Kappa Free Light Chain Index in the Real World-Do We Miss Clinically Relevant Information by Skipping Oligoclonal Banding?

Background: No standardized strategy for integrating κ-free light chain (κ-FLC) index into routine cerebrospinal fluid (CSF) diagnostics has yet been established.

Objective: To determine agreement between κ-FLC index and CSF-restricted oligoclonal bands (OCB), and to identify κ-FLC index range where second-line OCB testing is needed.

Methods: A retrospective analysis was conducted in patients who had κ-FLC measurement between December 2023 and December 2024 at the Medical University of Innsbruck.

Early acclimatization to high altitude: Acid-base and fluid balance dynamics during the first 2 days at 3100 m.

Immediate responses to hypoxia at high altitude are hyperventilation and successive respiratory alkalosis. Alkalosis, in turn, can affect cerebrospinal fluid pH and ventilatory control. The kidneys compensate metabolically for respiratory alkalosis.

High erythropoietin levels are associated with low neurofilament light levels in simulated high altitude: a further hint for neuroprotection by erythropoietin.

Background: Erythropoietin (EPO) plays a crucial role in the early adaption to high altitude and is possibly involved in neuroprotection. Neurofilament light chain (NfL) is an established marker of neuroaxonal damage.

Objective: To investigate whether EPO dynamics in simulated high altitude are linked to neuroaxonal damage as measured by NfL.

Kappa Free Light Chain Index and Oligoclonal Bands in Varicella Zoster Virus Infection and Neuroborreliosis: A Matter of Timing?

Background: The diagnosis of Varicella-zoster virus related neurological disease (VZD) and Lyme neuroborreliosis (LNB) is based on clinical presentation as well as cerebrospinal fluid (CSF) results.

Objectives: To evaluate and compare the diagnostic utility of oligoclonal bands (OCB) and the κ-free light chain (FLC) index in patients with VZD and LNB.

Methods: Patients with the diagnosis of VZD or LNB at the Department of Neurology of the Medical University of Innsbruck between 2008 to 2020 were included.

Kappa free light chain index predicts long-term disease activity and disability accrual in multiple sclerosis.

Background: The prognostic value of κ-free light chain (κ-FLC) index over the long term is unknown.

Objectives: The objective of the study was to determine whether κ-FLC index determined at disease onset predicts relapse activity and disability accrual during long-term follow-up.

Methods: Patients with a first demyelinating event of the central nervous system who had cerebrospinal fluid and serum sampling were eligible for inclusion.

Blood biomarkers for predicting disability worsening in progressive multiple sclerosis: a multinational, individual participant-level analysis.

Background And Objectives: Biologically informative markers like glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) may help predict confirmed disability worsening (CDW) in multiple sclerosis (MS). However, data on the prognostic value of their blood concentrations in progressive MS (PMS) are limited, and there are substantial discrepancies in the published literature. This international collaboration uses individual participant data to define the prognostic value of serum GFAP and NfL in people with PMS (pwPMS).

Effect of long-term frozen storage on stability of kappa free light chain index.

Objectives: To investigate whether frozen storage duration influences κ-FLC index.

Methods: CSF and serum samples of patients with multiple sclerosis collected for routine diagnostic purposes had been stored at -20 °C. κ-FLC and albumin concentrations were measured at two different timepoints, i.

Hypoxia in multiple sclerosis.

Low oxygen availability (hypoxia) is a prominent but poorly understood feature in multiple sclerosis (MS). Whether hypoxia causes or drives MS pathology and symptoms or whether it is a consequence of other pathological events, such as inflammation and vascular dysfunction, is unknown. Here, we summarize the available literature on the interplay between hypoxia and both pathological and symptomatic features of MS.

Short-Term Risk Factors for Bone Loss in Multiple Sclerosis: A Prospective Study and Literature Review.

Background: Reduced bone mass and increased osteoporosis risk are common in people with multiple sclerosis (pwMS). The aim of the study was to identify risk factors for short-term bone loss in MS.

Methods: This prospective study included 139 pwMS (ages 18-65).

