Abstract Background and Objectives: Cerebrospinal fluid (CSF) kappa free light chains (KFLCs) are emerging biomarkers of intrathecal immunoglobulin synthesis in multiple sclerosis (MS) and have been included as supportive markers in the 2024 McDonald criteria. However, data from the Indian subcontinent remain limited. The study aimed to evaluate the diagnostic performance of the KFLC index for MS and examine its association with laboratory and magnetic resonance imaging (MRI) biomarkers. Methods: In this cross-sectional study, adults (≥18 years) with MS, inflammatory controls (neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, seronegative optic neuritis), and non-inflammatory controls (idiopathic intracranial hypertension, normal pressure hydrocephalus) were enrolled. KFLC was measured in paired CSF and serum, and the KFLC index was calculated. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis, and associations with oligoclonal bands (OCBs), IgG index, disability (EDSS), and MRI biomarkers: central vein sign (CVS) and paramagnetic rim lesions (PRL) were evaluated. Results: Forty patients were included (22 MS, 12 inflammatory controls, 6 non-inflammatory controls) over six months. KFLC index was higher in MS (median 24 [interquartile range 9–54]) than in inflammatory (4 [3–10]) and non-inflammatory controls (6 [4–7]) ( P < 0.001). ROC analysis showed good performance (area under the curve [AUC] 0.855); a cutoff of 7.40 yielded 86.4% sensitivity and 72.2% specificity. KFLC positivity demonstrated moderate concordance with OCBs (κ = 0.55). KFLC index was significantly higher in patients with CVS and PRL but showed no correlation with IgG index or EDSS. Conclusions: KFLC index shows good diagnostic performance for MS and correlates with MRI biomarkers, supporting its clinical utility in the Indian setting.
Abstract Background and Objectives: Post-stroke spasticity is a common and disabling complication that hinders functional recovery. The aim of this study was to identify admission variables associated with the development of spasticity in patients with first-ever stroke. Methods: This prospective observational study enrolled consecutive adults with clinically and radiologically confirmed ischemic or hemorrhagic stroke within 7 days of onset, from July 2019 to September 2020. Baseline demographic, clinical, and radiological data were collected. The primary outcome was spasticity at 3 months, defined as a Modified Ashworth Scale score of 1 or higher in at least one affected joint. Results: Of 160 eligible patients, 149 completed follow-up and were analyzed. Spasticity developed in 106 patients (71.14%) at 3 months. In multivariable logistic regression, only the admission National Institutes of Health Stroke Scale score was strongly associated with an increased risk of spasticity at 3 months (adjusted odds ratio: 2.17, 95% confidence interval: 1.53–3.07). Conclusions: Simple bedside markers available during acute stroke management may help identify patients at high risk of developing spasticity. The initial stroke severity is the strongest predictor of subsequent spasticity.
