Persistence of antibrain antibodies in cerebrospinal fluid during plasmapheresis for multiple sclerosis

A man with chronic progressive multiple sclerosis received a 10 day course of treatment with adrenocorticotrophic hormone without beneficial effect. He then received six sessions of plasmapheresis, again without improvement. Treatment with adrenocorticotrophic hormone had no effect on serum antibrain antibody titres, but plasmapheresis virtually eliminated the antibodies from serum and caused a fall in serum IgG concentrations; neither treatment had any effect on the IgG concentration and antibody titre in the cerebrospinal fluid. Treatment with plasmapheresis may fail in patients with multiple sclerosis because it does not remove antibrain antibodies from the intrathecal space.     

A longitudinal study of antibrain antibodies in multiple sclerosis

The presence of complement-fixing antibrain antibodies is a distinctive feature of multiple sclerosis (MS). In a longitudinal study of 35 MS patients antibrain antibody titres in serum were followed for up to 5 years; in 18 of them also CSF titres were determined. No consistent correlations between antibrain antibody titres and clinical events were found. Thus, MS relapses are not caused by a general increase in antibrain antibody titres, and conversely the relapses did not cause a boosting of antibrain antibodies. Significant variations in the local plaque environment are, however, not ruled out by the present results.     

Percutaneous extraction of urinary calculi: use of the intercostal approach

The authors achieved successful percutaneous extraction of urinary calculi via an intercostal approach in 24 patients. In one patient, a large hydrothorax developed and thoracentesis was required; 2 patients had moderate and 6 minimal pleural fluid collections which did not require treatment. No patient had pneumothorax. Intercostal puncture provides direct access to the upper and middle poles of the kidney when they lie above the twelfth rib and subcostal angulation is not feasible. Such an approach is advantageous for stones in the ureter, as well as renal stones which are inaccessible from the lower pole. Fluoroscopy should be performed when planning the puncture in order to avoid the lung, and a working sheath is recommended.     

Different types of antibrain antibodies in multiple sclerosis: Studies employing myelin-deficient mutants of mice

The presence of complement fixing IgG class antibrain antibodies is a distinctive feature of multiple sclerosis (MS). Only two of the several specificities of these antibodies are yet identified. Testing a number of MS sera and CSF samples against homogenates of brain from two myelin-deficient mouse mutants, Jimpy and Quaking, and their littermate controls confirmed the occurrence of antibrain antibodies directed against both myelin-associated and non-myelin antigens.     

Multiple specificities of antibrain antibodies in multiple sclerosis and chronic myelopathy

The presence of complement-fixing antibodies against brain antigens was tested in paired serum and cerebrospinal fluid (CSF) samples from 60 multiple sclerosis (MS) patients, 15 patients with chronic myelopathy of undetermined cause (CM) and 60 control patients. Six MS sera, 34 MS CSF, 4 CM sera, 3 CM CSF, 4 control sera and 1 control CSF gave positive reactions either with a lipid extract or a saline extract of normal human brain. The proportion of anticomplementary CSF was significantly higher in the MS group than in the control group (15% vs 0%, P < 0.01). The reactivity of a large number of individual positive samples was further investigated. Seven antibody specificities were discerned in the MS samples. Most samples reacted with nonlipid antigens, the dominating being a heat-labile, nonlipid component associated with CNS myelin. Antibodies to cerebroside and sulfatide were detected in a few patients. A number of samples reacted with cholesterol in combination with a variety of lipids. Positive samples from the CM patients exhibited a similar heterogeneity. In the control group positive reactions were seen in one patient with systemic lupus erythematosus (SLE), two patients with rheumatoid arthritis (RA), and one with a spinal meningioma. The reaction patterns of these patients were different from those commonly seen in MS patients. The complement-fixing antibrain antibodies in MS CSF are usually of IgG class (Ryberg 1976). This applies also to the positive MS sera in this study. The distribution of the antibodies between serum and CSF indicated, in several cases, an intrathecal synthesis. All of a number of human brains, including one MS brain, contained all 6 antigens (haptens) reactive in saline extracts. Antibodies to tissues outside the CNS were rarely detected in MS patients. The varied humoral autoimmune response in MS might reflect a heterogeneity in the MS patients, the disease itself or its causative agent.