intracranial hypertension in pediatric MS

[Cece]

https://www.ncbi.nlm.nih.gov/pubmed/27909013

Children with MS were compared to children with primary intracranial hypertension. Both groups had comparable cerebrospinal fluid opening pressure, which is the pressure reading taken at the start of a spinal tap. It does not mention a control group but presumably both the pediatric MS group and the pediatric primary intracranial hypertension group have higher opening pressures than a healthy group would.

If this is true for pediatric MS, is it true for adult MS? Are there treatments given for intracranial hypertension that can be given for MS (Diamox, for example)? What is causing the higher than normal opening cerebrospinal fluid pressure in pediatric MS? Is it the CCSVI explanation, which would be due to poor drainage?

[ThisIsMA]

Hi Cece,

That's a good find, and an Interesting article. I hope Dr. Sclafani still reads this site. Or other CCSVI Doctors...

I don't have the medical background to decipher what it means, but it does seem like another clue.

Its sure frustrating that so many years have passed and we still don't have an answer. I haven't stopped by for awhile. Its good to see that you're still here Cece, and that you're still posting new information. Thank you!

M.A.

[centenarian100]

It looks like this is an error

There is massive difference in average opening pressure between the two groups. From the article:

"The cerebrospinal fluid opening pressure mean was 25.6 cm H20 in the demyelinating disease group and 35 cm H20 for the primary intracranial hypertension group (P = .1281)."

It's just that there were relatively few patients and a high standard deviation. I actually checked the p values (https://www.graphpad.com/quickcalcs/ttest2/), and they are roughly correct (note that this is not exactly accurate because I don't have the raw data with individual values). The reviewers should have made them edit the abstract given very low power.

Interestingly, In the data (table 2), they say the difference was 26.9 vs. 33.1. I'm not sure of the cause of the discrepancy.

However, an opening pressure of 25.6 is somewhat high.

-cent

[Cece]

J Child Neurol. 2016 Nov 30. pii: 0883073816681936. [Epub ahead of print]

Comparison of Cerebrospinal Fluid Opening Pressure in Children With Demyelinating Disease to Children With Primary Intracranial Hypertension.
Morgan-Followell B1, Aylward SC2.

Abstract
The authors aimed to compare the opening pressures of children with demyelinating disease to children with primary intracranial hypertension. Medical records were reviewed for a primary diagnosis of demyelinating disease, or primary intracranial hypertension. Diagnosis of demyelinating disease was made according to either the 2007 or 2012 International Pediatric Multiple Sclerosis Study Group criteria. Primary intracranial hypertension diagnosis was confirmed by presence of elevated opening pressure, normal cerebrospinal fluid composition and neuroimaging. The authors compared 14 children with demyelinating disease to children with primary intracranial hypertension in 1:1 and 1:2 fashions. There was a statistically significant higher BMI in the primary intracranial hypertension group compared to the demyelinating group (P = .0203). The mean cerebrospinal fluid white blood cell count was higher in the demyelinating disease group compared to primary intracranial hypertension (P = .0002). Among both comparisons, the cerebrospinal fluid opening pressure, glucose, protein and red blood cell counts in children with demyelinating disease were comparable to age- and sex-matched controls with primary intracranial hypertension.

Here is the full abstract. So it sounds like that statement I bolded is not supported. That's disappointing. Thank you, centenarian100.


https://www.aliem.com/2016/tips-for-int ... -pressure/

The normal range for CSF is reported differently in various sources, with most reporting a normal range of 7-18 cmH2O in adults,1 though some consider the normal range 5-25 cmH2O.2 However, a pressure >25 cmH2O or <5 cmH2O should certainly prompt you to look for a source.

Here it says that a pressure higher than 25 should prompt you to look for a source, despite it being on the outer edge of normal for adults. I haven't looked to see if pediatric is different than adult in this. Have there been studies of opening pressure in adults with MS? I wonder.

[Cece]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445641/

Here's another article on elevated lumbar puncture opening pressure in pediatric demyelinating disease patients.

Although this study was limited by its retrospective nature and limited sample size, our data confirm that elevated cerebrospinal fluid opening pressure does occur in pediatric patients with acute demyelinating disease; investigations for additional causes of elevated opening pressure in these patients may be unnecessary. As clinical and visible radiologic variables do not explain this finding in our pediatric demyelinating cohort, further understanding may require assessment of cerebrospinal fluid flow dynamics.