Hi everyone got a question that I’m guessing that Karen or George can probably advise further on. It’s a question about my LP results that I had. The consultant has had so many other things going on with me that I didn’t clarify things properly and it was do something that the hospital mentioned today at my CT scan that prompted it into my head again. The results of my lumbar puncture showed that my IgG is oglioclonal, but that my paired serum is not (I’m guessing that this meant by blood serum as it had come up negative on my previous blood work) The hospital had recorded that my results indicated a local synthesis of IgG, which they said was typical of demyelination, but they have said it was also possible with bacterial and viral antigens. I was under the impression that a positive LP for oglioclonal bands ruled out bacterial and virus things and that a positive LP meant ms with no question! Now I’m confused - wonder if you could shed some light Thanks
LPs are not a specific test for MS. The CSF and the blood sample taken at the same time are checked for various things, including oligoclonal bands.
A “type 2” LP result (oligoclonal bands in the CSF but not in the serum) means there has been an immune response in the nervous system. A “type 4” result (oligoclonal bands in both CSF and serum) means an immune response in the whole body: a “systemic” response. On here, we talk about “positive” LPs. This means a type 2 result.
MS is the most common cause of a type 2 result, but it is also found with other types of inflammation or infection (e.g. Lyme Disease) and paraneoplastic disorders (e.g. myasthenia gravis). So rather than a test specifically for MS, the LP gives another piece of the puzzle for the neuro. If someone has a history, symptoms and clinical exam that point towards MS and the LP is type 2, then MS is very likely. If someone only has the type 2 LP, then it could be anything. (Including an error!) Also, depending on what you read, LPs are only type 2 in about 80-90% of MSers.
I’m very tired so I’m not sure I’ve made this very clear! Please say if it’s not and I’ll have another go tomorrow.
Karen x
Hi Karen thanks very much for getting back to me. Yeah that’s made it clear- basically a type 1 means that its something that’s affected the nervous system but it could be a virus or bacterial attack or a list of numerous things other than just ms.
Type 2, but yes. Kx
How are you feeling today about it all?
Pip
Hi Karina,
A spinal tap, also known as a lumbar puncture, is a diagnostic procedure for multiple sclerosis and other neurological conditions. It involves collecting samples of cerebrospinal fluid (CSF), the fluid in central nervous system, blood serum and ordinary blood, analysing and comparing them. Examination of the CSF cannot be used to definitively diagnose nor exclude multiple sclerosis, but the results can be indicative of MS and are used to support a clinical diagnosis. The spinal tap is the only common diagnostic procedure commonly used for multiple sclerosis that causes significant discomfort and that has potentially severe side-effects.
I shall discuss the possible results of the spinal tap with respect to multiple sclerosis, after describing the procedure to obtain the CSF sample.
The Test Itself
The test involves lying on your side in the foetal position. The skin on your lower back is scrubbed clean to remove the possibility of infection and a local anaesthetic is injected. A spinal needle is then inserted into subarachnoid space between the 3rd and 4th lumbar vertebrae and the CSF pressure is recorded. A sample of the CSF is then taken. The entire procedure usually takes about 30 minutes but may take longer.
The anaesthetic injection stings when it is injected and the spinal needle causes a sensation of hard pressure and can hurt a little. The overall discomfort experienced during the spinal tap itself is not great.
It is important that you lie horizontally with your head slightly below the rest of your body for at least 6 hours after the test. Because the test will remove a small amount of your cerebrospinal fluid, the resulting drop in pressure can produce a splitting headache often with accompanying nausea. This usually lasts for no more than 24 hours but it some cases can last for up to a week.
Rarely complications such as bleeding into the spinal canal or continued leaking of CSF after removal can occur. If the tap is performed on someone with raised CSF pressure, the side-effects can be very severe occasionally resulting in brain damage or even death.
Results
A process called Electrophoresis is usually used to analyse the CSF and a phenomenon called IgG oligoclonal banding is often a corollary of MS.
In around 5% of clinically definite MS case, the CSF is normal.
In around 90% of cases, the Immunoglobin-G (IgG) index (a formulaic calculation comparing IgG levels in the blood with those in the blood serum) is raised to around 0.7. This gives rise to the IgG oligoclonal bands seen in the electrophoresis. Other conditions, especially viral infections and tumours are also associated with similar results.
In around 35% of cases, CSF helper T-cells counts are raised.
In around 80% of cases in acute relapse, myelin basic protein (MBP) levels are significantly raised.
Cerebrospinal Fluid Serum Blood
Increased gamma interferon (IFN-G) Increased IFN-G Increased IFN-G
Increased Immunoglobin-G (IgG) and oligoclonal bands Increased Tumor necrosis factor (TNF) Increased interleukin-2 (IL-2)
Increased Tumor necrosis factor (TNF) Increased interleukin-2 (IL-2) Increased IL-4
Increased activated Helper T-cells (CD4+) cells Increased IL-2 receptors Increased IL-1
Increased myelin basic protein (MBP) Decreased prostaglandin E release by macrophages
Decreased Killer T-cells (CD8+)
Hope this helps
George