Prof. Bernhard Hemmer MD PhDDirector of the Neurology ClinicTechnische Universität München

Multiple Sclerosis: Elevated IgG Linked to Risk of More Severe Disease Interview with:

Prof. Bernhard Hemmer MD PhDDirector of the Neurology ClinicTechnische Universität München

Prof. Hemmer

Prof. Bernhard Hemmer MD PhD
Director of the Neurology Clinic
Technische Universität München What is the background for this study? What are the main findings? 

Response: The course of multiple sclerosis (MS) is still highly unpredictable and reliable markers to predict disability progression are largely missing. We found that patients with a high IgG Index, which means that the produce large amount of IgG within the CNS, have a higher risk of disease worsening during the first 4 years. I would consider patients with an elevated IgG index at a higher risk to run a more severe disease course. The marker could be used together with others to guide treatment decisions after multiple sclerosis diagnosis. What should readers take away from your report?

Response: Perform a spinal tap during the diagnostic work up in multiple sclerosis . CSF findings help to exclude differential diagnoses, increase diagnostic accuracy and may help allow better prediction of prognosis. Should be done in every patient What recommendations do you have for future research as a result of this work? 

Response: We need long term prospective studies to demonstrate that the marker has a predictive value for long term outcome. It would also be important understand the pathomechanistic link between intrathecal IgG synthesis and disease worsening.

No relevant disclosure 


Gasperi C, Salmen A, Antony G, et al. Association of Intrathecal Immunoglobulin G Synthesis With Disability Worsening in Multiple Sclerosis. JAMA Neurol. Published online April 29, 2019. doi:10.1001/jamaneurol.2019.0905

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Last Updated on April 30, 2019 by Marie Benz MD FAAD