Clinical characteristics and outcome of double-AQP4/MOG-seronegative and not MS-associated monophasic and relapsing demyelinating transverse myelitis: A monocenter study.

Background: Demyelinating acute transverse myelitis (ATM) may occur as part of the clinical presentation in multiple sclerosis (MS) as well as neuromyelitis optica spectrum disorder (NMOSD) and myelin-oligodendrocyte-glycoprotein antibody associated disease (MOGAD). However, some patients with demyelinating ATM do not fulfill diagnostic criteria of MS, NMOSD or MOGAD and some of these even experience more than one spinal relapse. As double-AQP4/MOG-seronegative demyelinating ATM (DSD-ATM) is poorly investigated so far and treatment recommendations for these patients are lacking, we aimed to investigate clinical features and outcome of these patients.

Faster Decay of Cerebrospinal Fluid Red Blood Cells and Total Protein Predict Good Functional Outcome After Subarachnoid Hemorrhage.

Introduction: Prognostication after subarachnoid hemorrhage (SAH) is essential to guide clinical management and improve patient care.

Objective: To investigate whether decay rates of cerebrospinal fluid (CSF) red blood cells (RBC) and total protein (TP) after SAH predict functional outcome at 3 months.

Methods: Patients with SAH treated at the Neurological Intensive Care Unit Innsbruck with a first CSF sample (CSFfirst) within 72 h after admission and at least one subsequent sample were eligible for inclusion.

Impact of renal function impairment on kappa free light chain index.

Objectives: To investigate whether renal function impacts CSF κ-FLC concentration and/or κ-FLC index.

Methods: Patients with non-inflammatory neurological diseases were eligible. κ-FLC index was calculated as (CSF κ-FLC/serum κ-FLC)/albumin quotient.

Face exploration, emotion recognition, and emotional enhancement of memory in relapsing-remitting multiple sclerosis.

Background: Recognizing familiar faces and identifying emotions through facial expressions are essential for social functioning. This study aimed to examine whether people with relapsing-remitting multiple sclerosis (PwMS) differ from healthy control individuals (HC) in their performance on different tasks related to facial emotion processing.

Methods: In a cross-sectional controlled study, 30 PwMS and 35 HC completed a baseline neuropsychological evaluation and experimental tasks assessing visual exploration of facial stimuli through eye tracking, facial emotion recognition, and facial memory recognition.

Reactive Pleocytosis After Repeated Lumbar Puncture-Implications for Clinical Practice.

Introduction: Lumbar puncture (LP) is a routine clinical procedure and, in some cases, is repeatedly performed for diagnostic or therapeutic reasons. The impact of repeated LP on cerebrospinal fluid (CSF) findings is not clear.

Objective: To investigate whether repeated LP is associated with reactive pleocytosis and disruption of blood-CSF barrier function and to determine the role of interval between repeated LP.

Retinal thinning differentiates treatment effects in relapsing multiple sclerosis below the clinical threshold.

Objective: To investigate retinal layer thinning as a biomarker of disease-modifying treatment (DMT) effects in relapsing multiple sclerosis (RMS).

Methods: From an ongoing prospective observational study, we included patients with RMS, who (i) had an optical coherence tomography (OCT) scan within 6 to 12 months after DMT start (rebaseline) and ≥1 follow-up OCT ≥12 months after rebaseline and (ii) adhered to DMT during follow-up. Differences between DMT in thinning of peripapillary-retinal-nerve-fiber-layer (pRNFL) and macular ganglion cell-plus-inner plexiform-layer (GCIPL) were analyzed using mixed-effects linear regression.

Switching from natalizumab to antiCD20 monoclonal antibodies: Short transition interval is associated with improved outcome.

Objective: To investigate the impact of transition interval length when switching from natalizumab (NTZ) to anti-CD20 monoclonal antibodies (antiCD20) on recurrent disease activity and safety in relapsing multiple sclerosis (RMS).

