oligoclonal bands can be fouund if you look hard enough

Halbgebauer S, Huss A, Buttmann M, Steinacker P, Oeckl P, Brecht I, Weishaupt A, Tumani H, Otto M.Detection of intrathecal immunoglobulin G synthesis by capillary isoelectric focusing immunoassay in oligoclonal band negative multiple sclerosis.
J Neurol. 2016 Mar 19. [Epub ahead of print]

Oligoclonal immunoglobulin G bands (OCBs) restricted to the cerebrospinal fluid indicate intrathecal inflammation. Using isoelectric focusing and immunoblotting, they are detected in about 95 % of patients with clinically definite multiple sclerosis (MS). To elucidate whether in the remaining 5 % OCBs are truly absent or alternatively missed due to insufficient sensitivity of the routine measurement, we employed a new, highly sensitive nanoscale method for OCB detection. Capillary isoelectric focusing followed by immunological detection served to analyze OCBs in 33 well-characterized OCB-negative and 10 OCB-positive MS patients as well as in 100 OCB-negative control patients with non-inflammatory neurological diseases and 30 OCB-positive control patients with inflammatory neurological diseases. We detected intrathecal immunoglobulin G production in 10 out of 33 MS patients (30 %), initially diagnosed as being OCB-negative, and in all 10 OCB-positive MS patients, but in only 3 out of 100 non-inflammatory neurological controls (3 %) and in 29 of 30 inflammatory neurological controls (97 %). At least about one-third of MS patients without intrathecal immunoglobulin G synthesis according to standard methods are OCB-positive. Advanced methods for OCB detection may increase the analytical sensitivity for detecting OCB in patients with MS who are OCB-negative according to current routine methods.
This study looks at oligoclonal bandsand negative people and says that if you look hard enough they can be found 

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  • If clinical history, physical symptoms, and MRI are all saying it is MS and other diseases have been ruled out, is there any real value in being able to stick a needle in someone and use a more sensitive test just to prove MS?

    My maths is probably up poo creek, but it looks to me that based on the above numbers the percentage of people testing positive for OCBs would only go from 95% to 96.5% with use of the more sensitive test. As proving whether someone has OCBs or not isn't exactly a life or death scenario, is there much point to this?

  • I know particularly a case of a brazilian who lives in Finland and began to show symptoms suaggestives of MS.
    All other also suggestives diseases were excluded only left to MS, but since she had to check the negative oligloconals bands, even with demyelinating lesions filling CIS, it was not offered early treatment…

    This issue of oligloconals bands always intrigued me.
    Negative people know for oligloconals bands that have a more aggressive course of the disease and positive people to know the bands and which apparently has a milder course…

    • I feel there are many factors that can trigger relapses and make an MSers course of disease more or less aggressive.

      Infections triggering relapses – how well the MSer is in general, are they underweight?, healthy diet? are they in contact frequently with people with infections? such as toddlers who pick up many infections. Stress and anxiety triggering relapses. Heat can make symptoms feel worse. Sleep deprivation caused by many things can impact the immune system. These factors too I am sure will impact on recovery from relapses.

  • Firsy symptom 3/2015, diagnosed 4/2015. I had 14 o-bands in CSF and after 1 year of new symptoms popping up on a weekly basis, my neuro has finally started to believe that I may have a progressive course. Im just wondering, ocbs are just a marker of inflammation correct? Just because OCBs are found it does not mean you have MS 100%. You still have to rule out everything else correct?

    • You are totally correct, OCBs are far away of being MS-specific and other diseases (especially neuroinflammatory diseases) have to be ruled out. But this normally happens together with MRI and also the CSF analyses, as in the CSF analysis not only OCBs are performed but numberous more paramteres can be determined that greatly help in ruling out other diseases (e.g. Antibody specificity indices). That's why CSF diagnostics are so helpful!

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