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Background: Elevated levels of the cerebrospinal fluid (CSF) neuronal injury markers (neurofilament light chain [NF-L] and total tau protein [t-tau]) and of the astroglial marker glial fibrillary acidic protein (GFAP) are found in etiologically different neurological disorders affecting the peripheral and the central nervous system., Aims: To explore the role of CSF biomarkers in the clinical management of patients admitted for alarming neurological symptoms, but in whom neurological disorders could be excluded., Methods: Study participants were patients seeking medical attention for neurological symptoms primarily considered to be caused by a neurological diagnosis and investigated according to clinical routine. Demographic, clinical, and CSF data were extracted retrospectively from medical records. Patients with a final neurological diagnosis were excluded., Results: Out of 990 patients, 900 with a neurological diagnosis were excluded leaving 90 patients without a final neurological diagnosis. Sixty-eight (75.6%) were females. Median (range) age at lumbar puncture was 34.7 (16.9-65.1) years. Age-adjusted CSF-NF-L, CSF-t-tau, and CSF-GFAP concentrations were normal in 89 (98.9%), 86 (95.6%), and 87 (96.7%) patients, respectively., Conclusion: In patients with significant neurological symptoms but in whom a neurological diagnosis could not be made, the CSF markers NF-L, t-tau, and GFAP did not indicate signs of neuronal or astroglial cell damage close to symptom onset. Consequently, increased levels of CSF markers are not expected in this patient group and, if present, should raise suspicion of underlying neurological disorders and motivate further investigations., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The detection of cerebrospinal fluid (CSF)-specific IgG oligoclonal bands (OCB) by isoelectric focusing (IEF) is widely used to help diagnose inflammatory neurological disorders (IND), including multiple sclerosis. However, the quantification of free light chains (FLC) is increasingly evaluated as a surrogate method to determine the presence of an intrathecal inflammatory process. The objective of this study was to evaluate the diagnostic performance of kappa (κ) FLC measurement in comparison with OCB detection by IEF., Material and Methods: We measured serum and CSF κFLCs by turbidimetry using the SPA plus automated analyser and calculated the κ index in 142 samples from OCB-positive and negative MS, as well as from patients with inflammatory and non-inflammatory neurological disorders (IND and NIND)., Results: The κFLC index was significantly increased in OCB-positive MS and IND patients versus OCB-negative patients. Its performance was relatively comparable to that of IEF for MS diagnosis. When using a κFLC index cutoff value of 6.29, sensitivity increased from 61.2% to 75.7% in comparison with IEF for diagnosing IND (P = .0051), with a slightly lower non-statistically significant specificity (82.1% vs 100%). When considering both OCB status positivity or a κFLC index superior to 6.29 to diagnose IND status, sensitivity raised to 80.6% (P < .05) with an equal specificity., Conclusion: Our results demonstrate that the κFLC index does not discriminate MS from other IND patients, but is a reliable technique to detect intrathecal inflammation. However, κFLC quantification should probably be considered as a complementary method, rather than a substitute, to OCB detection., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To investigate chitotriosidase (CTTS) activity in serum and cerebrospinal fluid (CSF) in multiple sclerosis (MS) patients in relation to disease course and CSF markers for immune activation or inflammation., Materials and Methods: We studied 80 patients with relapsing-remitting MS (RRMS), 24 with secondary progressive MS (SPMS), 20 with primary progressive MS (PPMS) and 29 patients with other neurological disorders (OND). We measured CTTS activity and studied the correlation with CSF mononuclear cell count (MNC) and intrathecal IgG production., Results: CTTS activity was significantly higher in CSF, but not in serum, from the total MS group compared with OND and controls. In RRMS and SPMS CTTS, index was increased compared with controls (RRMS, 0.10 +/- 0.21; SPMS, 0.10 +/- 0.15; controls, 0.021 +/- 0.020), but not in PPMS (0.061 +/- 0.052). CTTS index was higher in MS patients with elevated MNC or CSF-restricted oligoclonal IgG bands than in MS patients without these CSF findings., Conclusions: CTTS index is elevated in RRMS and SPMS. The CTTS index is related to CSF markers of inflammation or immune activation.

