Frequency of an intrathecal IgM synthesis and MRZ reaction in children with MS

S Chen; Bertolini A; G Koukou; E M Wendel; C Thiels; M Baumann; C Lechner; A Blaschek; A Della Marina; G Classen; B Stüve; B Kauffmann; T Kapanci; B Mayer; M Otto; K Rostásy

doi:10.1016/j.ejpn.2024.04.005

Frequency of an intrathecal IgM synthesis and MRZ reaction in children with MS

Eur J Paediatr Neurol. 2024 Apr 16:50:51-56. doi: 10.1016/j.ejpn.2024.04.005. Online ahead of print.

Authors

S Chen¹, Bertolini A¹, G Koukou¹, E M Wendel², C Thiels³, M Baumann⁴, C Lechner⁴, A Blaschek⁵, A Della Marina⁶, G Classen⁷, B Stüve⁸, B Kauffmann⁹, T Kapanci¹, B Mayer¹⁰, M Otto¹¹, K Rostásy¹²

Affiliations

¹ Department of Pediatric Neurology, Vestische Kinder- und Jugendklinik Datteln, University Witten/Herdecke, Datteln, Germany.
² Department of Neuropediatrics, Olgahospital/Klinikum Stuttgart Pediatrics, Stuttgart, Germany.
³ Department of Neuropediatrics, University Children's Hospital, Ruhr-University Bochum, Bochum, Germany.
⁴ Department of Pediatrics I, Division of Pediatric Neurology, Medical University of Innsbruck, Innsbruck, Austria.
⁵ Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner's Children's Hospital, University of Munich, Munich, Germany.
⁶ Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, Centre for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Essen, Germany.
⁷ Department of Neuropediatrics, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany.
⁸ Department for Neuropediatrics, DRK Children's Hospital Siegen, Siegen, Germany.
⁹ Department of Neuropediatrics, Hospital Bremen Mitte, Bremen, Germany.
¹⁰ Institute of Epidemiology and Medical Biometry, University Ulm, Germany.
¹¹ Department of Neurology, Martin-Luther-University Hospital of Halle-Wittenberg, Halle, Germany.
¹² Department of Pediatric Neurology, Vestische Kinder- und Jugendklinik Datteln, University Witten/Herdecke, Datteln, Germany. Electronic address: k.rostasy@kinderklinik-datteln.de.

PMID: 38636242
DOI: 10.1016/j.ejpn.2024.04.005

Abstract

Background: Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of the CNS. An intrathecal IgM synthesis is associated with a more rapid progression of MS and the intrathecal immune response to measles -, rubella -and varicella zoster virus (MRZR) which, if present, increases the likelihood of a diagnosis of MS in adults.

Objective: To evaluate the frequency of an intrathecal IgM synthesis and MRZR in children with MS. MethodsChildren with MS and a data set including clinical and treatment history, MRI at onset, in addition to a CSF analysis, and determination of antibody index (AI) of measles, rubella, and zoster antibodies, were eligible. The presence of an intrathecal IgM synthesis and/or a positive MRZ reaction were compared to biomarkers of a more progressive disease course.

Results: In 75 children with MS, OCBs were present in 93.3 %). 49,2 % experienced their first relapse within 6 months. 50.7 % had a total lesion load of more than 10 lesions in the first brain MRI. Spinal lesions were identified in 64 %. 23.5 % had a positive MRZR and 40.3 % an intrathecal IgM synthesis. No significant associations were detected between the presence of an intrathecal IgM synthesis and MRZR and parameters including the relapse rate in the first two years.

Conclusion: An intrathecal IgM synthesis and a positive MRZR are found in a subset of MS children but are not associated with markers associated with a poor prognosis.

Keywords: Children; IgM synthesis; MRZ reaction; MS.