Myelin basic protein in the cerebrospinal fluid of patients with neurological disease: especially with malignant brain tumors
Nakagawa, H.; Fujita, T.; Tsuruzono, K.; Kubo, S.; Yamada, M.; Miyawaki, Y.; Tokiyoshi, K.; Kanayama, T.; Hasegawa, H.; Koshino, K.
No Shinkei Geka. Neurological Surgery 22(2): 111-118
1994
ISSN/ISBN: 0301-2603 PMID: 7509461 Document Number: 426042
Myelin basic protein (MBP) in the cerebrospinal fluid (CSF) of patients with brain tumors and other neurological diseases was measured before, during and after various treatments such as surgery, chemotherapy and irradiation. We assessed the significance of changes in the MBP levels during the course of treatment, and speculate on what the elevated level of MBP in brain tumor patients indicates. In meningeal dissemination of malignant tumors, meningeal carcinomatosis from cancer of the systemic organ showed the highest level of MBP followed by meningeal gliomatosis and meningeal lymphoma. Meningeal carcinomatosis and meningeal lymphoma, which have responded to chemotherapy, showed normal levels of MBP after chemotherapy. Six of eight patients with newly diagnosed malignant glioma showed moderate to high levels of MBP (range 4.6 - 35.5 ng/ml) just before intraarterial chemotherapy with VP-16 and CDDP. The level increased in five patients during the course of chemotherapy and then decreased in relation to the degree of tumor reduction by chemotherapy. In the solid type of metastatic brain tumor, five of seven patients with multiple tumors showed high levels of MBP and these levels also returned to normal after treatment in four patients. As for the influence of irradiation, levels of MBP did not increase after irradiation except in three patients who developed radiation necrosis, local extensive edema or atrophic change. In other brain tumors, levels of MBP were high in a patient with a large meningioma with very extensive edema and during an unstable postoperative condition after total removal of a large craniopharyngioma. However, benign tumors did not show abnormal levels of MBP in general, even though they were large. Other neurological diseases, hydrocephalus, bacterial meningitis and hemorrhagic infarction showed high levels of MBP, but the former two returned to normal after treatment. MBP reflects not only the severity of brain damage but also the effects of treatment. MBP may be a marker indicating the prognosis of disease. Cyst fluids of malignant glioma showed the highest levels of MBP and it is speculated that MBP may be derived from the tumor itself or the brain adjacent to the tumor. The mechanism of MBP increase in malignant brain tumors should be studied further.