Background: So far, an inflammation of the central nervous system (CNS) is diagnosed by immunoglobulin measurement in cerebrospinal fluid (CSF) and serum as well as by determination of the oligoclonal bands. With the free kappa and lambda light chains, new markers to diagnose intrathecal synthesis are available., Methods: In addition to routine diagnostic tests and the assessment of standard parameters, free immunoglobulin light chains were measured in the CSF of patients with neurological disorders., Results: A significant agreement was found between an increase in free kappa light chain CSF serum quotients and results of the currently widely applied method of oligoclonal band measurement for the detection of intrathecal immunoglobulin synthesis. A sensitivity of 95% and 100% specificity for free kappa light chain concentrations at a cut-off of 0.41 mg/l was determined for free kappa light chains compared with oligoclonal bands. However, the free lambda light chains in 20 out of the 110 investigated samples were characterized by inconsistent behaviour. These otherwise unremarkable samples yielded increased CSF quotients, leading to the assumption that free lambda light chains represent a highly sensitive measure of intrathecal immunologlobulin synthesis. Thirteen of the 20 samples described above were obtained from patients with cerebral infarction, 4 samples derived from patients with cerebral paresis (primarily facial paresis), one sample was from a patient with multisystem atrophy and two were obtained from patients with migraine and neuralgia., Conclusion: These findings suggest that the high sensitivity of lambda light chains for the detection intrathecal immunoglobulin synthesis may be of benefit in establishing clinical diagnoses.

Objective: To compare the sensitivity and specificity of isoelectric focusing (IEF) with immunofixation, agarose gel electrophoresis (AGE) and the IgG index in detecting intrathecally synthesized IgG in multiple sclerosis (MS) and in other nervous system disorders., Materials and Methods: Cerebrospinal fluid (CSF) and serum from 147 patients with various nervous system diseases, 20 of whom had MS, were compared with IEF, AGE and the IgG index., Results: CSF-restricted oligoclonal bands (OCB) were found in 20 of 20 patients with MS using IEF and in 9 of 20 using AGE. OCB were found in 12 patients with other nervous system disorders (OND) using IEF and 4 using AGE. The mean IgG index was 0.50 in OND and 0.96 in MS (P< 0.0001). Of 20 MS patients, 9 had an IgG index above the defined cut-off value of 0.72., Conclusions: IEF is about twice as sensitive as AGE in detecting OCB in MS. IEF is also far superior to the IgG index in determining intrathecal IgG synthesis.

Objectives: To analyse biotin concentrations in human cerebrospinal fluid (CSF) and serum from controls without evidence of nutritional or neurological disorders and patients with common neurological disorders., Patients and Methods: Cerebrospinal fluid was obtained from patients by lumbar puncture, serum was prepared from freshly drawn whole blood and biotinidase in samples was inhibited before being analysed for biotin by radioligand assay., Results: Assay characteristics were within an acceptable range (intra-and interassay coefficient of variations were 8.8 and 12.0 respectively, recovery: 91-114% and sensitive, lowest standard concentration 15 ng/l). Significantly lower values for biotin were found in patients with multiple sclerosis (both CSF and serum) in comparison to the controls. Significantly reduced values for cerebrospinal fluid biotin were found in epileptics compared to controls, whereas, in serum the difference was approaching significance. No significant differences were observed in other groups of patients., Conclusion: There is a significant reduction in cerebrospinal fluid biotin in epileptics and patients with multiple sclerosis compared to controls. In epileptics this may be related to competition between biotin and anticonvulsants bearing carbamide ring for absorption. Reduction of biotin levels in patients with multiple sclerosis could be attributed to intestinal malabsorption caused by the underlying disease or a biotin-binding immunoglobulin which may be involved in multiple sclerosis pathogenesis.

