A systematic review and meta-analysis indicated that the kappa-free light chains (κ-FLC) index has a similar diagnostic accuracy in MS as oligoclonal bands (OCB). Intrathecal κ-FLC synthesis might be included into the next revision of MS diagnostic criteria as an additional tool to measure intrathecal immunoglobulin synthesis.
Intrathecal IgG synthesis is a hallmark of MS . Determination of the OCB in cerebrospinal fluid (CSF) is the gold standard for detecting this. A highly-promising alternative method for the assessment of intrathecal inflammation is the quantification of κ-FLC in CSF. In the context of a consensus statement on how to best to evaluate CSF in patients suspected of MS, a systematic review and meta-analysis were performed by Dr Harald Hegen (Medical University of Innsbruck, Austria) and colleagues to compare the diagnostic value of κ-FLC and OCB [2,3].
Included were 34 studies that assessed diagnostic sensitivity and specificity of both methods to discriminate patients with MS or a clinically isolated syndrome (CIS) from control participants. The diagnostic sensitivity and specificity of κ-FLC were almost identical to those of OCB, confirming the diagnostic performance of κ-FLC (see Table). A central issue here is a cut-off value for the κ-FLC index, which was determined at 7.0.
Table: Performance of CSF evaluation using κ-FLC or OCB 
k-FLC, kappa-free light chains; OCB, oligoclonal bands.
An international expert panel reached consensus on several recommendations for standard CSF evaluation. One of these recommendations was that determination of intrathecal κ-FLC synthesis, e.g. by the κ-FLC index, should be included in the next revision of MS diagnostic criteria. The panel’s conclusions were endorsed by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS).
- Bonnan M. Mult Scler Int. 2015;2015:296184.
- Hegen H, et al. Cerebrospinal fluid kappa free light chains for the diagnosis of multiple sclerosis: a systematic review, meta-analysis and consensus statement. Abstract O056, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.
- Hegen H, et al. Wien Med Wochenschr. 2022;172(15-16):337–345.
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Table of Contents: ECTRIMS 2022
Letter from the Editor
ECTRIMS 2022 Highlights Podcast
Diagnosis and Prediction of Disease Course
A case for including optic nerve lesions in the McDonald criteria
Cerebrospinal fluid kappa-free light chains for MS diagnosis
Early, non-disabling relapses increase disability accumulation
Physical impairment is present before perceived MS onset
Chronic active MS lesions respond poorly to anti-CD20 antibodies
Treatment: Trials & Strategies
Dimethyl fumarate reduces the risk of a first clinical event in RIS
How and when to make a timely switch to high-efficacy DMT
Comparing real-world effectiveness of DMTs
Study fails to show non-inferiority of rituximab to ocrelizumab
Autologous haematopoietic stem cell transplantation versus DMTs
Stem cell transplantation not superior to natalizumab in progressive MS
Efficacy of DMTs fades away in secondary progressive MS
Smartphone tapping can help detect progressive MS
Early treatment with DMT effective in paediatric-onset MS
Fingolimod in paediatric MS: results of up to 6 years
Switching treatment after initial platform injectable DMT: real-world data
Pregnancy and infant outcomes in women receiving ocrelizumab
New safety data of anti-CD20 mAbs around pregnancy
MS activity and pregnancy outcomes after long-term use of natalizumab
Ravulizumab significantly reduced relapses in AQP4+ NMOSD
NMOSD patients are cognitively impaired regardless of serostatus
Evidence-based consensus on pregnancy in NMOSD
COVID-19 and MS: lessons learned thus far
Ocrelizumab and fingolimod increase the risk of COVID-19 and of worse outcomes
Humoral and cellular immune responses after SARS-CoV-2 vaccination
Re-myelination strategies in MS still pose many unanswered questions
MS associated with a broader Epstein-Barr virus specific T-cell receptor repertoire
Cognitive rehab and mindfulness reduce cognitive complaints in MS
MRI more sensitive for disease activity than relapses in SPMS
First long-term efficacy data of a BTK inhibitor
Gut microbiota composition associated with disability worsening