CSF O-banding in diagnosis MS

[sllowe]

In addition to our health page - This is a good resource as well:

http://ajcp.ascpjournals.org/content/120/5/672.full.pdf

Note, this resource says two or more unique banding.

-Shell

[eham05]

Excuse the typos... I meant long before i ever dealt with illness. I'm on a 14 hour car ride, typing in the dark.

[eham05]

I love reading about lab as well, long before i ever deadly with illness! I was an anatomy/physiology major in college. This area of lab work (CSF) is quite new to me so I'm just running off a few sources I've found so far- trying to piece things together so to speak. Thanks for your citing and I'll check out the other links! =)

[sllowe]

Sorry forgot another note:
Positive CSF for o-banding is not essential for the dx of MS. However, a positive tap may be the evidence needed for the dx for some.

[sllowe]

Thanks much I love lab sites :)
Most literature I've read there is no need to go from 2-4 unique o-bands for positive. Strange (to me) But, I'm no expert.

The report is from 2004, and they mention using the more sensitive EIF - IGg testing like the rest of the literature we are familiar with. So, I'm still not sure of the specific rationing of the need for more banding.

For what's it's worth I've copied some of it (I had problems with the link initially) and will paste here so all can read what this specific lab determines as positive.

It should be noted that not all labs require 4+ for positive o-banding. Where there are concerns, the doctor and patient should always be sure to know the number.   Thanks again for the link!

Happy reading....
__________________
"Nonetheless, the presence of O-bands in the CSF, that are not in the serum, remains the best single laboratory test to support the clinical diagnosis of MS. Because the methods originally used to detect the O-bands had limited sensitivity, most articles in the medical literature required only two or more bands to be present in the CSF, that were not present in the serum, to confirm the diagnosis of MS. In 1994, the use of isoelectric focusing (IEF) combined with IgG immuno-identification of the bands was shown to be the most sensitive method for the detection of O-bands (Andersson et al.). In the past year, semiautomated methods for this technique have become available.

"However, with the improved sensitivity of the method, in order to maintain high specificity, the number of bands required must increase from 2 to 4, as reported by Fortini et al. They found that the new semiautomated IEF-IgG method had 90% sensitivity vs. 60% for their older high-resolution agarose method. The enhanced sensitivity for detecting O-bands gave a significant improvement in the reproducibility of the IEF-IgG method. With agarose, the average positive case contained only 2.2 O-bands (with a requirement of 2 or more bands for a positive result), whereas the IgG-IEF technique had an average of 8.0 bands in a positive case (with a requirement of 4 or more bands for a positive test result). Therefore, the new method provides improvement in the confidence of a positive result. Further, in their study, 17 of the 20 cases of definite MS demonstrated 8 or more bands by the IEF-IgG method."

"Our own in-house studies confirm the improved sensitivity and reproducibility of the IEF-IgG method and we have adopted this new method and the requirement of 4 or more O-bands for positive supporting evidence for the diagnosis of MS. Samples with 1-3 O-bands are considered only equivocal supporting evidence"

[eham05]

Hello, here's a link that helped me understand why Mayo, and other clinics, use the four band approach and higher sensitivity testing.

http://www.wardelab.com/edit_15_1.html

[sllowe]

This downloaded from the Journal of Neurology Neurosurg Psychiatry

CSF in differential diagnosis of MS:

http://jnnp.bmj.com/content/71/suppl_2/ii9.full.pdf+html

This is a good one too - like the 1st link it includes CSF in differential dx. For those who are interested in knowing what the CSF of differential dx's looks like, i.e.,

ADEM
Whipples disease
Neurosarcoidosis
Behcet's disease
Sjogrens
Cerebral vasculitus
SLE
Non-disseminated demyelination
Transvers myelitis
Foix-Alajouanine
HIV
Infectious disease (i.e., lyme)
Unrelated inflammatory disorders

Just to name a few....
-Shell

[sllowe]

I hope you all don't mind. But, I'll use this post as a topic wants and add source info to it over time.

University of Birmingham also says 2 or more:

http://www.birmingham.ac.uk/facilities/clinical-immunology-services/neuroimmunology/other-services/OCB-patterns.aspx