Correlation of myelin basic protein‐like material in cerebrospinal fluid of multiple sclerosis patients with their response to glucocorticoid treatment

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Abstract
Predictors and laboratory correlates of the response of patients with multiple sclerosis to glucocorticoids are not well defined. Our study was undertaken to determine if the levels of myelin basic protein (MBP)‐like material in cerebrospinal fluid (CSF) might indicate which patients with multiple sclerosis would show a short‐term (5 day) or intermediateterm (40 day) improvement of at least a full‐grade Kurtzke disability score after initiating treatment with glucocorticoids. A total of 62 patients received 71 courses of treatment consisting of 5 days of intravenous methylprednisolone (500 mg per day) usually followed by a 4‐week tapering dose of oral prednisone. CSF was obtained before initiation of treatment and analyzed for MBP‐like material by radioimmunoassay. Results were analyzed by χ2 tests of association and by logistic regression. Individuals having a CSF MBP‐like material level of ≥0.1 ng/ml overall showed a greater likelihood of continued improvement at day 40 (p = 0.014) or further improvement between days 5 and 40 (p = 0.003). Those in the first 15 days of worsening and with an elevated CSF MBP‐like level were more likely to respond by day 5. Relapsing–remitting and relapsing–progressive forms of the disease were more likely to respond at both time points than were patients with primary or secondary chronic progressive patterns. The Kurtzke disability score at entry and the major anatomical site of the central nervous system symptomatically affected were not predictive of outcome at either time. These studies indicate that the level of CSF MBP‐like material may help select those patients with multiple sclerosis who will show a response to short‐term glucocorticoid or other treatment.