Here is My Question:
Does the number of oligoclonal bands found in CSF determine the prognosis of your MS? What is an”median” number of bands found in someone with MS? My LP revealed 14 bands and I wondered how this relates to my MS diagnosis and prognosis?
The term "CSF (Cerebrospinal Fluid) Oligoclonal bands", or sometimes shortened to Oligoclonal bands, refers to the presence of several unique immunoglobulins (also called antibodies) in the spinal fluid that cannot be identified in a matched plasma sample. This is a qualitative test that requires some experience for the identification of the individual band number in the sample. The proteins within the body fluid being sampled (plasma or CSF or whatever) are separated on an agarose gel by their size and electrophoretic properties (remember, proteins have an electric charge) and stained for visualization. The staining process reveals the migratory location of the various proteins on the gel for visualization (see below). Counting individual bands can be difficult if they are faint or overlap with other protein bands, but various techniques have been developed over the years to improve the resolution of the assay. The picture that follows (reproduced many times in other publications and online) gives you an idea of the qualitative nature of the assay. The left-hand panel for both the normal and abnormal patient (abnormal referring to the one with multiple sclerosis) is the CSF banding pattern and the right-hand panel on each side is the plasma sample from the same person. It is easy to identify the different staining patterns in the CSF immunoglobulin region from the person with MS compared to the "normal" person without MS (both labeled), but I challenge you to count the number of bands in this region from the CSF sample that are not present in the adjacent plasma sample.
So, this is how the assay is done. What does it mean? The presence of 2 or more CSF oligoclonal bands is a sensitive diagnostic marker for MS in the correct clinical circumstances(positive predictive values of 95 % in some circumstances).This means that CSF oligoclonal bands can be seen in other conditions and cannot be used alone to diagnose MS but is extremely useful and predictive in the right circumstances.
More recent studies suggest that the number of oligoclonal bands is predictor of disease severity. In one study of people with a first attack of MS, the median number of oligoclonal bands at onset was 8 and those individuals with more than 8 oligoclonal bands at onset experienced more disease activity. In another study of people with known MS on DMTs, those with greater than 10 oligoclonal bands experienced a worse prognosis. At present there is no accepted cut off for a number of oligoclonal bands that indicate a worse prognosis. We prefer to use several pieces of information, including the number of CSF oligoclonal bands, to make this assessment. This information may include other biomarkers such as CSF free kappa light chains or serum neurofilament light chain measurements. These are particularly good measures because of their associations with disease activity and severity and the quantitative and sensitive nature of the assays used. We also use demographic features (age and sex), clinical features, responses to prior treatments and MRI measurements to help with prognostication. Hopefully, we will be able to develop a panel of measures in the future that when combined allow us to both prognostic risk of disease activity and response to treatment.
Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
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