Objective: We measured measles-specific IgA in matched pairs of cerebrospinal fluid (CSF) and sera of patients with subacute sclerosing panencephalitis (SSPE), multiple sclerosis (MS), other central nervous system (CNS) infectious diseases (INF) and other neurological diseases (OND) by using enzyme linked immunosorbent assay., Materials and Methods: CSF and sera from 23 patients with SSPE, 15 with MS, 14 with INF, and 15 with OND were included in the study., Results: The ratios of measles-specific IgA in CSF to serum were increased in SSPE patients compared to patients with MS, INF or OND., Conclusion: The data indicate a local production of measles-specific IgA in the CNS of SSPE patients.

The CD30 molecule, a member of tumor necrosis factor superfamily, has been suggested to be preferentially expressed and released in soluble form by activated T cells that produce T helper 2 type (Th2) cytokines. To evaluate whether determination of soluble CD30 (sCD30) levels could have a diagnostic value in diseases associated with Th1 and Th2 cytokine involvement, we investigated sCD30 in plasma and cerebrospinal fluid (CSF) from patients with multiple sclerosis (MS), HIV infection and other nervous system diseases. There was no statistically significant difference for plasma sCD30 levels in these clinical groups. However, patients with HIV infection had higher levels of sCD30 in CSF than MS patients. The mean sCD30 values were 3 to 6 folds higher in plasma than in CSF in all patient groups. No relationships were found between sCD30 levels and different clinical variables of MS and HIV infection, except that higher plasma sCD30 levels in HIV-infected patients were found in those with higher CD4+ T cell counts (> 200 x 10(6)) compared to the group with lower cell counts. The findings indicate that determinations of plasma and CSF sCD30 levels in MS and HIV infection have limited or no value as diagnostic or prognostic indicator.

Introduction: Acetylcholine (ACh) is a well known neurotransmitter in the central nervous system, but determining its level in cerebrospinal fluid (CSF) is very difficult and the origin of CSF ACh is still unknown. In this study, we attempted to measure CSF ACh by a specific and sensitive radioimmunoassay (RIA) from patients with neurologic diseases., Material and Methods: Patients with cerebral infarction (n = 7), Parkinson's disease (n = 6), spinocerebellar degeneration (n = 6), Alzheimer's disease (n = 3), amyotrophic lateral sclerosis (n = 3) and disc herniation with no central nervous involvement (n = 8) participated to determine the CSF ACh levels., Results: Of these 33 patients, the mean ACh level in CSF was 282.2 +/- 61.7 fmol/ml (mean +/- SE, range 20-1505.8 fmol/ml). The mean ACh level of spinocerebellar degeneration group was lower than others, but not statistically significant., Conclusion: We conclude that an amount of ACh detectable by RIA is certainly present in CSF.

We analyzed 352 paired CSF and serum samples with isoelectric focusing and immobilized pH gradients (IPG-IEF) using three different gradients. All MS patients (n = 35) had several (from 5 to 30) oligoclonal bands (OBs) in the CSF and most of them had few (from 1-8) OBs in serum. 54.5% patients with CNS infections (n = 12) had oligoclocal bands. OBs in these patients were fewer in number and located at the more acidic pH region compared with the MS samples. Also, corresponding serum bands were more often recognized. We suggest that IPG-IEF improves the diagnostic evaluation of the oligoclonal band pattern. The possibility of the use of extremely narrow gradients makes it a valuable tool for the analysis of selective proteins in various disorders.

