???Heath pages McDonald Criteria

[lala47]

I am confused about McDonald criteria on the health pages.  It says 2 or more unique O-bands found in the CSF, but not in the serum OR elevated IGG index.  My confusion is, is the elevated IGG  in the CSF or the serum?  Or if you have an elevated IGG index and 2 or more O-band is that a neg test?  Any help to help to make me understand this would be great.

Thanks,
lala47

[Ufrustrated2]

>>My CSF was positive for both = positive result.

Hey Dr Q, you may have visited my following question when viewing the time line but since I cannot rememeber I'll ask it again here:

Just before sceduled back surgery while in the USNavy, both my IgG was elevated and O-bands were present. Surgery was canceled if you recall. So, I see you got a positive and I got a negative from the USNavy & VA since then.

Although the new MS specialist I have been referred to finally states a current diagnosis as a demyelinating disease of the CSF.

It weirds me out to keep mentioning this like a broken record but when I see a Pos for others and a Neg for me during that time and all through the years, well, like I said, it weirds me out.  Can you empathize with that type of frustration or am i just out in the ocean all alone on this?

Cheers!

[Quixotic1]

I'm glad it helped.  The increased IgG in the blood would not have anything to do with MS.  That would indicate a problem out in the body - as opposed to the brain or spinal cord.

The actual "IgG Index" is calculated only on the spinal fluid.

Quix

[lala47]

Thank you so much for explaning that in lay terms.  I questioned that because I have an incresed IGG in my  serum blood no spinal tap yet.  I am being referred to a hematologist and have to have a bone density test before I go.  As werid as this may sound I think I may need a LP,  because every time I go to neuro she always brings up MS.  Although she still has not dx'ed me.  My last MRI this month, I had no new lesions.  Report stated stable early demitating diesaes.

Thanks for explanation.
lala47

[PastorDan]

Good question, good answer, from my perspective.

[Quixotic1]

For a positive CSF you can have an IgG Index AND/OR 2 or more O-Bands.  Many neuros prefer the O-Bands because they are more sensitive to MS.  The McDonald Critieria does not express a preference.  My CSF was positive for both = positive result.

Did I help the question or hurt it?

Q

[Quixotic1]

Hi, there!  The elevated IgG Index would be found in the CSF.  They arrive at the IgG Index by comparing the IgG Synthesis Rate in the CSF again the IgG Synthesis rate in the serum.

Here is what I wrote recently about the difference between the CSF IgG Index and CSF O-Bands:

In the CSF they measure a couple different things having to do with antibody formation.

One is the overall production of antibodies. To understand this you have to know that the real name for antibodies in medicine is "immunoglobulins." There are several different kinds of immunoglobulins, of which the most common is "gammaglobulin." (short for Immunoglobulin Gamma) The short way to refer to gammaglobulin is IgG. (Other forms are (IgM, IgA, IgE and IgD)

In one test they measure the overall amount of antibodies of ALL kinds that are currently being produced in the CSF. This calculation gives the rate of IgG Synthesis. In times of very active immune activity in the Central Nervous System the IgG Synthesis rate will be elevated, but if the immune activity (also referred to as immune inflammation) settles down, the Synthesis Rate will also drop.  A couple of examples where this would happen are  1) New inflammatory MS lesions (which might enhance on MRI) would cause the Rate to go up.  As the inflammation dies down, the Rate will also drop.  2) A brain infection, like encephalitis, will cause the IgG or IgM Synthesis Rate to rise and then drop as the infection clears.  In this test they measure ALL of the IgG at once and it may be made up of hundreds or thousands of antibodies.  During a person's life their Synthesis Rate will increase and decrease many times.

Another test they do is looking for the production of large amounts of a single antibody made by "clones" of an antibody-producing lymphocyte. These are run in a test that allows the group(s) of antibody to be seen as a "band" on a substrate like paper or gel. The test is a type called electrophoresis and each different antibody shows up in a different location, called the Band. In this test they are looking just for those individual antibodies that exist in huge amounts and there may be none, a few or several of these. These resulting bands are called "Oligoclonal Bands." The word comes from "Oligo - few" and "Clonal - from 'clones.'"

Here is a place that has great pictures of what the "Bands" look like on the test.


(Please note that the results of #4 and #5 here have been reversed)

http://www.ii.bham.ac.uk/clinicalimmunology/Neuroimmunology/IEF.htm

In MS, oligoclonal bands tend to persist for life. So their numbers will stay stable or increase in the future, but will generally not decrease.


Quix