Well puncture is a tool used to spot oligoclonal bands and more recently free kappa immunoglobulin light chains, this study argues that it doesnt add alot to diagnosis if not supported by typical classical MRI lesions. I’m not a neuro and it difficult to say what I think but it will be music to the ears of some. However it is known that the frequency of oligoclonal bands is much less in people without MRI lesions and I would think this is part of the thought process of neuros…but I am elimination of lumbar punctures would be to remove a tool that has value for some. Yes I havent had one….both me, MD2 and profG volunteered to donate 50ml of CSF for a study on endocannabinoids, but the neuros didnt think it was ethical to do so…we did get some people undergoing diagnostic lumbar puncture to donate CSF….It showed the endocannabinoid dysbalance in spasticity was not a goer.
Deschamps R, Boudot de la Motte M, Chaugne E, Lamirel C, Savatovsky J, Bensa C, Freiherr Von Seckendorff A, Philibert M, Gueguen A, Marignier R, Vignal-Clermont C, Lecler A, Papeix C. Rethinking routine lumbar puncture in isolated optic neuritis: results from a large cohort study. J Neurol. 2025;v272:730.
Background: Lumbar puncture (LP) remains widely recommended in the diagnostic evaluation of isolated optic neuritis (ON), when brain MRI does not reveal lesions suggestive of multiple sclerosis (MS). However, the true clinical utility is unclear in the era of advanced serological and imaging diagnostics.
Methods: In this monocentric retrospective study of all consecutive adult patients with acute or subacute ON and no MS-like lesions on initial brain MRI, we analyzed the final aetiological diagnoses, the specific contribution of LP, and treatment timing.
Results: Among 184 patients, diagnoses at the end of the follow-up (median 15.3 months) included idiopathic (only optic neure issues and not brain and spinal cord) ON (48.4%), myelin oligodendrocyte glycoprotein-IgG associated disease (MOGAD; 22.3%), MS (19.6%), neuromyelitis optica spectrum disorders (4.3%), sarcoidosis (4.3%), and chronic lymphocytic leukemia-related ON (CLL; 1.1%). LP contributed to the final diagnosis in only 4 cases (2.2%), including 2 MOGAD (MOG-IgG only in cerebrospinal fluid) and 2 chronic lymphocytic leukemia-related ON, always in conjunction with other tests and clinical context. Conversely, spinal or orbital MRI and antibody testing were key diagnostic tools. Median delay between MRI and LP was 3 days, contributing to a median 11-day interval from symptom onset to corticosteroid treatment initiation.
Conclusions: Routine LP has minimal diagnostic yield in isolated ON without MS-typical MRI findings and may delay treatment. Our results support a more selective, context-driven diagnostic strategy prioritizing MRI and antibody testing over systematic LP.
Source: multiple-sclerosis-research.org