No this has nothing to do with the legendary rubbish British Metal Mockumentary of the band Lumbar Puncture or something like that. It is not Spinal Tap Eleven as you turn up the volume but are we going to see the re-birth of the lumbar puncture. In some countries you get a spinal tap as part of your diagnostic work-up but it fell out of favour perhaps as people from across the pond dont seem to want them…but with Old McDonald Criteria 2024 more modern technology is apprearing to assess antibody production in the CNS but this paper says you can do it all with a spinal tap. So the dreaded P for prediction appears
Ghezzi L, Kosa P, Greenwood M, Alvarez E, Freedman CL, Cross AH, Pace F, Freedman MS, Kocot J, Piccio L, Bielekova B. From Diagnosis to Disease Staging: Multisite Validation of Cerebrospinal Fluid Molecular Tests in Multiple Sclerosis. Anals of Neurology. 2025 Oct 3. doi: 10.1002/ana.78047.
Objective: The growing demand for personalized treatment in multiple sclerosis (MS) highlights the need for more precise biomarkers that can outperform magnetic resonance imaging and clinical assessment in patient stratification. Advances in multiplex proteomic technologies suggest that cerebrospinal fluid (CSF) analysis at MS onset may not only improve diagnostic accuracy, but also offer prognostic and staging information, as well as insight into molecular therapeutic targets.
Methods: This multicenter study retrospectively analyzed cryopreserved CSF samples from 160 individuals undergoing diagnostic evaluation for possible neuroimmunological disorder, and among these, followed a cohort of 96 people with confirmed MS for at least 3 years. The goal was to externally validate previously published CSF-based diagnostic and prognostic classifiers.
Results: Upon unblinding, the CSF-based molecular diagnostic test distinguished 96 people with confirmed MS from 30 individuals with other inflammatory neurological diseases, and 34 individuals with non-inflammatory neurological diseases, achieving an area under the receiver operating characteristic curve of 0.94 (p = 4.7 × 10-21). The test also differentiated 65 individuals with relapsing-remitting MS from 31 individuals with progressive MS, with an area under the receiver operating characteristic curve of 0.76 (p = 1.4 × 10-5). The prognostic classifier predicted prospectively measured Expanded Disability Status Scale scores at follow up (rho = 0.43, p = 2.54 × 10-5).
Interpretation: This multicenter external validation study demonstrates that CSF-based molecular tests can robustly distinguish MS from other neurological conditions, stratify MS subtypes, and predict future disability progression in real-world settings. These results lay the groundwork for development of next-generation molecular tools to personalize care in MS. ANN NEUROL 2025.
Source: multiple-sclerosis-research.org