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147426 tn?1317265632

Oligoclonal Bands - MAJOR RETRACTION!

Okay, everyone, this is it.  This is my major boo-boo of the year!  I have been doing a lot of reading on O-bands.  One of the big questions is whether you can diagnose MS with an LP that is negative for O-bands.  The answer is not what I have been telling people.  It goes more like this:  If the lab is using the newest technique for identifying O-bands, a technique that was reported to the world just 2 or 3 years ago, and if the technician is well-trained in the interpretation, then O-Bands should be positive in the great majority of patients at diagnosis.  The studies looking at the predictive value of "Positive oligoclonal bands" in CIS, show that about 96% of people at presentation will be positive for O-bands in their lumbar puncture.

So about 1 in 25 people will be negative if the right test is run and is run right!  Does that mean what we have heard here so many times, that a doctor "can't" diagnose MS if there are no O-Bands?  No, it does not.  I have a couple opinions on this topic, as always.

1) The doctor who isn't willing to take the time to find 1 in 25 is going for the easy points.  A neurologist is paid big-bucks and should be willing to stay with the atypical patient, keeping their mind open.  Not doing this is lazy.

2) There is STILL no recommendation in the world of MS Diagnosis that a positive LP for O-bands should be included in the requirements for diagnosis.

3) No neurologist is accurate in saying that no O-bands "rules out MS."

4) I am concerned that we don't know if all the labs that do the analysis for O-bands are using the new technique, called "Isoelectric Focusing with Immunoblotting."  or something similar.  We know that the minimum MRI strength recommended for MS diagnosis is 1T, yet some people are still being sent to MRI machines which are weaker.

So, I have to temper my statements about how accurate O-band testing is, keeping in mind the technique that achieves this 96% is relatively new.  But, IT IS NOT 100% as some doctors claim.

************************************************************************************************

OLIGOCLONAL BANDS - What Are They and How Are They Reported?

What Are O-bands?

Oligoclonal Bands are large groups of antibodies that can sometimes be found in the blood and in the cerebrospinal fluid, the CSF.  They are caused by a state of inflammation in either the body or the Central Nervous System or both.  This kind of inflammation is caused by the immune system which makes a colony of B-lymphocytes, by "cloning" one B-lymphocyte into a large group of cells.  All of these cells make the same antibody.  Because of this, the group of antibodies identified as an O-bands is huge.   The antibody may be directed against many things such as an invader like a virus or bacteria or against an abnormal cell, like a cancer or foreign cell like a transplant.  Or, for some some reason, the antibody may be directed against a tissue of the body itself.  This causes a condition referred to a "auto-immunity."  This word means "immunity to self."  

A few definitions:

The term "oligoclonal" means "oligo = few" and "clonal = produced by cloning."

The word "Band" refers to the appearance of these antibodies when a specific test is run on the fluid looking for them.

The immune system is programmed to ignore proteins and tissues of it's own body for obvious reasons.  However, several things may trigger it to attack its own body.  Some of these triggers are understood and some are not.  These antibodies, which attack our own tissues, are the most obvious villains in what are called "auto-immune diseases."  The most commonly known examples of autoimmune diseases are Autoimmune Thyroid disease, Lupus, Rheumatoid Arthritis, Psoriasis and many, many others.  In Multiple Sclerosis we know that some antibodies attack the myelin sheath which insulates the nerves of the white matter of the brain and spinal cord.  What we don't know is exactly what triggers the attack by our own immune system on our own nerovus system.

How Do They Test For O-bands?

To understand how oligoclonal band can be important in the diagnosis of MS, you have to understand a little about how they are found and counted.  Antibodies are found in the body by drawing blood and testing it or by obtaining spinal fluid and testing it the same way.  The process involves tagging the antibodies with something that will make them visible and then letting them diffuse across an area of gel or across special paper. I will just call this the "gel."  There is more to this process, but this is not important right now.   Because the body makes millions of different antibodies, there are a lot to look at, and each antibody moves to a different place on the gel.  Normally, in the healthy person, with no big infections or immune inflammation, the antibodies migrate across the gel making a broad area of that looks all the same throughout.  It is said to appear homogeneous.  Please look at the following link to see a picture of a normal result.

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

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

If there are huge amounts of the same antibody present in the sample of fluid (serum or CSF) then there will be dense lines superimposed on and going across the gel at one or more locations.  Remember, this is because there are clones of antibody-producing cells, each making abnormally large amounts of just one antibody.  All of these antibodies will migrate to the same spot on the gel and will show up as a darker line or "band."  Two clones of B-cells will make two O-Bands because each colony makes a different antibody.  The more colonies of cells there are, the more O-bands will show up.

Quix
the final part will be on the next post
34 Responses
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Avatar universal
Thanks Ess!

That's very helpful!  Have you been told yet today that you are wonderful???

Well, you are wonderful!  :)

Tammy
Helpful - 0
Avatar universal
This is from Wikipedia.  Hope it helps.  ess



Oligoclonal bands are also found in:

    * Multiple sclerosis
    * Devic's disease
    * Systemic lupus erythematosus
    * Neurosarcoidosis
    * SSPE
    * Subarachnoid haemorrhage
    * Syphilis
    * CNS Lymphoma

Helpful - 0
Avatar universal
Hi

I believe that Soonermom asked this question before, but what other diseases can O-bands be present in??  

