Focal cortical atrophy following transient meningeal enhancement in a progressive multiple sclerosis.

Recent studies identified chronic leptomeningeal enhancement (LME) in late-acquired FLAIR sequences in secondary progressive (SP) multiple sclerosis (MS). These LMEs correlate with focal cortical inflammation and demyelination observed by pathology, which are supposed to drive long-term cortical atrophy. We report a spontaneously remitting meningeal uptake in a patient suffering from SP MS.

Estimation of intrathecal IgG synthesis: simulation of the risk of underestimation.

Objective: The low level of passively diffused IgG through the blood-brain barrier is sufficient to blur the estimation of intrathecal IgG synthesis (ITS). Therefore, this estimation requires a mathematical calculation derived from empirical laws, but the range of normal values in healthy controls is wide enough to prevent a precise calculation. This study investigated the precision of various methods of ITS estimations and their application to two clinical situations: plasma exchange and immune suppression targeting ITS.

No evidence of disease activity (NEDA) in MS should include CSF biology - Towards a 'Disease-Free Status Score'.

The concept of NEDA (no evidence of disease activity) was forged to describe relapse-free patients under treatment with recent drugs, but this goal is reached by less than half of all patients and not sustained over time. However a complete remission of disease is expected to be associated with the normalization of CSF biomarkers. On pathophysiological grounds, we propose to add the criterion of no evidence of biological activity in CSF to design a future 'disease-free status score'.