Fifty consecutive patients with neurosarcoidosis were evaluated retrospectively. Sarcoidosis presented first with neurologic signs in 24 patients (48%), but systemic symptoms developed later in all but five. Main neurologic involvements were central nervous system lesions in 33 patients (66%), cranial nerve paresis in 12 (24%), and peripheral nerve lesions in five patients (10%). Seventeen patients (34%) had more than one type of neurologic involvement. Routine cerebrospinal fluid (CSF) parameters showed unspecific abnormalities in 35 patients (70%). CSF angiotensin converting enzyme was elevated in 18 of 31 patients (58%). Brain computerized tomography was abnormal in 13 of 32 patients (41%). Visual and brainstem evoked potentials were abnormal in ten (43%) and eight (35%) of 23 patients, respectively, suggesting subclinical lesions in 13 patients. Neurologic signs improved in 24 patients (48%), were stable in 11 (22%), and progressed in 15 patients (30%). Six patients died. Cranial nerve lesions improved most often. Course of neurologic involvements was similar in acute or subacute and chronic sarcoidosis. The effect of steroid treatment was inconsistent.

Beta-2-microglobulin was measured in specimens of cerebrospinal fluid (CSF) collected from 167 patients classified in 14 diagnostic categories at an outpatient Department of Neurology. In the control group of 29 subjects without any obvious disease of the nervous system, the concentration of beta-2-microglobulin was 1.15 +/- 0.37 mg/1 (M +/- s.d.). The concentration was almost significantly elevated in the groups with fresh brain infarct, central nervous system infection, and polyneuropathy. The serum concentrations of beta-2-microglobulin did not differ significantly among these diagnostic categories. The mean ratio between CSF and serum beta-2-microglobulin was 0.79 +/- 0.32 in the control group and more than 1.0 in the patients with brain infarcts, CNS infections and spinal paresis, but the differences were not statistically significant.

CSF and serum was obtained from 216 patients with neurological or psychoneurotic symptoms and the concentrations of albumin and IgG were immunologically determined. The IgG/albumin index, calculated as the quotient of the CSF/serum ratios of IgG and albumin was compared with electrophoresis on agar gel. In "normal" cases, the IgG/albumin index was between 0.26-0.66. Pathological electrophoresis, i.e. with two or more IgG bands in the gamma globulin region was found in 85 per cent of the MS patients; in 29 per cent of the patients with a possible demyelinating disease; in 41 per cent of patients with CNS infection; and in 4 per cent of patients with other neurological disorders; whereas an increased IgG/albumin index ( greater than 0.66) was found in 88 per cent of the MS patients; in 43 per cent of the patients with a possible demyelinating disease; in 50 per cent of the patients with CNS infection; in 11 per cent of patients with immunological disorders; and in 18 per cent of patients with other neurological diseases. The increase of the IgG/albumin index was sometimes moderate (0.67-0.90), except in patients with MS, syphilis and other CNS infections, where a pathological electrophoresis combined with an IgG/albumin index above 1.0 was found to be a valuable support for the clinical diagnosis.

Cerebrospinal fluids from patients with neurological diseases have been studied. It appeared that the detectability of immunoglobulin G subclasses 1, 2, 3, 4, and the occurrence of oligoclonal bands in the IgG region increased with increasing concentration of IgG in the spinal fluid. No specific pattern emerged in the different disease groups. Formula: see text.

Immune complexes (IC) were assessed in serum and CSF from 11 patients with acute inflammatory polyneuritis (AIP). An 125 I-labeled Clq binding assay (Clq BA) was used. IC were present in the sera of four patients and in the CSF of six. CSF-Clq BA of AIP (Group 1) were compared with 12 patients with other inflammatory neurological diseases (Group 2) and 22 patients with non-inflammatory neurological diseases (Group 3). There was only a significant difference between Group 1 compared to Group 3 (p less than 0.05). Serum and CSF IC did not correlate either with blood-brain barrier lesions or with immunoglobulin deposits in sural nerve biopsy.

