An alternative test for oligoclonal bands again

Hassan-Smith G, Durant L, Tsentemeidou A, Assi LK, Faint JM, Kalra S, Douglas MR, Curnow SJ.High sensitivity and specificity of elevated cerebrospinal fluid kappa free light chains in suspectedmultiple sclerosis. J Neuroimmunol. 2014. pii: S0165-5728(14)00236-7. doi: 10.1016/j.jneuroim.2014.08.003. [Epub ahead of print]

Cerebrospinal fluid (CSF) analysis is routinely used in the diagnostic work-up of multiple sclerosis (MS), by detecting CSF-specific oligoclonal bands (OCB). More recently, several studies have reported CSF free light chains (FLC) as an alternative. We show that absolute CSF κFLC concentrations were highly sensitive – more than OCB testing – and specific for clinically isolated syndrome, relapsing remitting and primary progressive MS. Measurement of κFLC alone was sufficient. Our results suggest that CSF κFLC levels measured by nephelometry, if validated in a larger series, are a preferred test to OCB analysis in the diagnostic work-up of patients suspected of having MS.
On of the diagnostic tests in MS the presence of oligoclonal bands
another test is the presence of free immunoglobulin light chains.  This study suggests they could be better however we have posted on this before and what specificity and sensitivity means as well as whether oligoclonal bands have had there day.

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  • Hi Prof Mouse.
    Do they specify their reference values for normal k- and l-FLC levels?
    This test is performed routinely alongside with OCB test where I do live. Although the readings are ambiguous.
    E.g. laboratory specified normal range is 0-0.5ug/ml (kappa) and 0-0,1 ug/ml (lambda) and my test is considered negative by them, but consulting neuro said the correct range is 0-0.05 for kappa and thus test is positive. Although she gave no reference and I could not find anything on this in the available literature as most of it on FLC ratio and not absolute numbers. I wonder who is right there.

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