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Os caracteres gerais do método eletroforético são apresentados de modo sumário, especialmente aquêles referentes à eletroforese em papel, no sentido de familiarizar o neurologista quanto aos seus aspectos principais e sua utilização no estudo das frações proteicas do liqüido cefalorraquidiano cujos aspectos particulares são discutidos. The main aspects of electrophoresis are summarised, specially those concerning paper electrophoresis, as a practical guide for neurologists, in its appliance to the study of cerebrospinal fluid protein fractions.

In order to analyse the paper strip electrophoresis contribution to the knowledge of cerebrospinal fluid (CSF) proteins in cysticercosis of the central nervous system (CNS) 40 patients were studied (identification data in table 1); the clinical forms and diagnostic data of 30 of them, who had CNS cysticercosis (cases 1 to 30) are summarized in the table 2; cysticercosis of the CNS might play a role in the pathologic condition presented by the remaining 10 patients. CSF protein fractions were examined in all the cases (results in tables 4 and 7) and those of blood sera in cases from 1 to 15 (results in table 5) by paper strip electrophoresis under the specifications previously reported54. A second examination of CSF protein fractions was made some time later in 4 cases (results in table 6). CSF samples were analysed also in respect to cytology, total protein content, Pandy and colloidal benzoin reactions and complement fixation tests for syphillis and cysticercosis (results in table 3). The values obtained for CSF protein fractions were compared to norma) values found in 30 control subjects; these normal values were detailed in a prior publication55 and are summarized in table 8. This comparison shows that CNS cysticercosis produces changes in the electrophoretic prophiJe of CSF proteins (table 9); an increased y-globulin fraction was the main change observed, commonly associated to a low j8-globulin relative concentration. An inversion of a1/a2 quocient was found in 4 cases. The contributions to the study of CNS cysticercosis resulting from the electrophoretic analysis of CSF proteins are discussed in three groups: 1 - Informations obtained by paper electrophoresis of CSF proteins are independent from those resulting from the other laboratory aspects studied. Thus, if the protein fractions of blood sera are considered, although the changes found have mean values similar to those found to the CSF protein fractions (table 10), it was observed that there are individual differences in the protein fraction relative concentrations in blood and CSF (table 11), no correlation being found between them. Considering CSF itself, changes in its protein fractions induced by CNS cysticercosis are similar in ventricular and subarachnoid samples (lumbal and cisternal) (table 13); their intensity is related to the intensity of the whole of CSF changes (table 12). Informations obtained by electrophoretic analysis of CSF proteins, however, differ from those resulting from the other examinations conducted in the CSF sample as was shown in the analysis of cytology (tables 14 and 15), total protein content (table 16), colloidal benzoin reaction and positivity of complement fixation test for cysticercosis. 2 - The clinical value of data achieved by CSF proteins electrophoresis is discussed. Results may have an important role in diagnosis, in the knowledge of its clinical forms (table 17) and in the control of evolution if pathogenetic mechanisms involved in disease are considered. Cases 31 to 40 illustrate the clinical aspects of contributions given by CSF electrophoresis. 3 - The CSF protein fractions changes found in CNS cysticercosis justify their classification among those changes commonly observed in subchronic and chronic inflammatory diseases of the CNS and/or its leptomeningeal coverings. It is assumed in the literature that there occurs a local production of globulins, specially the y-globulin fraction, in such pathologic conditions. Concerning CNS cysticercosis, if CSF total protein content and electrophoretic data on its fractions are considered together (table IS and 19; graph. 1), it is possible to evidence that at least two mechanisms participate in the origin of protein changes (tables 20 and 21; graph. 2) : blood-CSF barrier disturbances are able to explain data concerning albumin, a and globulin changes, which are similar; the local production of y-globulin is the hypothesis most reliable to explain the peculiar changes of this fraction. This hypothesis agrees with literature data concerning other chronie inflammatory diseases of the CNS. The probable role of y-globulin in carrying specific antibodies is pointed out through correlative exploration of its concentration in the CSF sample and the corresponding positivity of complement fixation test for cysticercosis.

Partindo dos dados referentes à aplicação da eletroforese em papel de filtro na separação das frações proteicas do LCR, apresentados em publicação anterior, são revistos os dados da literatura sob o ponto de vista do laboratório clínico. Tanto os valores relativos normais referentes a cada uma das reações proteicas, como alterações patológicas mais freqüentemente encontradas em diversos tipos de afecções do sistema nervoso são apresentados, ressaltando-se a importância dos achados frente à fisiopatologia do liqüido cefalorraquidiano e frente à Clínica Neurológica. Data on the use of paper electrophoresis in the study of cerebrospinal fluid proteins are reviewed as to show the importance of this method for the clinical laboratory. The mean of protein fractions concentration as well as the references concerning to pathologic findings are presented and discussed. The main aspects of contributions in this field are discussed, showing the aid brought by the protein electrophoretic studies to the physiopathology of cerebrospinal fluid and to pathogenetic interpretations of some nervous diseases.

