Rodica Bălaşa: The Role of CSF Analysis in Multiple Sclerosis Diagnosis – Balancing Non-Invasive Tools and Biomarkers

In this short interview, Rodica Bălaşa discusses the evolving role of cerebrospinal fluid (CSF) analysis in the diagnosis of multiple sclerosis, particularly in light of the 2024 revision of the McDonald criteria.

Although non-invasive investigations remain central to the diagnostic work-up, CSF continues to serve as an important complementary tool in selected patients. Rodica also addresses how advances in kappa free light chain testing have renewed interest in this established biomarker when additional diagnostic clarity is needed.

Watch the interview

When is cerebrospinal fluid analysis still necessary in the diagnosis of multiple sclerosis?

In the interview, Rodica Bălaşa outlines a pragmatic, stepwise approach to multiple sclerosis diagnosis, emphasizing the preference for non-invasive investigations while highlighting the continued relevance of cerebrospinal fluid analysis in selected cases.

Key points discussed include:

• Why MRI remains the preferred first-line diagnostic tool in multiple sclerosis
• The role of complementary non-invasive assessments in strengthening diagnostic certainty
• How the 2024 revision of the McDonald criteria reinforces the place of CSF biomarkers
• In which clinical situations imaging and clinical findings alone may be insufficient
• When CSF analysis becomes necessary to provide additional biological evidence
• The importance of a pragmatic, stepwise diagnostic approach

What is the current relevance of CSF analysis in diagnosing MS today?

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Key messages from Rodica Bălaşa

Non-invasive investigations remain the foundation of multiple sclerosis diagnosis, with MRI serving as the central tool in most cases. In this interview, Rodica Bălaşa underscores the importance of prioritizing patient-friendly assessments whenever possible.

At the same time, cerebrospinal fluid analysis continues to play a meaningful role within the updated McDonald criteria. While not required routinely, it provides valuable biological evidence in situations where clinical and imaging findings do not offer sufficient certainty.

Overall, the discussion reinforces a pragmatic, stepwise approach, starting with non-invasive methods and reserving CSF analysis for cases in which additional diagnostic support is needed.

Curious to learn more about the expert behind this interview?

Visit Rodica Bălaşa’s full biography for more insights into her expertise.

Rodica Bălaşa

Professor of Neurology at the University of Medicine, Pharmacy, Sciences and Technology „George Emil Palade” of Targu Mures (UMFST), Romania
Head of the Neurology 1 Clinic, Emergency Clinical County Hospital of Mures, Romania
Main field of research interest is the diagnosis and management of multiple sclerosis, cerebrospinal fluid biomarkers, and neuroimaging.
Active contributor to the development of diagnostic criteria and innovative approaches in MS care.

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