I think that is just as important too, because an LP with O-bands doesn't only point towards MS, right?
Thanks
Tammy
Helpful - 0
230625 tn?1216761064
Thank you again for a wonderful explanation!!

Of all things, your write-up has given me even more confidence in my neuro.

As you know, my LP came out completely "normal" with no O-bands, no elevated protein.  My neuro ordered it as soon as my brain MRI came back abnormal.   My office exams are all normal, so he was looking for that extra piece of "evidence".

I've had all the EVPs, EMG/NCV, vision field tests, VNG and everything is still normal.

A recent repeat brain MRI, 14 months after my initial one in Feb 2007, is stable.  I still have that large (1.5 cm x 1.0 cm) periventricular lesion and 2 "punctate" ones.

When my neuro got the LP results, he stated that the LP could be "normal" early in the MS disease.  As you stated, it's supporting evidence, not evidence that will "break the deal".

He is still following me and sees me every 2-3 months.  Even though my only abnormal test has been the brain MRI (which has been stable), he has not ruled out MS as my demyelination can't be explained by any other cause as of yet.  He has been persistent in looking for answers.   I guess I'm an "atypical" patient as well.

My thoughts are with all of you that are also in limbo and can't get your neuros to keep looking for answers and follow you.  

Take care, Pat :)
Helpful - 0
Avatar universal
As someone who had a "negative LP", I found your post on O Bands extremely informative and easy to follow. I have read a lot online in the nine months since my journey begun, and this is the first time that I think I have really understood O Bands.  Thanks!

Amy
Helpful - 0
405614 tn?1329144114
Ha ha ha ha ha ha ahhhh,

I needed that!

Kathy
Helpful - 0
147426 tn?1317265632
Yup, When you's been dismissed, you'd better march right on out that door!

1 in 25 is NOT = 0 !!  That is 40 people in 1,000.  (Heck, that's 4,000 people out of 100,000!  Enough to populate a town!)  40 people who would be p*ssed off to know that they had been not given a chance.  If her child had a 4% chance of having a serious disease, would she blow it off and go to Cancun?

In terms of "teaching" such people stuff, I always remember the saying:

"You can't enlighten the unconscious."

Q
Helpful - 0
405614 tn?1329144114
Thanks for using your powers for good!

I called the lab that did my LP and asked if they used the new technique, and after much research, I was told that they do use Isoelectric Focusing, but she had no idea if that was what my doctor had ordered, that they have many tests that they do.

Do they continue to use less accurate methods when better ones are available?  

My neuro thinks that since I have no O-bands, I have no MS.  

She also sent me for the LP after saying that my brain lesions aren't "textbook".  Could be she had her mind made up, and sent me for the older technique. Who knows.

I won't try to tell her I could be one in twenty-five; I know by now that when I've been dismissed, to move on.

Thanks again for all you do.  I'm glad to see you posting more; hope that means you're doing better.  

Kathy

Helpful - 0
147426 tn?1317265632
Wowwiekahzowwiee!!!  Superspongogulaous!  That table is great.  I will be tapping your skills later for my McDonald Criteria.

I made a correction in the comments on the page.  If you go back into edit I think you can do it easily.

Now, a few tweaks and you can add my first part on what O-bands are to the top!  Only you can add text to your HP.  I've been trying to get people to write some up, but no one has sent me anything.  HINT HINT !! You guys know who you are!

The I can ask MedHelp to also tack it into my outline where it belongs under DIAGNOSIS -> Testing -> LP.  Eventually that outline in an expanded form will be the main page (I hope) and it will be easy to find useful articles

And actually Anyone can write something up.  You should write it in your own words.  These are for the benefit of the forum and a lot of you have great ideas!!  The Health Pages are NOT my domain only.  I hope everyone understands that.

This is great!  I am so Jazzed!  Quix
Helpful - 0
147426 tn?1317265632
I'll PM you an address.  But I also have heard that tables are difficult to do in HTML.  I can present it to MedHelp and see if they can do it.
Quix
Helpful - 0
198419 tn?1360242356
Oh boy, your going to have to knit me a beating, I didn't think that would post like that on the health pages - was playing around to see if it would allow the table - yikes. . .
Helpful - 0
198419 tn?1360242356
I can save it as an image and post it on my pictures or something, but I won't be able to view it from the computer I'm at.  We're blocked from about everything here.

-Shell
Helpful - 0
198419 tn?1360242356
Ok -

I put the possible outcomes in a table - where can I send it so you can see it?

Can only post things as text here.

-shelly
Helpful - 0
147426 tn?1317265632
Uhhh....table form???????

This is where I show I'm a technotard.

Would you do it and give me an example?  :)

Quix
Helpful - 0
198419 tn?1360242356
You Question: Was the part on How O-bands are tested for and interpreted clear enough to go ahead and put up??

