Elevated Igg Index / CSF

Does the IgG index fluctuate with MS?  

Would it be higher when you are having an attack or flair/many symptoms?

Or is it like the csf o-bands that are a relatively permanent thing in ms?

Reason I am asking is that when I had my LP many of my symptoms were subsiding and it wasn't at the height of my attack.  In fact it was about 5 weeks after my attack initially started.  

LP results for me were negative o-bands and elevated Igg index.

So, would my Igg index have been even more elevated if it had been done sooner?

[sllowe]

Hi there,
It's my understanding that elevated IgG does not = MS. I believe IgG can rise and fall depending on phases of infection, and/or disease too (i.e., other than MS, and again, just my understanding). So, would be unlike the o-banding in that regard.

There likely is a comparison to the serum IgG in your report. There is no simple explanation unfortunately, and to understand it at the cellular level we'd need an interp from someone with a degree in neuroimmunology. And then that interp would need be applied to you specifically. If unmentioned by the doc I'd think clinically insignificant by a thorough doc, but I remember you mentioning not much was explained to you by yours :(

All this bio, cellular immunology level learning can make even the strong batty, lol

[kwarendorf]

Submitted FYI

This is from the 2010 revisions to the MacDonald Criteria...

"What is Positive CSF?
Oligoclonal IgG bands in CSF (and not serum) or elevated IgG index"

So it can be either O-Bands or elevated IgG index.

[kwarendorf]

For what it's worth I had both o-bands and an elevated IgG index in my CSF. In my serum I had no o-bands and an IgG index under the low end of the range.

[sllowe]

Hi Kyle,

Yes - understood. Mentioned IgG does not = MS because there are other causes of elevated IgG. And, while in the context of MS we mention o-banding remaining in the CSF, IgG can fluctuate depending on the cause.  IgG level in blood serum was not mentioned here. Hope this provides some context my response.

[sllowe]

This is an excerpt of guidelines of what Kyle mentions ref. the IgG index and o-bands...

THE VALUE OF CEREBROSPINAL FLUID FINDINGS IN DIAGNOSIS.

The Panel reaffirmed that positive cerebrospinal fluid (CSF) findings (elevated immunoglobulin G [IgG] index or 2 or more oligoclonal bands) can be important to support the inflammatory demyelinating nature of the underlying condition, to evaluate alternative diagnoses, and to predict CDMS.

This is an excerpt only. I'll post the entire revision in a separate post.
But, what's important to take from this is that elavated "can" support clinically definite MS, or alternative diagnoses.  Like results of imaging, labwork, o-banding, IgG elevations, etc. are all pieces to the overall clinical puzzle.

Hope this helps.

[kwarendorf]

I meant only that an elevated IgG index was sufficient to earn a Positive CSF result. I agree with you that a positive CSF result only does not tell you much :-)

[kwarendorf]

Each time I read through this stuff I find something new!

This time I think I read that if they look at your MRI and see lesions that they think are the result of demyelination, positive CSF will confirm/support that thought?

[twopack]

Increased CSF IgG levels can be seen when one of several potential disease culprits (including MS) prompt increased production of the protein in the CNS.  It can also be seen when inflammation or trauma causes leakage of serum IgG into the CSF.

The reported IgG INDEX results from a formula that indicates the origin of the IgG found in the CSF sample.  A high IgG index reflects a result that indicates the CSF proteins were indeed produced in the CNS.

I believe once MS intrathecal antibody production is established it remains stable over time.  I suspect that would mean if the IgG index is elevated as a result of MS it would, like the number of o-bands, remain stable (or perhaps increase) rather than fluxuate.

Do you know the actual number reported for your IgG index or only that it was high?

Hope this helps clarify a little.  Please keep us informed about how your diagnostic process unfolds.

Mary

[sllowe]

Mary - thank you sooooooo much for this clarification! I hope all see it.

Kyle - I surely can't be certain, but I know o-bands did seem to etch my dx in stone (my opinion).