Methods: Aggregating data from 8 MS centres in Austria, Switzerland, and Germany, we included RMS patients who (i) continuously received NTZ for ≥3 months, (ii) were switched to antiCD20, and (iii) had ≥12 months follow-up after switch. The primary endpoint was occurrence of relapse after switch, secondary endpoints included severe infections (CTCAE grade ≥3).

Increased EBNA1-specific antibody response in primary-progressive multiple sclerosis.

Background And Objectives: The impact of viral infections on disease susceptibility and progression has predominantly been studied in patients with relapse-onset MS (RMS). Here, we determined immune responses to ubiquitous viruses in patients with primary progressive MS (PPMS).

Methods: Antibody responses to Epstein-Barr virus (EBV), specifically to the latent EBV nuclear antigen 1 and the lytic viral capsid antigen VCA, human herpesvirus 6 (HHV-6), human cytomegalovirus (HCMV), and measles virus were determined in a cohort of 68 PPMS patients with a mean follow-up of 8 years and compared with 66 healthy controls matched for sex and age.

Neurofilament Light Chain Is Associated With Acute Mountain Sickness.

Background: Neurological symptoms are common in acute mountain sickness (AMS); however, the extent of neuroaxonal damage remains unclear. Neurofilament light chain (NfL) is an established blood biomarker for neuroaxonal damage.

Objective: To investigate whether plasma (p) NfL levels increase after simulated altitude exposure, correlate with the occurrence of AMS, and might be mitigated by preacclimatization.

Cerebrospinal fluid red blood cells and total protein are associated with clinical outcome in spontaneous subarachnoid hemorrhage.

Background And Purpose: Prognostication in patients with spontaneous subarachnoid hemorrhage (SAH) can be challenging. The aim of this study was to assess whether cerebrospinal fluid (CSF) red blood cell (RBC) count and total protein (TP) concentration are associated with SAH prognosis.

Methods: Patients with SAH treated at the neurological intensive care unit (ICU) in Innsbruck were included in this real-world, observational study.

Association of Disease-Modifying Treatment With Outcome in Patients With Relapsing Multiple Sclerosis and Isolated MRI Activity.

Background And Objectives: Isolated value of MRI metrics in relapsing multiple sclerosis (RMS) as a surrogate marker of response to disease-modifying treatment (DMT) and, thus, as decision criteria for DMT escalation in the absence of clinical signs of disease activity is still a matter of debate. The aim of this study was to investigate whether DMT escalation based on isolated MRI activity affects clinical outcome.

Methods: Combining data from 5 MS centers in Austria and Switzerland, we included patients with RMS aged at least 18 years who (1) had initiated first-line, low-to-moderate-efficacy DMT (interferon β, glatiramer acetate, teriflunomide, or dimethyl fumarate) continued for ≥12 months, (2) were clinically stable (no relapses or disability progression) on DMT for 12 months, (3) had MRI at baseline and after 12 months on DMT, and (4) had available clinical follow-up for ≥2 years after the second MRI.

Association of Complement Factors With Disability Progression in Primary Progressive Multiple Sclerosis.

Background And Objectives: The complement system is known to play a role in multiple sclerosis (MS) pathogenesis. However, its contribution to disease progression remains elusive. The study investigated the role of the complement system in disability progression of patients with primary progressive MS (PPMS).

Olfactory threshold as a biomarker of long-term relapse activity in multiple sclerosis.

Background: Olfactory threshold (OT) is a marker of short-term inflammatory activity in multiple sclerosis (MS).

Objective: To investigate whether OT predicts long-term MS clinical disease course.

Methods: This was a 6-year prospective longitudinal study on MS patients at the MS clinic Innsbruck.

Sex impacts treatment decisions in multiple sclerosis.

Background: Individual disease-modifying treatment (DMT) decisions might differ between female and male people with MS (pwMS).

Objective: To identify sex-related differences in DMT strategies over the past decades in a real-world setting.

Methods: In this cohort study, data from the Austrian Multiple Sclerosis Treatment Registry (AMSTR), a nationwide prospectively collected registry mandatory for reimbursement, were retrospectively analyzed.