Cerebrospinal fluid (CSF) cytocentrifugation was performed for plasma cells' demonstration in parallel with white cell count (WCC) and quantitative protein assays. Over a 5-year period, 154 consecutive multiple sclerosis (MS) patients were studied and compared to 28 other inflammatory neurological disease, 85 non-inflammatory neurological disease and 29 non-neurological disease cases. CSF cytology was easy to perform, gave definitive results within 2 h and was abnormal in 80 MS patients, 26 of whom had a normal WCC. Its sensitivity in MS was 0.57, i.e. higher than for WCC (0.45) but lower than for IgG index (0.70) and IgG synthesis rate (0.71). Its specificity was 0.86, not significantly different from specificity of WCC, IgG index and IgG synthesis rate. Plasma cells demonstration in MS CSF was neither a disease activity nor a prognosis marker. It was significantly correlated with pleiocytosis and intrathecal IgG synthesis. If these morphologically defined plasma cells are actual B cells, they could represent circulating individuals of the lymphocyte clones active in MS plaques and have a pathogenetic significance.

Cerebrospinal fluid (CSF) and peripheral blood (PB) lymphocyte sensitization to rabbit myelin basic protein (MBP) in 44 multiple sclerosis (MS) patients, 21 patients with other neurological diseases (OND) and 14 persons with neurosis was studied with the antigen-active rosette forming cells (Ag-ARFC) assay. The frequency of sensitization of CSF lymphocytes to MBP in groups of MS patients in the relapse stage and the chronic progressive stage was higher than in the group of MS patients in the stable stage and the OND patients. None of the healthy subjects showed a positive reaction with MBP. In BP there were no differences in the incidence of sensitization to MBP between patients in various stages of the disease, but it was higher than in the group of patients with OND and neuroses. In the patients who had suffered from MS for less than 4 years, sensitization to MBP was more common in CSF lymphocytes than in BP lymphocytes. The results suggest that primary sensitization to MBP occurs in CSF, and is probably secondary to myelin damage. However at present it is difficult to determine the extent to which sensitization of CSF and PB lymphocytes to MBP play a role in further demyelination processes.

Zinc (Zn), copper (Cu) and magnesium (Mg) concentrations in cerebrospinal fluid (CSF) and serum were determined with atomic absorption spectrophotometry in 74 patients suffering from various neurological diseases, and in 28 healthy controls. Increased CSF zinc levels were found in the group of peripheral nervous system diseases (P less than 0.01) and in the cases of different neurological syndromes with increased CSF protein concentration (P less than 0.001). Increased CSF and serum copper levels were found in the cases with increased CSF protein levels (P less than 0.05). It is probable that the damaged blood-brain-barrier (BBB) permits the passage of the trace elements Zn, Cu and of Mg into the subarachnoid space. Decreased serum Cu levels (P less than 0.01) were found in the group of multiple sclerosis (MS). The findings are correlated to those of previous communications.

Using antisera against Bence-Jones protein, the concentration of light chains type k and l can be determined in CSF. The calculation of the ratio of type k to type I light chains in CSF represents a sensitive measure for the evaluation of immunological processes involving the CNS. Our results demonstrate that an increase k/l ratio is encountered in 48% of CSF specimen from multiple sclerosis (MS) patients, but also in 50% from patients with other inflammatory diseases involving the CNS, in contrast to only 18% from other neurological diseases. In none of the MS or inflammatory cases is the altered k/l ratio the only indicator of a CNS inflammation, most commonly it is accompanied by an overproportional CSF-IgG elevation (increased QG ratio), an increased cell count or both. For these reasons determination of CSF k/l ratios is helpful in the differentiation of MS and other neurological diseases, but not for the differentiation of other inflammatory CNS diseases from MS.

