Patterns of cerebrospinal fluid pathology correlate with disease progression in multiple sclerosis

Multiple sclerosis is a chronic inflammatory and demyelinating disease of t he CNS with, as yet, an unknown aetiology. Temporal profile, intensity and treatment responses are highly variable in multiple sclerosis suggesting pa thogenetic heterogeneity. This hypothesis has been supported by histopathol ogical studies disclosing at least four different subtypes of acute demyeli nating lesions. Although stratification of multiple sclerosis patients into these categories would be extremely helpful for clinical studies, this app roach is impractical as it requires brain biopsy. In this study we investig ated CSF cytology from 60 multiple sclerosis patients by flow cytometry. We identified different patterns of CSF cytology, which were independent of i mmunological parameters in the peripheral blood. The most variable CSF para meter was the B cell to monocyte ratio, which remained stable during differ ent phases of disease in selected patients. The ratio correlated with disea se progression but not with disability or disease duration in a retrospecti ve, consecutive analysis. A high ratio (predominance of B cells) was associ ated with more rapid disease progression, whereas a low ratio (predominance of monocytes) was found in patients with slower progression. Our study dem onstrates the existence and potential clinical relevance of different CSF c ytology patterns. We hypothesize that CSF cytology patterns may reflect the heterogeneity in the pathogenesis of multiple sclerosis.