How are the O-bands Counted and Reported?
The blood will show the effect of these colonies out in the body, like an autimmune disease that is outside of the brain. The CSF may show one of two things. It can "echo" the same O-bands made out in the body because these antibodies "leaked across" the blood-brain barrier. This can especially happen in infections. Or, the CSF can show different O-bands than the serum. If an O-band appears only in the CSF and not out in the body (the serum of the blood) then we know that those colonies of B-cells are making antibodies ONLY in the Central Nervous System, as would happen in Multiple Sclerosis.
IMPORTANT - The serum and the spinal fluid both must be tested for the O-Band result to be valid. It is not enough to look for them in the CSF alone, so there must be a blood draw on the same day as the lumbar puncture. The two results will be compared to see if there are any O-bands that exist ONLY in the CSF, but not out in the body. On the lumbar puncture report the only thing that is usually reported are O-bands that do appear in the CSF but DO NOT appear in the blood/serum. (see below)
There are four possible combinations of results you can see when you compare the serum with the CSF.
#1 The serum gel appears homogeneous with no dark bands
The CSF gel appears homogeneous with no dark bands
INTERPRETATION: This means that there is no source of cloned antibodies making large amounts of the same antibody in either the body or the central nervous sytem.
This will be reported as "Negative" for O-bands on the LP report.
#2 The serum gel has dark bands across it (+ O-bands)
The CSF has appears homogeneous with no dark bands
INTERPRETATION: This means that any antibody clones are only out in the body and are not involving the central nervous system. This will be reported as "Negative" on the LP result.
#3 The serum appears homogeneous with no dark bands
The CSF gel has dark bands running across it (+ O-bands)
INTERPRETATION: This result means that all of the O-bands seen in the CSF are unique. If there are two or more O-bands on the CSF gel, then this would be reported as a "Positive" result for the O-bands on the LP report.
#4 The serum gel has dark bands (+ O-bands)
The CSF gel also has dark bands (+ O-bands)
This means that there are some large groups of antibodies appearing in both places. The two sets of bands must be carefully compared to see if all the bands are in identical locations. If all the bands are identical it indicates that all source of the problem is out in the body and maybe also in the brain or the antibodies have leaked into the spinal fluid. This will appear as a "Negative" result on the LP report and is is not consistent with Multiple Sclerosis. However, if there are 2 or more bands which appear in the CSF, but do not appear in the serum, this is likely to indicate MS. This will be reported as a "Positive" result for O-bands on the LP report.
Labs report O-bands differently. Some report the number of distinct bands appearing only in the CSF. Some just report Positive or Negative. Also, the appearance of only one band is considered "equivocal" or "indeterminant." One unique band in the CSF can be seen in normal people or in people with a CNS infection.
The last part will be the meaning of O-Bands for the patient, for the diagnosis, for the prognosis, for whatever I can find. It is not written yet. Q
I am not sure what test I had run, but will definitely look into it. I did test negative for O-bands, but had an elevated IgG Index. I also have brain lesions only. What can cause these other than MS? Am I barking up the wrong tree here??????
If you read the top part, the negative O-bands are found in 1 out of 25 patients with MS at diagnosis. So, it does not rule out MS, it just makes it less likely than I have been saying.
My next blurb will talk about the other stuff.
My LP was negative for O-bands and elevated IgG index. I asked my neuro about this last week because it had never been explained to me, and he said without going into a lot of detail something to the effect that it probably was an inaccurate result due to the testing method. I didn't bother to probe further since my dx is confirmed based on several other criteria, and I had too many other questions on my list for him to spend more time on this item. It did make me curious though; if they don't trust the accuracy of the way that they test, why bother?
Very interesting. Perhaps he has requested the updated test and it hasn't happened. Why do it? Because if it is positive, you have good info. If it is negative, you have the option of disregarding it. And it is part of the protocol.
Actually, you're right, but as we have seen the world isn't rational.
What you tell me tho, is every lab has NOT switched over to the better test. That makes me wonder if all the neuro's that claim "no O-bandsm no MS" know what test their lab is using.
What do you think?
Qix, thanks for this clarification. I don't think we knew here that there are now more accurate CSF analysis prodecures out there. If this info and clarification hasn't found its way to the Health Pages, it really should.
Also, everyone needs to remember that many cases of MS have been diagnosed with no LP at all, but based on other evidence. So although an LP is often ordered, it isn't some requirement.
My wife had no o-banding and her IGg index was not elevated, but was diagnosed and starts beta-seron next week.
Just an example.
Quix, great write up...thanks for the info.
Wow, this is very informative!
I have a q, and apologize if it's answer is contained in your posts, but if it is I missed it.
Does it matter when you get testing for O-bands? What I mean is, if my symptoms go away, should I still get this test? I've heard claims going both ways on this one, so I'm a bit confused. I (or anyone) would not want to get this invasive test done unless I am sure it is done at the right time (if time is even a factor).
Also, what about medication? If I am on steroids, could that effect the test results?
Thanks so much in advance!
Sorry, thought of another Q about all of this.
