According to Poser's diagnostic criteria, 170 incident cases of MS have been identified from 1975 to 1994 in the city of Catania. All these subjects underwent a complete neurological examination to confirm the diagnosis of MS and to identify those patients with a history of seizures. Diagnosis of epilepsy was based on the criteria proposed by the International League Against Epilepsy (ILAE) in 1993, and seizures were classified according to the classification of the ILAE, 1981. RESULTS: From 1975 to 1994, 170 subjects with MS had the clinical onset of the disease. The mean annual incidence of MS was 2.3/100,000 (95% CI, 2.0-2.6). Of the 170 defined MS patients, four developed epilepsy after the onset and also diagnosis of MS, giving an incidence rate of epilepsy of 285/100,000 person years at risk (95% CI, 119-684) and 147.8/100,000 when age adjusted to the world standard population. The cumulative risk of developing epilepsy after the onset of MS, evaluated by using the life-table methods, was zero at 1 year and 1.76% at 5 years. Of these four patients, three were classified as having partial seizures with secondary generalization and one with tonic-clonic seizures. CONCLUSIONS: Our data are consistent with those reported in literature suggesting that the risk of developing epilepsy is threefold higher among MS patients than in the general population.     

Immunogenetic heterogeneity of multiple sclerosis in Sardinia

Multiple sclerosis (MS) predisposition is thought to be influenced by a complex, yet unclear interaction of genetic and environmental factors. Studying ethnically selected populations may reduce genetic and environmental heterogeneities and help clarify the underlying mechanisms of MS susceptibility. Sardinians kept a homogeneous genetic structure and have among the highest MS frequency rates worldwide. Interestingly, MS in Sardinia is linked to otherwise rare HLA alleles. In this light, recent findings from epidemiological and immunogenetic studies of Sardinian MS are presented. Results confirm that, likely due to significant genetic differences at a microgeographic level, even in this homogeneous population MS is immunogenetically heterogeneous and tends to preferentially cluster in some more archaic areas of the island.     

Two populations with multiple sclerosis

Summary Cross-sectional data from 1,793 cases of definite or probable multiple sclerosis (MS) identified in an extensive population survey in King and Pierce (K-P) Counties, Washington and Los Angeles (LA) County, California, were analyzed. Compared to the U.S. population as a whole, patients were more likely to be divorced and to have more years of schooling. The prevalence of MS was higher for females, and for northern-born, regardless of sex. Reconstructed age-, sex-specific incidence rate estimates for natives of the two areas showed a much higher peak annual incidence occurring in an older age group in K-P than in LA. Earliest symptoms in both areas were numbness in the legs, double vision, and loss of vision in one or both eyes. Weakness in arms, speech difficulties, and urinary incontinence tended to be late symptoms. The overall assessment of disability levels showed more than half of the patients to be fully ambulatory at the time of the first interview, with a somewhat higher proportion of each sex severely disabled in California. The ages of onset tended to be younger in LA than in K-P. The earlier onset of disease and the higher proportion of patients with high disability in Los Angeles County suggest that the course of disease is more malignant in this low-prevalence area.Supported by Grant 2R01 NS 10186 from the National Institute of Neurologic and Communicative Disorders and Stroke, National Institutes of Health. Computing assistance was obtained from the Hospital Data Processing Facility, University of California, Los Angeles (UCLA)     

The prevalence of migraine in multiple sclerosis (MS): A systematic review and meta-analysis

ObjectivesWe designed this systematic review to estimate pooled prevalence of migraine in patients with multiple sclerosis (MS).MethodsWe searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, google scholar and gray literature including references from identified studies, conference abstracts which were published up to December 2019.The search strategy included the MeSH and text words as ((Disorder, Migraine OR Disorders, Migraine Disorder OR Migraine OR Migraines, OR Migraine Headache OR Migraine Headaches) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).ResultsThe literature search found 2100 articles. After eliminating duplicates, 1500 articles remained. Eleven articles and twelve abstract conference papers were included for final analysis.A total of 11,372 MS cases and 2627 MS patients with migraine included in the analysis. The prevalence of migraine ranged from 2% to 67%.The pooled prevalence of migraine in included studies was 31% (95%CI: 22%–40%) (I² = 99.3%, p < 0.001). The pooled prevalence of migraine in different continents were significantly different (p < 0.001).The pooled prevalence was 24% in Asian countries, 43% in American countries, 25% in European countries and 43% in African countries.ConclusionThe results of this systematic review shows that the prevalence of migraine in MS patients is 31% while the prevalence differs significantly among residents of different continents.     

