Given that combo #2 is the only one without any reference to MS, it shouldn't come as a surprise that LP's are losing favor as a diagnostic too :-)
The studies mention either positive or negative oligoclonal bands. Nothing specific about the pattern of O bands however.
Can you have the HLA-DRB1*15 allele and unique CSF O bands without MS? Good question. I never say never in medicine because anything is possible. That said, if you have the genetic risk factor, the positive O bands specific for MS (pattern 3 and 4), and have ruled out CNS infections for pattern 3, i would think the odds of another medical condition showing positive O bands with clinical symptoms of MS would be very low.
ClinNavigator - Oligoclonal Bands in CSF...
"1 Polyclonal pattern (no discrete bands) in both serum & CSF:
Rare Multiple sclerosis
Myelitis
CNS vasculitis
Paraneoplastic syndromes
Systemic lupus erythematosis
2 Same number of OCB in serum & CSF:
Myelitis
CNS vasculitits
Paraneoplastic syndromes
Lupus
CNS infections
Neoplastic meningitis
Behcet Disease
Rasmussen Disease
Hashimoto encephalitis
Lymphoproliferative disorders
Hepatitis C
3 OCB in both serum & CSF; CSF has at least 2 more bands than serum
Multiple sclerosis
Most CNS infections
4 More than 2 OCB in CSF & polyclonal pattern in serum
Most Multiple sclerosis
5 Monoclonal band in both serum & CSF
Normal individuals
Multiple sclerosis
CNS lymphoma
CNS inflammatory disorders
Patterns 3 and 4 are reported as positive for OCB. Although a single band difference between CSF and serum is not diagnostic of multiple sclerosis, more than one half of these patients will progress to a full oligoclonal pattern."
RS-
Does this analysis suggest that someone with the HLA-DRB1*15 allele would show unique CSF o-bands even without MS?
Kyle
You're right Jude, MRI is not a single method for diagnosing MS. There is no single method for diagnosing MS. Life would be a lot easier if there were for example a blood test that definitively identified MS.
An MS diagnosis is arrived at through the evaluation of many things. Among them are:
Clinical Exams
MRI's
Lumbar Punctures
Evoked Potentials
Blood Tests
Nerve Conduction Studies
All or some of these things can be used to diagnose MS. Different doctors use different combinations of these things. Some use all. Because there is no smoking gun available to diagnose MS, we are left with the examination and discussion of statistics. It's all we got :-)
I don;t know whether it's possible in Romania, but I would urge you to get a second opinion.
Kyle
Thank you all for the answers. I've done lots of web research these 4 months since my diagnosis and I still have doubts regarding the specific MRI lesions for MS. The lesions called specific for MS are not 100% specific for this diagnosis, we keep talking about statistics and results from the clinical trials, but we don't have the 100 % assurance that those certain lesion are characteristic for a certain diagnosis.
That's why I do not consider MRI being the single method of diagnosis. Not a single one (as my case) ...
Anyway ... thank you all for the answers. Be healthy and joyful! :-)
As far as i'm aware, positive for Obands indicates the problem is negatively affecting the central nervous system, though what it is that's causing the problem is determined by all the other test results. The combined results limit the conditions that could be causation, MS is one of the conditions that affects the CNS, so it adds weight towards a dx of MS.
If a person has abnormal clinical neuro test results indicating lesions or the causation is neurological and they have an MRI which shows they have lesions in 2 or more of the MS locations (Mcdonald MS criteria), but their LP doesn't have Obands or abnormal visual field tests, then MS would still be their more likely dx.
MRI lesions in 2 or more of the areas specified, would meet the criteria for MS, a positive LP is additional weight to the dx of MS, as are a few other test. The more evidence there is, the more solid the dx of MS and if you don't have enough diagnostic evidence for your neurologist to call it, then a positive LP would normally be what will satisfy the neuro, that the dx is MS.
Cheers......JJ
Jude,
Welcome aboard. Great question and even better responses - now you see why I often say we have some of the most informed people with MS on the web at this forum.
As for why they test for O-bands -it is a test that is beginning to lose favor in the diagnostic world. The presence of the o-bands only supports a diagnosis of MS but it does not prove it. The trauma - both perceived and real - of a spinal tap is not justifiable to many doctors and they have stopped using it for MS dx. It's too bad that word hasn't gotten around to all neurologist. I had absolutely no problems with my LP, but still cringe when I think of the procedure.
Shell wrote a great Health Page on this subject and I encourage you to read it at
http://www.medhelp.org/health_pages/Multiple-Sclerosis/Can-you-Diagnose-MS-with-an-LP-that-is-Negative-for-O-bands/show/142?cid=36
good luck with the next step(s)
Laura
Some doctors don't test for o-bands at all. It's not the gold standard. I think it comes from a time when MRIs weren't nearly as accurate. If testing for all other mimics keeps returning negative results, positive o-bands can help a doctor be more confident that they're 'on the right track' with MS as a possible diagnosis. If some of the test results are a little ambiguous, they may take a more conservative approach.
