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Monday

 
MS AND THE SPINAL TAP
AKA: LUMBAR PUNCTURE

Your brain and spinal cord are bathed in spinal fluid. A spinal tap, also called a lumbar puncture, is a procedure that removes and tests some of this fluid to help diagnose disorders of the brain and spinal cord, including multiple sclerosis.

The fluid, called cerebrospinal fluid (CSF), contains glucose (sugar), proteins, and other substances that are also found in the blood. Analysis of the fluid includes looking at the number and types of white blood cells (infection fighting cells), the level of glucose, the types and levels of various proteins (especially immune system proteins called antibodies or immunoglobulins), and testing for bacteria, fungus, or abnormal cells.
How Does a Spinal Tap Help Diagnose Multiple Sclerosis?

A spinal tap that reveals a large number of immunoglobulins (antibodies) as well as oligoclonal bands (the pattern of immunoglobulins on a more specific test) or certain proteins that are the breakdown products of myelin is suggestive of MS. These findings indicate an abnormal autoimmune response within the brain and spinal cord, meaning that the body is attacking itself.

Over 90% of people with MS have oligoclonal bands in their CSF. While increased immunoglobulin in the CSF and oligoclonal bands are seen in many other brain and spinal cord conditions, their presence is often useful in helping to establish a diagnosis of MS.

However, a "negative" spinal tap does not rule out MS or other diseases; some 5% to 10% of people with MS never show CSF abnormalities. And, an abnormal autoimmune response in CSF is found in a number of other diseases, so the test is not specific for MS. Therefore, a spinal tap by itself cannot confirm or rule out a diagnosis of MS. It must be part of the total picture that takes into account other diagnostic procedures such as evoked potentials and magnetic resonance imaging (MRI).

How Do I Prepare for a Spinal Tap?

No preparation is needed for a spinal tap unless your doctor gives you special instructions. In most cases, you will be asked to stop taking any blood thinners, including aspirin, for a number of days before your spinal tap. If you are allergic to latex or any medications, tell your doctor.


What Happens During a Spinal Tap?

You will be asked to lie on your side with your knees drawn as close to the chest as possible or to sit with your arms and head resting on a table.

Your skin around your lower back will be cleansed and covered. You will be given a local anesthetic to numb the area. A long, thin hollow needle is then inserted in your low back between two bones in the lower spine and into the space where the CSF is located. The spinal canal is entered and fluid is collected. One to two tablespoonfuls of fluid are withdrawn. The spinal cord is never touched.

After the fluid is collected and the needle is removed, you will be asked to lie on your back or stomach for a few hours.

Your blood may be drawn and sent to the lab with the spinal fluid.

What Happens After a Spinal Tap?


After a spinal tap, your doctor may recommend that you lie down for several hours after the procedure to prevent a spinal headache. If you develop a headache, lie down as much as possible and drink plenty of fluids.

Avoid strenuous or vigorous exercise for a day or so following the spinal tap.

Is a Spinal Tap Safe?

Yes, a spinal tap is safe; however, as with most tests, there are risks. These include:

Headache. Approximately 10% of people develop a spinal headache (one that worsens when sitting or standing).
Infection. The risk of infection is extremely low.
Bloody tap. Occasionally, a small blood vessel is pierced during the procedure, causing a "bloody tap." No treatment is needed.

Warning:

Call your doctor immediately if you notice any unusual drainage, including bloody discharge, or worsening pain symptoms.
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