The Dreaded Spinal Tap

The Dreaded Spinal Tap & Tears

No matter what we call it – lumbar puncture, spinal tap, or even just LP – we all dread the idea of this procedure being done on ourselves or anyone else.1,2 The mere idea of having this done has brought many strong people to tears. The LP is done by a highly skilled medical person inserting a long, thin needle into the spine between two vertebrae and extracting a small amount of the cerebrospinal fluid (CSF) which surrounds and protects our brain and spine. The test is done for a number of different inflammatory diseases and is routinely used to substantiate the diagnosis of Multiple Sclerosis. There are markers in the CSF called o-bands, that can indicate the possibility of a demyelinating disorder, but it doesn’t prove we have MS. It’s a test I keep hoping will fall out of favor because it is such a scary prospect to be told you need a spinal tap.

I must say my LP was done by my neurologist in his office, with absolutely no complications. As soon as it was complete, he sent me on my way and even though I had been forewarned about the dreaded post-LP headache, I had no problems. Unfortunately not everyone is so lucky and I have read that up to 25% of all people who have an LP develop this headache , which comes from the puncture wound not healing rapidly and allowing the CSF to leak from the spinal column. The headache only occurs when the person is standing – it doesn’t hurt while lying down, which is often the only prescribed cure. For extreme LP headaches the doctor may do a blood patch – taking a small amount of blood and injecting it into the place where the CSF is leaking. The blood patch works like a natural bandage and seals the minute puncture wound.

The LP isn’t the most comfortable of test procedures to undergo, but is often essential. The LP is also used for people who have been on nataluzimab (Tysabri) and may be showing suspicious signs of converting to JC virus positive status, which would increase the risk of developing PML. PML is shorthand for progressive multifocal leukeoencephalopathy, a rare brain infection that has been associated with the use of Tysabri by people who are JC Virus positive.

Although I came through my LP with no problems, it’s not a test I would quickly volunteer to do again and now it turns out there may be an alternative way to sample the CSF. Researchers in France released the results of their study Tear analysis as a tool to detect oligoclonal bands in radiologically isolated syndrome.

They studied a group of people (n=45) who had been diagnosed with Radiologically Isolated Syndrome (RIS). RIS is where the MRI tests show areas that may be MS, but there are not the other clinical signs to support a diagnosis of Multiple Sclerosis. The researchers were looking at alternate ways to collect our bodily fluid that might show markers of oligoclonal bands (OCBs).

They looked at the question if our tears can be tested for the same markers as those in our CSF obtained through an LP. In place of the long needles, they used strips of paper that wick away the moisture from the eyes and can be tested for OCBs. Some of you may have had this type of test done at the ophthalmologist when being checked for dry eyes. I had this done by mine and it was more uncomfortable than my LP – having strips of cardboard stuck under my eyelids for several minutes was a different form of physical torture. It literally brought tears to my eyes, which I guess was the point anyway.

The results of this intial trial with a small sample of participants looks promising. They found “In 45 recruited RIS patients, OCBs were detected in CSF for 55% (25/45) and in tears for 50% (21/42) of samples.” That number is pretty close to each other and it looks like they may be on to a good thing to change how the CSF is tested.

It has long been the thought of going through the lumbar puncture would reduce even the strongest people to tears in fear of the procedure. If further tests show this is a reliable method, the shedding of tears over the collection of CSF would be welcome.

Wishing you well,
Laura

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