Unconcentrated cerebrospinal fluid (CSF) and corresponding serum from 30 patients with multiple sclerosis (MS), 30 with other neurological disease and 30 controls suffering from tension headache or psychoneurosis, were examined for oligoclonal IgG bands by initial separation employing agarose isoelectric focusing (AIF) followed by a modified procedure of immunofixation with monospecific antiserum and silver staining. This method is specific for demonstration of IgG and has a limit for detection of 0.4 microgram of IgG. Comparing the results with those obtained by AIF followed by capillary blotting to nitrocellulose membrane, double antibody peroxidase labeling and avidin-biotin amplification, both methods revealed similar frequencies of positive findings for oligoclonal IgG bands in the three patient groups. AIF followed by antiserum immunofixation and silver staining is a simple, sensitive and specific method for detection of oligoclonal IgG in unconcentrated CSF.

CSF and sera from 238 newborns and children with various neurological diseases were assayed on bovine cells for the presence of alpha-interferon (IFN). An intrathecal synthesis of pH 2-resistant alpha-IFN was recovered in all newborns and in more than 90% of children with herpes encephalitis. It was also observed in one case of mumps encephalitis and in one case of encephalitis associated with Influenza A infection. An acid-labile alpha-IFN production was detected in CSF from more than one half of patients with viral meningitis or active congenital rubella and in those with neurological complications of systemic lupus erythematosus. This alpha-IFN subtype was also detected in CSF from only 2/37 children with measles encephalitis. In contrast, no alpha-IFN (less than 2 IU) in CSF was found among patients with subacute sclerosing panencephalitis, Guillain-Barré syndrome, Reye's syndrome, acute cerebellar ataxia, infantile spasms or facial paralysis of unknown origin.

A CSF Poly(C)-avid ribonuclease (RNase) activity was determined in serum and CSF of 11 controls and 75 neurological patients (34 multiple sclerosis (MS), 18 infectious processes and 23 other neurological diseases (OND]. In controls, the blood-CSF ratio of RNase activity is low. This fact and the absence of correlation between serum and CSF RNase activity (except in OND group), and between CSF albumin and CSF RNase activity in controls and MS patients, suggest an intrathecal origin for the major part of this CSF RNase activity. A formula taking into account any plasmatic enrichment in RNase of the CSF is proposed to evaluate this intrathecal activity. The normal mean value of this intrathecal RNase activity is 27 +/- 3 units/ml (mean +/- SE) in our experimental conditions and using our formula. The highest intrathecal RNase activity is observed in infectious processes and this finding is associated with a significant increase in the local anti-RNA antibody synthesis. An increase in intrathecal RNase activity is rarely found in MS and local anti-RNA synthesis is only observed in one third of MS patients.

Proliferative response to phytohemagglutinin (PHA) of cerebrospinal fluid lymphocytes (CSF-L) and peripheral blood mononuclear cells (PMBC) from patients with multiple sclerosis (MS) and other neurological diseases (OND) was tested using either bulk culture conditions or limiting dilution techniques in the presence of additional exogenous IL2. CSF-L response to PHA was found significantly lower than that of PBMC in both MS and OND patients. There was no significant difference in the response of CSF-L between the two groups. The limiting dilution analysis of the frequency of the precursors of PHA-responsive cells showed a strikingly decreased frequency of these precursors among CSF-L.

The occurrence of soluble immune complexes (IC) in the cerebrospinal fluid (CSF) of 14 multiple sclerosis (MS) patients, four acute polyradiculoneuritis patients, 30 patients with other neurological diseases (OND) and 30 patients with disc prolapse (DP) was examined by a solid phase C1q-protein A binding assay (C1q-PABA) and a complement consumption test. IC-positive reactions were observed only in the C1q-PABA. The binding indices determined by the C1q-PABA differed significantly (P < 0.01) when the MS or the OND patient groups were compared to the DP group. No significant (P < 0.1) difference was observed between the indices in the MS and OND groups. Binding indices in C1q-PABA showed no correlation either to IgG concentration, total protein concentration or cell counts in CSF of MS patients. Three of the four polyradiculoneuritis patients were strongly IC-positive while the fourth patient was negative. Filtration and PEG-precipitation data indicated that a major part of the IgG-containing IC in CSF detected by C1q-PABA was of macromolecular nature.