I get confused over "having ms" vs. "probably will develop ms" descriptions. It seems some tests will only show positive over time, and that time varies by individual, but ppl can have lots of symptoms before knowing for sure.
Do you think CSF analysis is a good test for ppl who have only been symptomatic for a relatively short time? If this test is neg, but symptoms persist/recur, should it be repeated?
People can stop reading at this point, below is just my rant about why I have these Q's! Read at own risk of being bored :-)
I had a clear MRI in Feb. after my first episode that began Jan. After a month of normalcy, I had a second "episode" in April that is still affecting me. My 1st neuro ordered an LP at my request, but bullied me into not going through with it, saying I was wasting everyone's time since my MRI (brain, c-spine, w and wo con.) was clear. He said I needed Prozac. I consulted 2 therapists. Neither felt I was depressed or that my symptoms could be purely anxiety based. Neither recommended medication or that I continue therapy, both said I need a new neruo. Went to my doctor, she said there were no more tests for her to do and said I really need a new neuro (she had already checked my blood and hear, all checked out). I go to see a new neuro this Thurs, so this post came in perfect time for me! But obviously, I am scared I will be dismissed again, so I want to go in armed with information.
HAVE I TOLD YOU LATELY HOW WONDERFUL YOU ARE! WELL, YOU ARE!
THIS IS GREAT. CAN YOU ADD IT TO THE HEALTH PAGES. WE GET SO MANY QUESTIONS ABOUT THE 0-BANDS. YOU DON'T EVEN HAVE TO WAIT UNTIL YOU GET YOUR LAST PART IN, YOU CAN DISCLAIMER IT AS WORK IN PROGRESS. . .
THANK YOU SO MUCH FOR THIS, IT'S SO HELPFUL AND INFORMATIVE.
Thanks for the info..there is a lot of neurologist, though, that try to throw out MS as a DX if the LP doesn't show o-banding which I think is wrong to do for the same reason you stated above. Especially when all labs are probably NOT doing things the new way. The funny thing is, you mentioned how protocol isn't followed all the time including the strength of the MRI machine. My last neuro didn't follow protocol because he kept sending me to a 0.7 tesla strength machine and it makes you wonder what else wasn't done right including the new standards for doing the LP, which mine was negative.
By the way, how would you go about finding out if they used the new or old method of doing the LP?
If you have not had an LP should you? I was dx'd without one due to other MS symptoms.
I was very happy NOT to have one. But then if an neg LP does not rule out MS then I am wondering why go through it.
Thank you for taking the time to organize and write all of this down for us. I know this is all a "labor of love" for you, but we all appreciate you SO MUCH!!
I was wondering if it is possible for more O-banding in the CSF vs serum to occur in ANY other diseases or is it unique to MS?
Wow! It seems that my info on the new technique for determining O-bands was the most exciting part of my post. That is very interesting. I think we all suspect that the technique is not necessarily in broad use.
But, I also really need input on the understandability and readability of the part that describes how they test for O-bands. Is it in good enough shape to just place up on the Health Pages?
Now: There were some great questions asked whose answers are for the next segment, but I'll go through them briefly first.
Sherry - Brain lesion, and an elevated IgG Index, along with suggestive symptoms and signs does suggest MS. In the McDonald Criteria the O-bands and the IgG Index are interchangeable piece of information.
ess - You make a huge important point. An LP is not a required part of the qork up for MS. Many people are rightly diagnosed with having one. So if it is not needed all the time, how in the heck can a neuro rule out MS if it is negative?????
Magoo - Great to see you back! Yes, your wife was diagnosed (as we thought she would be) AND WITHOUT AN LP AT ALL! Thet's the point I'm making.
Wonk - The O-bands seem to appear with successive bouts of inflammation. There are fewer O-bands (in general) earlier in the disease. As you acquire more you keep them life long. If someone is in remission, their O-band count will be the same. Steroids will not change this. Your other questions we should deal with on a thread devoted to them, not this one, so if you would post your dilemma in a new thread.
Slightly - The lab test report ideally will state the method they used to run it. If it doesn't, most lab results carry the name of the lab and the pnone number. You can call the lab supervisor and ask what specific test is used to detect O-bands.
LA - The LP is needed as a supportive test when there is not enough information from the history and physical (to which too little attention is paid!) and from the MRI evidence. It's role is supportive. It is not supposed to be used as a rule-in or rule-out test!!!!!!!!!!!!!
I'm glad you had these questions. I willtry to clear up these and any more I can think of plus any that more people come up with.
Again: Was the part on How O-bands are tested for and interpreted clear enough to go ahead and put up??
why is my neurologist suggesting I get an LP? when she says most likely it is ms? OHHHHHH ugggg,, I'm just not understanding????
So an LP can NOT rule in or out Ms right?
geeeeese Quix i'm so confused and dont know what to do:(
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?
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.
The article seems quite clear . . . so clear, it gave us all something new to ponder :0
Thank you for all you do.
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,
This is where I show I'm a technotard.
Would you do it and give me an example? :)
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.
I can save it as an image and post it on my pictures or something, but I won't be able to view it from the computer I'm at. We're blocked from about everything here.
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. . .