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Correspondence
Lumbar drains can affect CSF biomarker levels
  1. Claudia Louise Craven1,
  2. Miles D Chapman2,
  3. Linda D’Antona1,
  4. Simon D Thompson1,
  5. Neghat Lakdawala2,
  6. Henrik Zetterberg3,4,5,
  7. Laurence D Watkins1,
  8. Ahmed K Toma1
  1. 1Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
  2. 2Department of Neuroimmunology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
  3. 3Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
  4. 4Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
  5. 5UK Dementia Research Institute at UCL, London, UK
  1. Correspondence to Dr Claudia Louise Craven, Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; claudia.craven{at}gmail.com

https://doi.org/10.1136/jclinpath-2018-205296

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    Tau and Aβ1–42 are two conventionally measured cerebrospinal fluid (CSF) biomarkers that can assist with the diagnosis of neurodegenerative disease. In Alzheimer’s disease, a high CSF total-tau (T-tau) concentration reflects neuroaxonal degeneration/injury and low CSF Aβ1–42 correlates with senile plaque pathology.1

    There is evidence that these markers could be useful in the diagnosis of normal pressure hydrocephalus (NPH). In NPH, lumbar CSF levels of Tau and Aβ1–42 are typically low or low/normal (respectively), and could potentially discriminate from Alzheimer’s disease, in addition to being a putative prognostic marker for shunt responsiveness.2 3

    When measured in the context of investigating NPH, CSF is usually sampled from the lumbar drain (LD), in situ as part of the diagnostic protocol.4 Increasingly lumbar drains are also being used in study protocols to obtain longitudinal biomarker results (to avoid multiple lumbar punctures (LP)).5

    CSF transfer between collection tubes is known to reduce the overall concentration of Aβ1–42 by 25% due to adsorption to the ionic surfaces.6 It is unclear if the same effect is observed when CSF is sampled from lumbar drain. We investigated the effect of both silver-lined (Silverline, Spiegelberg) and barium-impregnanted (EDM, Medtronic) lumbar catheters, versus LP on concentrations of Aβ1–42 and T-tau in …

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    Footnotes

    • Contributors All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content, and (3) final approval of the version to be submitted.

    • Competing interests LDW has received honoraria from and served on advisory boards for Medtronic, Bbraun and Codman. Other authors have no competing interests to declare.

    • Patient consent Not required.

    • Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethic committee approval was not required for this type of study.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Presented at Portions of this work were presented in abstract form at the Hydrocephalus 2017 International Society for Hydrocephalus and Cerebrospinal Fluid Disorders Conference, Kobe, Japan, September 2017.