Gamma Globulin Studies in Multiple Sclerosis and Their Application to the Problem of Diagnosis

The demonstration of the association between a positive colloidal gold reaction and an increase in the y-globulin in the cerebrospinal fluid (Kabat, Landow, and Moore, 1942) has stimulated further study of this protein fraction. An increase in this moiety in the spinal fluid of patients with multiple sclerosis has been reported by workers using free-solution and paper electrophoresis, as well as immunochemical methods. Jt has been shown (Yahr, Goldensohn, and Kabat, 1954) that the serum y-globulin remains unaltered, although changes have been reported in the serum albumin and ao- and fl-globulin concentrations (Volk, Saifer, and Rabiner, 1954; Press, 1956). The present study is primarily concerned with the y-globulin fraction of the cerebrospinal fluid as determined by filter paper electrophoresis. The application and limitations of this estimation in the diagnosis of multiple sclerosis are discussed. Material The cerebrospinal fluids of 156 patients together with the sera in some of these cases were examined by means of paper electrophoresis. This series of patients consisted of three groups: Group 1: 81 Patients with Multiple Sclerosis.-In 13 patients the spinal fluid was examined during the first episode of the disease, and in 12 patients during an acute exacerbation characterized by significant worsening of existing symptoms or clinical evidence of fresh lesions of less than two weeks ' duration. In the remaining 56 patients the disease was considered to be chronic: there were permanent symptoms (often with severe disability) which were slowly progressive or in some cases static. The diagnosis in all instances was unequivocal; doubtful cases were excluded from the study.