Optic neuritis in relation to multiple sclerosis

Summary Available estimates of the frequency with which a patient with optic neuritis develops multiple sclerosis range from as low as 13 percent to as high as 87 percent. In an effort to obtain a better estimate, a nation-wide study of optic neuritis was carried out in Israel. Patients who fulfilled strict diagnostic criteria of optic neuritis were identified and examined periodically.Between 1955 and 1964, 105 patients were found and on the basis of these, the average annual age-adjusted incidence of optic neuritis in Israel was 0.56 per 10⁵ population compared to 1.2 per 10⁵ cases of multiple sclerosis per year, i.e. optic neuritis was about half as frequent as multiple sclerosis each year. As with multiple sclerosis, optic neuritis was more common in European immigrants to Israel than in Afro-Asian immigrants.During a follow-up interval which ranged from 3.3 to 15.6 years (mean 9.5 years), at least 27 of the 105 patients developed multiple sclerosis (28 percent). A life-table analysis showed that after 10 years 32.3 ± 5.6 percent of patients with optic neuritis would develop multiple sclerosis and, after 14 years, about half would develop multiple sclerosis.Risk of dissemination was highest in those who were youngest when optic neuritis developed. Neither sex nor ethnic background influenced risk significantly. Results of the present study support earlier work using life-table methods carried out in Hawaii which also showed that between 29 and 39 percent of patients with optic neuritis will develop multiple sclerosis within 10 years of onset. The life-table method is a better predictor of prognosis than newer laboratory techniques such as spinal fluid studies of IgG, kappa-lambda light chain ratios and serum/CSF IgG ratios.

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Zusammenfassung Schätzungen der Häufigkeit, mit der ein Patient mit Retrobulbärneuritis eine Multiple Sklerose bekommt, schwanken zwischen 13 und 87%. Um zu genaueren Werten zu kommen, wurde eine die ganze Bevölkerung umfassende Studie in Israel ausgeführt. Patienten mit den typischen Merkmalen einer Retrobulbärneuritis wurden erfaßt und periodisch untersucht.Zwischen 1955 und 1964 wurden 105 Patienten gefunden. Das ist eine durchschnittliche jährliche altersbereinigte Häufigkeit der Retrobulbärneuritis in Israel von 0,56 bei einer Bevölkerungszahl um 10⁵. Verglichen damit ist die jährliche Häufigkeit der Multiplen Sklerose 1,2 auf 10⁵, d. h. die Retrobulbärneuritis ist halb so häufig wie die MS. Wie die MS ist die Retrobulbärneuritis häufiger in Israel unter europäischen Einwanderern als bei Afro-Asiaten.Während der Kontrollperiode von 3,3 bis 15,6 Jahren (Durchschnitt 9,5 Jahre) zeigte sich bei 27 der 105 Patienten eine MS (28%). Die Sterbetafeln ergaben eine Häufigkeit von 32,3 ± 5,6% nach 10 Jahren, nach 14 Jahren zeigte sich etwa bei der Hälfte der Patienten eine MS. Das Risiko war am höchsten bei den jüngsten Patienten. Weder Geschlecht noch ethnische Abstammung beeinflußten dieses Risiko signifikant.Die Ergebnisse der Studie bestätigten frühere Untersuchungen in Hawaii, die nach den Sterbetafeln eine Häufigkeit von 29 bis 39% ergab, mit welcher innerhalb von 10 Jahren nach Ausbruch der Retrobulbärneuritis eine MS auftrat. Die Sterbetafeln gestatten eine bessere Voraussage der Prognose als neuere Labortechniken wie die Untersuchung der IgG im Liquor, der Kappa-Lambda leichte Kettenrationen und IgG in Serum und Liquor.