We have MRI, medical history, all the bloodwork ruling out mimic diseases... and clinical exams. This is still considered a clinical diagnosis. A good (though likely quite old at this point!) neurologist could at one time diagnose MS without an MRI with reasonable confidence.
In fact, the ER admitting doctor took one look at me (I didn't even have a GP at the time, so no records for him to look at) and said I likely have MS. He saw my age, my sex, knew my right foot had stopped working two weeks previously, and was staring at my eyes... which were pointing in two different directions (right internuclear opthalmoplegia). Six weeks later when my left eye went blind, and the exam showed no pupil response to light, that was me diagnosed. The MRI sealed it, but I would have gotten the diagnosis without it.
Ok then ... why O-bands tested? Is there any other explanation for the reason why O-bands are to be tested when MS diagnosis is presumed? I mean, if they are present or absent, it looks to me that they make no difference after all ... The evoked visual potentials also ..
All in all we have the MRI that counts for the diagnosis and the medical history. And that's it. Correct?
Hi Jude,
I'm not confident "that 99% of patients with MS have the oglicolonal bands present. " is actually statistically accurate, a lot of the research i've read on O bands doesn't record the stats as being that high, eg.
87.7% of 12 253 MS and 68.6% of 2685 CIS patients were OCB positive. http://jnnp.bmj.com/content/early/2013/02/20/jnnp-2012-304695.abstract
One hundred and ninety-six patients were included. In 176 patients (90%), the CSF showed type II OB, 20 (10%) patients were OB negative.
http://www.ncbi.nlm.nih.gov/pubmed/22909670
Twenty-two of 209 patients (10.6%) showed no OB in CSF.
http://www.ncbi.nlm.nih.gov/pubmed/16473370
I've only got little snippets of 'basic' information regarding Obands running through my head, approx 10% are Oband negative..... 1 in 10 are Oband neg.... 1,000 in ever 10,000 are negative...... 2+ Obands UNIQUE to CSF is classed as positive..... negative doesn't rule out MS..... some research questions accuracy of lab testing for Obands....... Obands are not exclusive to MS..... positive adds diagnostic weight towards MS but isn't conclusive evidence of MS..... number of Obands changes over time.....etc
Basically what it all boils down to from my perspective is that, there is no one test that can determine if the correct dx is MS, absence of proof can't rule out MS but the lack of Obands (even when all the other diagnostic evidence is highly suggestive of MS) is often enough stated by neurologists to absolutely positively rule out MS and thats untrue.
Cheers.........JJ
Scientific mumbo jumbo! :)
Research has found certain genes are associated with oligoclonal band positive MS and oligoclonal band negative MS. Most, if not all, autoimmune diseases are found in the HLA (human leukocyte antigen) region. DRB1 is a protein coding gene and different versions (alleles) of the same gene are given a number.
Positive oligoclonal band MS:
HLA-DRB1*15
Negative oligoclonal band MS:
HLA-DRB1*0404/0405
HLA-DRB1*0301
HLA-DRB1*0301/*0401
HLA-DRB1*1301/1501
I believe there are some folks here that have been diagnosed without unique o-bands in their CSF. Remember, MS if first and foremost a clinical diagnosis.
Kyle
Well ... after Kyle's kind answer, it rose another question with relation to what Quiz stated: has anyone with negative O-bands, both in CSF and in serum, been diagnosed with MS? Thank you all for your support.
Would it be possible for you to translate this, for those of us not fluent in labspeak?
Thanks,
Kyle
Genetics. Interesting eh? :)
"Several studies have shown that the HLA-DRB1*15 allele is associated with OCB positive MS [12], [18], [19] (Leone et al. personal communication), or confer a stronger risk for OCB positive MS than OCB negative MS [14], [17]. OCB negative MS has shown association to the HLA-DRB1*0404/0405 alleles [12], [19], or the HLA-DRB1*0301 allele and the HLA-DRB1*0301/*0401 and HLA-DRB1*1301/1501 genotypes [17]."
- Excerpt from: Oligoclonal Band Status in Scandinavian Multiple Sclerosis Patients Is Associated with Specific Genetic Risk Alleles. PLoS One. 2013; 8(3): e58352. Published online 2013 March 5. doi: 10.1371/journal.pone.0058352
PMCID: PMC3589422.
O-bands are an indication of inflammation. Relating to MS, o-bands are found in the cerebral spinal fluid but not in a blood sample taken at the same time.
The presence, or absence, does not provide definitive proof of MS. O-bands found in your CSF but not in you blood, serve to confirm other evidence of MS like lesions found on MRI's. As you point out, 99% of us with MS have o-bands unique to our CSF. The absence of o-bands in your CSF does not completely rule out MS, but it makes it far less likely.
Quix, a member of our group a while bac, is both a doctor and a person with MS. She wrote a very good explanation of o-bands here:
http://www.medhelp.org/posts/Multiple-Sclerosis/Oligoclonal-Bands---What-are-they/show/1468270
Kyle