Oligoclonal bands in MSers: worse prognosis?


Cerebrospinal fluid (CSF) oligoclonal bands (OB) imply intrathecal
immunoglobulin synthesis and B-cell immune process. There is scarce
evidence of OB having a role in disease prognosis. The objective of the
present study was to determine OBs prognostic value regarding disease
Between January 1994 and January 2007, relapsing-remitting MS (RRMS)
patients in which OB were determined were included. Demographic,
clinical aspects and presence of OB were analyzed. We compared OB+
versus OB- patients regarding progression to expanded disability status
scale (EDSS) of 6.0 and to secondary progressive MS (SPMS). Cox
proportional hazard models were used to compare the outcome between
groups. P values <0.05 were considered significant.
One hundred and ninety-six patients were included. In 176 patients
(90%), the CSF showed type II OB, 20 (10%) patients were OB negative.
There were no differences between age, clinical presentation and EDSS at
onset or in the immunomodulatory treatment received between OB+ and OB-
patients. Sixty-two (31.6%) patients converted to SPMS during the
follow-up, 59 (33.5%) were OB+ and 3 (15%) were OB-. EDSS of 6 was
recorded in 56 (28.5%) patients during the follow-up; 54 (31%) were OB+
while only 2 (10%) OB- patients reached this outcome (reach SP phase,
P=0.032; HR: 2.2; 95% CI: 1.3?7.5 and EDSS of 6, P=0.037; HR: 1.9; 95%
CI: 1.3?8.5).

We observed during the follow-up that OB- patients had a better
prognosis and milder disability compared to OB+ patients.

This study looked at the spinal fluid of MSers and found that those with antibodies, notably the oligoclonal bands were
more (twice) likely to have a worse outcome (prognosis) if there were
oligoclonal bands in the spinal fluid in relation to time to using a
walking stick or developing progression. 

Rojas et al. Oligoclonal bands in the cerebrospinal fluid and increased brain atrophy in early stages of relapsing-remitting multiple sclerosis.Arq Neuropsiquiatr. 2012 ;70:574-7.
determine if the presence of oligoclonal bands (OB) at early stages of
multiple sclerosis was associated with higher brain atrophy, when
compared with patients without OB.

Relapsing-remitting multiple sclerosis (RRMS) patients with less than
two years of disease onset and OB detection in cerebrospinal fluid (CSF)
were included. SIENAX was used for total brain volume (TBV), gray
matter volume (GMV), and white matter volume (WMV).

Forty patients were included, 29 had positive IgG-OB. No differences
were found between positive and negative patients in gender, expanded
disability status scale (EDSS), treatment received, and T2/T1 lesion
load. TBV in positive IgG-OB patients was 1.5 mm³ x 10(6) compared with
1.64 mm³ x 10(6) in the negative ones (p=0.02). GMV was 0.51 mm³ x 10(6)
in positive IgG-OB compared with 0.62 mm³ x 10(6) in negative ones
(p=0.002). No differences in WMV (p=0.09) were seen.

CONCLUSIONS: IgG-OB in the CSF was related to neurodegeneration magnetic resonance (MR) markers in early RRMS.

This study looked at the spinal fluid of MSers and found that those with oligoclonal bands  had a greater chance of having nerve destruction in early RRMS.

Taken together this suggests that having immune activation in your brain is more damaging

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  • If these studies are correct, then surely they are proof that early MSers with OBs need early aggressive treatment (if they want)rather than waiting for the prophesy to be fulfilled? Maybe the rules on what you can prescribe and when need to take these studies into account.

    • yes, I agree. But until we do proper confirmatory studies nobody will make decisions like this. But I can't disagree with you.

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