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content:csf_immunoglobulins [2022/04/30 22:16] – administrator@icnapedia.org | content:csf_immunoglobulins [2024/03/08 19:44] – [Interpretation] administrator@icnapedia.org | ||
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====== Oligoclonal bands ====== | ====== Oligoclonal bands ====== | ||
- | + | Oligoclonal bands (OCBs) are bands of immunoglobulins that are seen when a patient' | |
- | The presence of two or more bands of immunoglobulin on isoelectric focusing (IEF ) of | + | |
CSF is referred to as ' | CSF is referred to as ' | ||
indicative of local CNS IgG production when the banding pattern in the CSF is distinct | indicative of local CNS IgG production when the banding pattern in the CSF is distinct | ||
- | from the pattern seen in the serum. For this reason a serum sample must be sent with a | + | from the pattern seen in the serum. |
- | CSF sample, as is done of course for the CSF:serum IgG index. | + | |
While OCBs are well known to assist in the diagnosis of multiple sclerosis it is | While OCBs are well known to assist in the diagnosis of multiple sclerosis it is | ||
- | important to recognize that they are found in many other situations | + | important to recognize that they are found in many other situations |
- | (subacute sclerosing panencephalitis, rubella panencephalitis, neurosyphilis, | + | |
- | neuroborreliosis) or autoimmunity (anti-NMDA receptor encephalitis). | + | infections |
+ | | ||
+ | * rubella panencephalitis | ||
+ | * neurosyphilis | ||
+ | | ||
+ | |||
+ | or autoimmune conditions | ||
+ | * anti-NMDA receptor encephalitis) | ||
+ | * Guillain–Barré syndrome | ||
+ | * Neuromyelitic optica | ||
Although it has been suggested that in adults, where multiple sclerosis is a | Although it has been suggested that in adults, where multiple sclerosis is a | ||
predominant condition that it is only necessary' | predominant condition that it is only necessary' | ||
wise to request both quantitative (CSF:serum IgG index) and qualitative (isoelectric | wise to request both quantitative (CSF:serum IgG index) and qualitative (isoelectric | ||
- | focusing for OCB) measures to determine whether there is local CSF IgG synthesis[(: | + | focusing for OCB) measures to determine whether there is local CSF IgG synthesis [(: |
+ | |||
+ | ===== Interpretation ===== | ||
+ | **Five patterns are typically recognised: | ||
+ | * Normal CSF pattern - polyclonal IgG | ||
+ | * Oligoclonal CSF with a normal serum pattern – consistent with MS | ||
+ | * Oligoclonal bands in CSF not seen in serum but some common oliogoclonal bands found in both – consistent with MS but can have other causes. | ||
+ | * Identical oligoclonal bands in serum and CSF - this indicates that there is no local synthesis. This pattern is seen in Guillain Barre, HIV infection and other chronic inflammatory states. | ||
+ | * Monoclonal band in CSF and serum – myeloma or Monoclonal gammopathy of undetermined significance (MGUS). | ||
---- | ---- | ||
~~REFNOTES~~ | ~~REFNOTES~~ | ||
{{tag> | {{tag> | ||
+ | ~~DISCUSSION~~ | ||
+ | {{threads> |