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

[essdipity]

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.

ess

[magoo58]

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.

[wonko]

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!

[wonko]

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.

Thanks again!

[sllowe]

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.

SL

[slightlybroken]

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?