Cerebrospinal fluid in first pediatric demyelinating event: diagnostic and prognostic value for conversion to multiple sclerosis
DOI:
https://doi.org/10.69849/wdvavt13Keywords:
Cerebrospinal fluid, Multiple sclerosis, Demyelinating diseases, Pediatrics, BiomarkersAbstract
Pediatric demyelinating diseases of the central nervous system represent a heterogeneous group of immune-mediated conditions whose diagnosis and prognosis remain challenging, particularly at the first clinical event. This study aims to analyze the role of cerebrospinal fluid in the diagnostic differentiation and prognostic stratification of major pediatric demyelinating disorders, with emphasis on the risk of conversion to multiple sclerosis. This is a narrative review based on the critical analysis of relevant studies addressing cerebrospinal fluid biomarkers, including oligoclonal bands, immunoglobulin G index, pleocytosis, and protein levels. The findings indicate that the presence of oligoclonal bands and an elevated immunoglobulin G index are associated with a higher risk of conversion to multiple sclerosis, reflecting chronic intrathecal inflammation, whereas profiles characterized by more pronounced pleocytosis and absence of persistent intrathecal synthesis are more commonly associated with monophasic conditions such as acute disseminated encephalomyelitis and myelin oligodendrocyte glycoprotein antibody-associated disease. Furthermore, the interpretation of cerebrospinal fluid parameters, when integrated with clinical and neuroimaging data, significantly improves diagnostic accuracy and prediction of disease progression. In conclusion, cerebrospinal fluid represents an essential tool in the evaluation of pediatric demyelinating diseases, contributing to a more precise, individualized, and risk-oriented approach, although important gaps in the literature remain and require further prospective and standardized studies.
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