Foram analisadas, mediante electroforese em papel, as proteínas do LCR cisternal de 30 pessoas adultas (13 sadias e 17 portadoras de neuroses); as médias encontradas em relação às diversas frações proteicas foram as seguintes: pré-albumina 2,2%; albumina 51,6%; globulinas α1 5,0%, α2 8,7%, β (incluindo os percentuais da fração τ) 21,6% e γ 10,9%. Em relação aos resultados encontrados para as frações proteicas do soro sangüíneo de 30 pessoas adultas (17 normais e 13 portadoras de neuroses) incluindo 7 daquelas cujo LCR foi estudado, o perfil das proteínas do LCR mostrou-se diferente, pois no LCR verifica-se a presença da fração pré-albumina, maior riqueza em globulinas β e pequeno teor de γ-globulina. Cisternal cerebrospinal fluid (CSF) protein fractions were studied by paper electrophoresis. Through sub-occipital puncture samples were collected from 30 adults (age range from 15 to 45 years old) : 13 healthy people and 17 psychoneurotic patients, without past history of neurologic disease and/or evidence of organic affection. Syphilis serology was negative in all cases as well as CSF showed any abnormality in respect to pressure, aspect, color, cytology, total protein content, colloidal reactions, syphilis and cysti-cercosis complement fixation tests. Technical details were previously described; protein concentration was achieved by dyalisis against 30% poli-vinylpirrolidone at 4°C. Results are detailed in the table 1; mean values obtained for protein fractions were: pre-albumin 2.2%, albumin 51.6%, globulins: α1 5.0%, α2 8.7%, β 21.6% (including the τ fraction) and γ 10.9%. There was any significative difference between results found in normal people and in psychoneurotic patients. The values found are in agreement with those reported by Mumenthaler and Marki from data published until 1956. For comparison purposes the author's data are presented together with others obtained by several investigators (table 4). The results were compared to those found in sera from 30 adults selected in the same way and analysed by the same technique (table 2). Comparison showed similar results when the means found in respect to all sera and CSF samples were considered or when means found for seven cases in which it was possible to analyse CSF and serum proteins simultaneously were considered (table 3). Albumin (including pre-albumin) and α-globulins have similar relative patterns in both CSF and serum protein profiles, but those of β and y-globulins are disimilar. As far as to the sera, CSF proteins have relatively more jg-globulin (1.5 to twices) and less y-globulin (0.5 approximately).

O presente trabalho é baseado no estudo dos perfis eletroforéticos das proteínas do líquido cefalorraqueano de 300 pacientes normais ou portadores de diversas entidades neurológicas. Analisando êste material, os autores verificaram que a gama-globulina é a fração protêica cuja variação tem grande importância na prática neurológica para o diagnóstico diferencial. A principal conclusão a que chegaram indica que há dois diferentes mecanismos que atuam na alteração do perfil eletroforético das proteínas do líquor: a) alteração da permeabilidade da barreira hêmato-encefálica; b) liberação intratecal de gama-globulina. Portanto, o método eletroforético não permite o diagnóstico de determinada entidade neurológica, mas indica o mecanismo fisiopatológico em atividade. This paper is based on the study of the protein profile of the cerebrospinal fluid of 300 neurological patients. This material was analysed in the same way as that one performed by Matiar and Schmidt (1958) and it was found almost the same results. These findings suggested the great value of the cerebrospinal fluid gamma-globulin concentration in the neurological differential diagnosis. In order to enlarge these studies in our own material, it was tried to find some correlation between albumin and globulin fractions expressed in mg/100 ml. The logarithm of albumin concentration was plotted graphically against the logarithm of globulin concentration; each disease was noted down as different symbols. It was verified linear bilogarithmic correlation between albumin and each globulin fraction. Graphs with albumin/alpha-globulin or with albumin/beta-globulin showed absence of characteristic disease behaviour. On the contrary, the graph with albumin/gamma-globulin showed a typical behaviour for neurolues and brain cysticercosis data. Assuming that the cases of spinal block may very well indicate the condition where the changes of the spinal fluid proteins were due to a modification of permeability of the blood-brain barrier, it was calculated the regression equation for the various gamma-globulin concentrations of these cases. It was found that most of the cases of brain tumors, intracranial hemorrhages, meningitis and polyradiculoneuritis were in perfect agreement with the cases of spinal block, suggesting that in these cases the protein changes were due to a modification of permeability of the blood-brain barrier. On the contrary, the great majority of the cases of neurolues and brain cysticercosis did not follow this pattern, suggesting that there was an increase of the spinal fluid gamma-globulin which must be originated intrathecally. These findings point out to two different mechanisms in the changes of the protein profile of cerebrospinal fluid and, therefore, electrophoresis did not allow the diagnosis of a determined neurological disorder, but it shows the particular physiopathological mechanism involved. Escola Paulista de Medicina Serviço de Neurologia UNIFESP, EPM, Serviço de Neurologia SciELO