Engel Mia¹, Martin Leo², Walsh Amelie³, Otto Luca⁴, Hammond Sophie⁵, Huber Emil⁶
ABSTRACT:
Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system characterized by heterogeneous clinical manifestations and disease courses. Cerebrospinal fluid (CSF) analysis provides unique insights into MS pathophysiology, aiding diagnosis, prognosis, and treatment monitoring. This review evaluates established CSF biomarkers, including oligoclonal bands (OCBs), immunoglobulin G (IgG) index, and novel candidates such as neurofilament light chain (NfL), chitinase-3-like-1 (CHI3L1), and glial fibrillary acidic protein (GFAP). We discuss their roles in differentiating MS subtypes, predicting disease progression, and assessing treatment responses. Technological advances in high-sensitivity assays and multi-omics approaches are highlighted, alongside challenges in standardization and clinical validation. The integration of CSF biomarkers with imaging and serum markers promises to advance precision medicine in MS management.