Yes, it's good to go up.  You've got: definition of O-Bands, various testing techniques, possible outcomes (ref: band or no bands) anything additional to that, is just icing!

I will read it again for flow and order, but I think it's good.  I'm thinking you can put the possible outcome examples in table form (your #1 - 4's), that way it would break up the text a little.  It's super!

Thank you again, Mama Q,
-SL

Helpful - 0
Avatar universal
The article seems quite clear . . . so clear, it gave us all something new to ponder :0

Thank you for all you do.

Sherry
Helpful - 0
147426 tn?1317265632
I meant to add that all of the evidence, symptoms, signs, MRI, LP, VEP are looked at together.  The only part that can make the diagnosis ALONE is the history and physical over time.

I'm trying to get a diagnostic page up soon on the Health Pages.

Quix
Helpful - 0
147426 tn?1317265632
If the neurologist is looking for more evidence pointing toward MS they will request an LP.  You can't rule MS in or out SOLELY ON THE BASIS OF THE LP.  But it certainly can act as supporting evidence.  Does this make sense?

Quix
Helpful - 0
476834 tn?1228398709
I'm confused,

why is my neurologist suggesting I get an LP?  when she says most likely it is ms?  OHHHHHH ugggg,, I'm just not understanding????  

So an LP can NOT rule in or out Ms right?

geeeeese Quix i'm so confused and dont know what to do:(
Helpful - 0
147426 tn?1317265632
Wow!  It seems that my info on the new technique for determining O-bands was the most exciting part of my post.  That is very interesting.  I think we all suspect that the technique is not necessarily in broad use.

But, I also really need input on the understandability and readability of the part that describes how they test for O-bands.  Is it in good enough shape to just place up on the Health Pages?

Now: There were some great questions asked whose answers are for the next segment, but I'll go through them briefly first.

Sherry - Brain lesion, and an elevated IgG Index, along with suggestive symptoms and signs does suggest MS.  In the McDonald Criteria the O-bands and the IgG Index are interchangeable piece of information.

ess - You make a huge important point.  An LP is not a required part of the qork up for MS.  Many people are rightly diagnosed with having one.  So if it is not needed all the time, how in the heck can a neuro rule out MS if it is negative?????

Magoo - Great to see you back!  Yes, your wife was diagnosed (as we thought she would be) AND WITHOUT AN LP AT ALL!  Thet's the point I'm making.

Wonk - The O-bands seem to appear with successive bouts of inflammation.  There are fewer O-bands (in general) earlier in the disease.  As you acquire more you keep them life long.  If someone is in remission, their O-band count will be the same.  Steroids will not change this.  Your other questions we should deal with on a thread devoted to them, not this one, so if you would post your dilemma in a new thread.

Slightly - The lab test report ideally will state the method they used to run it.  If it doesn't, most lab results carry the name of the lab and the pnone number.  You can call the lab supervisor and ask what specific test is used to detect O-bands.

LA - The LP is needed as a supportive test when there is not enough information from the history and physical (to which too little attention is paid!) and from the MRI evidence.  It's role is supportive.  It is not supposed to be used as a rule-in or rule-out test!!!!!!!!!!!!!

I'm glad you had these questions.  I willtry to clear up these and any more I can think of plus any that more people come up with.

Again:  Was the part on How O-bands are tested for and interpreted clear enough to go ahead and put up??

Quix, quizzically???
Helpful - 0
373367 tn?1246402035
Thank you for taking the time to organize and write all of this down for us.  I know this is all a "labor of love" for you, but we all appreciate you SO MUCH!!

I was wondering if it is possible for more O-banding in the CSF vs serum to occur in ANY other diseases or is it unique to MS?  

thanks,
Stacey  
Helpful - 0
233622 tn?1279334905
If you have not had an LP should you?  I was dx'd without one due to other MS symptoms.

I was very happy NOT to have one.  But then if an neg LP does not rule out MS then I am wondering why go through it.

LA
Helpful - 0
279234 tn?1363105249
Thanks for the info..there is a lot of  neurologist, though, that try to throw out MS as a DX if the LP doesn't show o-banding which I think is wrong to do for the same reason you stated above. Especially when all labs are probably NOT doing things the new way. The funny thing is, you mentioned how protocol isn't followed all the time including the strength of the MRI machine. My last neuro didn't follow protocol because he kept sending me to a 0.7 tesla strength machine and it makes you wonder what else wasn't done right including the new standards for doing the LP, which mine was negative.

By the way, how would you go about finding out if they used the new or old method of doing the LP?
Helpful - 0
198419 tn?1360242356
HAVE I TOLD YOU LATELY HOW WONDERFUL YOU ARE! WELL, YOU ARE!

THIS IS GREAT.  CAN YOU ADD IT TO THE HEALTH PAGES.  WE GET SO MANY QUESTIONS ABOUT THE 0-BANDS.  YOU DON'T EVEN HAVE TO WAIT UNTIL YOU GET YOUR LAST PART IN, YOU CAN DISCLAIMER IT AS WORK IN PROGRESS. . .

THANK YOU SO MUCH FOR THIS, IT'S SO HELPFUL AND INFORMATIVE.

SL
Helpful - 0
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