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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
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
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
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
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
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
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
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
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
Quix
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. . .
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