Oligoclonal Band Questions - MS and "Mirror-Patter" Banding.

[Sarahsmom46]

I have a friend who had an LP a few weeks ago and just got her results. We need your help with this question.

She had a "mirror-patter" result in the OCB banding result.  3 bands in the serum and 3 in the spinal fluid.  The result said - negative.  

We looked it up on the internet sites and found the other conditions that could cause this pattern, but then we also saw that 10% of patients dx with MS could also have this pattern.  

Can anyone help us figure this out this confusing information?  Thanks.

Julie

P.S.  Her clinical conditions are MS-like and her IgG was slightly elevated.  Otherwise the CSF report was unremarkable.  

[manci19]

Julie,

Thank you for getting back to me. I'm in the process of getting a second opinion. Will post here if they figure out anything, it's been dragging on for almost a year now.

[Sarahsmom46]

I never got a chance to ask the neuro when I saw him  few weeks ago.  Too much other stuff was on the front burner.  I wish we still had thae "Ask an Expert" doctor someone we had last year who was an MS neurologist, but aside from that there really isn't much information out there.

My freind Cindy said that her neuro was not dismissing the LP result and at the same time is not considering it as a criteria in his diagnosis for MS.  Like most people will tell you here, a negative LP - no obands, does not rule out MS.

WIsh I could have found an answer for this, but  I think it is like anything else in this MSterious disease in that you can have different doctors have different opinions in how and what they will use to come to a final diagnosis.  

Julie

[manci19]

Julie,

Could you follow up when you figure out something. I have the same LP result with MS like symptoms and have been looking all over the place for explanation of mirrored OGB's and there is very little info on this.

[Quixotic1]

I have to weigh in here.  Jen is correct.  The "mirror pattern" means the two samples, serum and CSF had identical patterns of O-Bands.  The O-Bands were exactly the same in both samples, thus none were "unique to the CSF".  The study is saying that 10% of MSers were found to have O-bands , but none of them were unique to the CSF.  That is the same thing as saying that 10% of the MSers studied had a negative result as far as O-Bands.

Now, the interesting thing here is that this study is from 2008 and uses the techniques perferred in finding O-Bands.  Remember how hot under the collar I get at the dufus neuros who state that an LP which is negative for O-Bands conclusively do NOT have MS?  This is why.  Good studies, usings large samples show that as many as 10% (not just 5%) of people with MS have no O-bands.  People, that's ONE in TEN!  Are we comfortable discounting as many as ten percent?  That's a signficant number.

Add onto that info that in a formal study EVRERYTHING possible is done to insure that the O-Band analysis is done properly to ensure that they pick up all the O-Bands that are there.  In the hustle of real life,  my experience is that lab procedures are generally more sloppy, that is they have a higher margin of error.  I still believe that the number of people who have MS and have no O-Bands is probably higher than 10%.  So many of our members have had the diagnosis of MS excluded because of a negative LP.  This is ridiculous!

STill, that early study (around 2004) which showed that the use of iso-electric focusing improved the ability to identify O-Bands, stated that 100% of people with MS had unique O-Bands in their CSF.  No study since that one has found the rate to be that high.  Many are in the 95% to 97% but there are significant numbers of studies that show the percentage to be closer to 10%.  Again, under the rigorous conditions of a study, I believe the O-Bands found will be higher than in real life.  That first study was very WIDELY publicized and is the only thing many neuros seem to remember about the topic.

It has been my experience that in real life there are very few incidences of the ratio of 100% to 0%.  

This is why we must scream against the idiocy of stating that "No O-Bands equals No MS."  

Thanks everyone for discussing this and bringing this point out.  

I am coming to the increasing belief that MS is widely under-diagnosed.  And this, plus other "lies my Neuro told me" are the reasons.  And yes, I believe that about 10% of people diagnosed with MS actually have some other mimic.  The science is fuzzy and hard, but I will continue to scream when I see the obvious myths being perpetuated.

Quix

[Lulu54]

Jen is right- I assumed that you would remember that the o-bands have to be unique in your csf from your serum.  Good luck at the doctor's tomorrow.
hugs, L

[Sarahsmom46]

Thanks for your responses ladies.  I remember doing a lot of research on OCBs after I had my first LP and but couldn't find my old resources, so thanks again.  

I am seeing my neuro in the morning, last minute appointment opening, and if I get a chance I'll might ask.  We have a lot of catching up to do though, so it might not happen.  

Appreciate you guys.  

Julie

[jensequitur]

The reason they discounted this information was because there was the same number of bands in the CSF as in the blood.  This means that there probably isn't a breach of the blood-brain barrier.  While they're not sure what a breach would do, it's indicative of MS disease activity.

So while the negative LP is not an ender for an MS diagnosis, it's one more reason to believe that it's something else besides MS.

[Lulu54]

Remember that MS continues to be a disease on contradictions and just when you think it understands the rules, you realize there are no 100% rules for MS.  

The O-bands in the csf is never a guarantee one way or the other for MS.  I wish your friend well in getting answers sooner rather than later.
about.com says that other causes could be  encephalitis, meningitis, Guillain-Barr syndrome, polyneuritis, headache, among others.



good luck at your appt in the heat today!
-L

[Sarahsmom46]

I found this article from "Neuroimmunology" and that's where I saw the 10% figure.  I hope someone can help comment on this one.  Thanks.  J.

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Received 14 April 2008; received in revised form 27 May 2008; accepted 4 June 2008. published online 08 July 2008.
Abstract

We evaluated oligoclonal IgG band (OCB) patterns obtained by analyzing paired cerebrospinal fluid (CSF) and serum samples of 77 patients with acute demyelinating encephalomyelitis (ADEM) and 411 patients with multiple sclerosis (MS). OCBs were searched with isoelectric focusing and capillary immunoblotting. CSF-restricted OCBs were found in 89% of MS patients and 10% of ADEM patients (p<0.0001). Identical serum and CSF OCBs (‘mirror pattern’), or no OCBs, were detected in 10% of MS patients and 84% of ADEM patients (p<0.0001). OCBs were also analyzed in 27 mice with proteolipid protein-induced experimental autoimmune encephalomyelitis (EAE). In this animal model, the ‘mirror pattern’ was the most frequently detected pattern (74%), with the immunizing antigen being the main OCB target. These results indicate that CSF analysis can help differentiate between MS and ADEM and that, similarly to EAE, the ‘mirror pattern’ observed in ADEM accounts for a predominantly systemic immune activation