Isoelectric focusing and agarose gel electrophoresis of CSF and serum revealed similar frequencies of oligoclonal bands in multiple sclerosis (100% with both methods), infectious CNS disorders (38 and 23%) and other neurological diseases (8 and 10%). In selected cases with unsure CSF oligoclonal bands on agarose gel electrophoresis, isoelectric focusing displayed definite oligoclonal bands. In contrast to agarose gel electrophoresis, isoelectric focusing revealed evidence for oligoclonal bands in serum as well as in CSF in 41% of the multiple sclerosis patients, indicating diffusion from CSF to serum. In 4 cases with gammaglobulin bands appearing in both CSF and serum on agarose gel electrophoresis, isoelectric focusing revealed normal CSF and serum protein patterns at pH above 6.4 where most IgG is migrating.

Cerebrospinal fluid (CSF) from patients suffering from various degenerative neurological diseases was fractionated into "CSF-specific" and antigenically serum-like proteins, using affinity chromatography with antihuman serum antibodies. The samples were isoelectric focused. Protein patterns were compared to similarly treated CSF from young normal volunteers and age matched controls. Several changes are described and 2 pathological patterns of the CSF-specific fraction could be identified. One pattern was characteristic for Alzheimer's dementia (AD) and senile dementia of the Alzheimer type (SDAT), but also seen in a few other diseases. The other pattern was seen in several of the investigated groups, most prominent in Huntington's chorea.

Paired serum and cerebrospinal fluid (CSF) specimens from 30 multiple sclerosis (MS) patients and 30 patients with other neurological diseases (ONDs) were analyzed for the presence of immune complexes (ICs). With each of the 4 tests used, ICs were found more frequently in sera from both MS and OND patients than in sera from healthy blood donors. IC-positivity for MS and OND patient CSF varied from 10-33% and from 10-17% in different tests. The number of IC-positive sera or CSF in MS patients did not differ significantly from those in OND patients. For both MS and OND patients, the positivity pattern for serum and CSF specimens in each IC test was essentially unique. Furthermore, because several CSF IC-positive and serum IC-negative paired specimens were found, intrathecal IC formation may be independent of IC formation in peripheral blood. The presence of ICs in serum or CSF did not correlate with the clinical status of or laboratory data on the MS patients, nor was a correlation found with the diagnosis of the OND patients. In total, these results suggest that the presence or absence of ICs in MS or OND patients may simply reflect changes in the immunological regulation of individual patients.

The activities of four lysosomal acid hydrolases, beta-galactosidase, alpha-mannosidase at pH 4.5 and 5.5, N-acetyl-beta-glucosaminidase, and acid phosphatase, have been measured in serum and cerebrospinal fluid from 179 patients with different neurological diseases and from 20 healthy controls. In patients with tumours, decreased activity of beta-galactosidase was found in both serum and cerebrospinal fluid, and in patients with multiple sclerosis and collagen diseases, decreased activities of beta-galactosidase and N-acetyl-beta-glucosaminidase were found in cerebrospinal fluid. The variations of enzyme activities were great between the individual patients even with these groups and analysis of lysosomal enzymes seems to have a very poor clinical value.

15 patients with psychosomatic disease, 26 patients with miscellaneous neurological diseases, and 16 patients with cerebrovascular disease were investigated with regard to concentrations of ferritin in serum and cerebrospinal fluid (CSF). The mean CSF ferritin concentration in the psychosomatic group was 6.2 micrograms/l +/- 2.4 (1 S.D.). Patients with recent cerebral infarction had similar values while 2 patients with intracerebral hematomas had very high CSF ferritin concentrations. There was a positive correlation between serum and CSF ferritin levels and between CSF total protein and ferritin in patients with a damaged blood-CSF barrier only. At present, the practical value of analysing ferritin in the CSF is very small.