Intrathecal synthesis of IgM and IgA in neurological diseases: comparison of two formulae with isoelectric focusing.

The intrathecal IgM and IgA immune response was studied by detecting oligoclonal IgM and IgA bands in CSF and by determining both the IgM/IgA indices as well as the intrathecal production of IgM and IgA by the Reiber formula. A good correlation was found between the demonstration of oligoclonal IgM (r = 0.890) and IgA bands (r = 0.927) and the Reiber formula. Compared with the finding of oligoclonal IgM/IgA bands calculation of an intrathecal IgM/IgA synthesis by the Reiber formula was less sensitive (86%). In two out of 22 controls and in 12 of 19 patients with polyradiculitis IgM and IgA indices were elevated while the other evaluation methods were negative. Even though oligoclonal IgM and IgA bands are considered to be a useful diagnostic tool in detecting intrathecal synthesis of IgM and IgA, i.e. in meningoencephalitis or neuroborreliosis for clinical practice, the Reiber formula provides reliable results. Detection sensitivity of assays for CSF-IgM and -IgA should be at least 1.0 mg/l.