Oligoclonal Bands - MAJOR RETRACTION!

[Quixotic1]

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.

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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

[sllowe]

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

[Quixotic1]

Uhhh....table form???????

This is where I show I'm a technotard.

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

Quix

[sllowe]

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

[risnerrose]

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

Thank you for all you do.

Sherry

[Quixotic1]

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

[Quixotic1]

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