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Can anyone help

Hi I have a question that I’m hoping someone can answer. I’m under a neuro and had my LP and he said it looks probable for ms which I was expecting. I didn’t get much time to spend asking him questions so wonder if anyone could shed anymore light on what was written on the results sheet CSF ISOELECTRIC FOCUSING. The results show that IgG is oglioclonal, but paired serum is not. The results indicate local synthesis of IgG, typical of demyelination, but also possible with bacterial and viral antigens.

So sorry, haven’t a clue but I do know that Oliagloconal(sp) banding is common to ms. Hopefully my reply will bump you to someone who knows, Chis

A spinal tap (also known as a lumbar puncture) is a procedure whereby a sample of cerebrospinal fluid (CSF) is taken from close to the spinal cord. At the same time a blood sample is taken usually from the arm and a quantity of blood serum is isolated. Both of these samples are then processed using a technique called electrophoresis. A positive spinal tap will produce oligoclonal bands in the CSF but not in the blood serum. These bands indicate a type of immune system activity. Although uncomfortable, the spinal tap itself is often not too painful, whereas in the period following the tap, the patient may experience dizziness, nausea, vomiting and severe headaches, occasionally for as much as a week. There are a few rare but serious side-effects of spinal taps. For more information about spinal taps and how to reduce the possibility of some of the more unpleasant side-effects follow this link: Spinal Tap.

95% of people with a definite diagnosis of MS exhibit oligoclonal bands on a spinal tap. This may sound impressive but so do 90% of people with Sub-Acute Sclerosing Panencephalitis and 100% of people with Herpes Simplex Encephalitis among other conditions. Positive spinal taps are indicative of an immunological response but they are not diagnostic for a particular condition. That 5% of PwMS do not exhibit oligoclonal banding means that spinal taps neither rule-in nor rule-out MS.

The primary purpose of CSF analysis should be to rule out other conditions than multiple sclerosis. Although they can be highly suggestive of MS, they do not, in themselves, provide definitive disgnosis.

So therefore banding was shown in your CSF but not in your blood serum which suggests MS; or rather that there’s something going on.

Hope this helps

George

So normally you would have banding in your blood and your csf is that what you mean? So it’s not definite ms without pairing is that what it means?

The presence of oligoclonal bands shows that the immune system has been active; fighting some sort of infection/virus/foreign invader. Oligoclonal bands in serum (which is the fluid left when blood coagulates/goes thick) means that the immune system has been fighting something in the body. Oligoclonal bands in CSF (cerebrospinal fluid - the fluid in the central nervous system) means that the immune system has been fighting something in the central nervous system.

Blood is always taken at the same time as an LP so there can be a comparison between the two.

Oligoclonal bands in both CSF and serum means that there has been a “systemic” infection (“systemic” because it’s throughout the system). As far as MS is concerned, a positive LP result is more than one oligoclonal band in the CSF but not in the serum. This means that the immune response was limited to the nervous system.

BUT, this is not a perfect test. Anything up to 20% of people who definitely have MS do not have positive LP results.

In fact, there is no perfect test for MS. This is why neuros have to consider all the different test results as well as people’s history, symptoms and clinical exam results.

It is possible to get a diagnosis of MS with a clear MRI and a negative LP. It’s not common, but it does happen.

Karen x

Well, paired serum will be from blood taken at the same time as cerebrospinal (CSF) was collected by lumbar puncture. The test is not definite for MS but banding in the CSF that is not in the blood (serum) does indicated demylination in the CNS (possibly MS). The results sheet says, “The results indicate local synthesis of IgG, typical of demyelination, but also possible with bacterial and viral antigens.” and so say it could be caused by bacterial and viral antigens. There are also other demylianting diseases other than MS.

http://www.homerton.nhs.uk/our-services/pathology/guide-to-laboratory-tests-and-directory/biochemistry-tests/csf-oligoclonal-bands/

http://www.nlm.nih.gov/medlineplus/ency/presentations/100145_1.htm

I actually had the same result sheet showing the same information - my consultant didn’t say how many oglioclonal bands I had though. I was going to raise this at my next appointment after my PET scan. Didn’t really understand too well at what the result sheet showed