Oligoclonal Banding, Serum and Cerebrospinal Fluid

Cerebrospinal fluid (CSF) and serum, collected at the same time

0.5 mL cerebrospinal fluid (CSF) and 0.5 mL serum

0.1 mL CSF and 0.1 mL serum

Red-top tube or gel-barrier tube and plastic (CSF) tube

Spinal tap

Diagnose diseases of the central nervous system including meningitis, tumor, syphilis, and multiple sclerosis

Isoelectric focusing (IEF) and immunoblotting on agarose gel

None found; four or more CSF-specific bands have been shown to be most consistent with MS.

Most of the clinical interest in CSF electrophoresis is focused on the γ region. Oligoclonal bands are multiple distinct bands in the γ zone of the CSF pattern that are not present in serum. These bands in the CSF pattern are produced by a limited number of immunocompetent cell clones, each producing IgG with its own specificity. More than 90% of patients with multiple sclerosis show oligoclonal banding at some time during the course of their disease.

The presence of oligoclonal bands in CSF from patients with multiple sclerosis does not correlate with the activity of the demyelinating process. Oligoclonal bands can be present even when the CSF IgG level is normal.

Approximately 2% to 3% of clinically confirmed MS patients show little or no evidence of oligoclonal bands in the CSF; however oligoclonal bands may develop as the disease progresses.

Increased IgG production by the central nervous system is not specific for multiple sclerosis, but is an indication of chronic neural inflammation. Oligoclonal bands in CSF have been reported in cases of neurosyphilis, acute bacterial or viral meningitis, progressive multifocal leukoencephalopathy, subacute sclerosing panencephalitis, progressive rubella panencephalitis, polyneuritis, optic neuritis, trypanosomiasis, and other infectious or autoimmune diseases.

The oligoclonal band pattern is blurred when a concomitant inflammatory response causes increased protein leakage of plasma proteins into the CSF. If the CSF protein concentration is >200 mg/dL, even high immunoglobulin production in the central nervous system can be obscured by the presence of plasma proteins.

Since 80% of normal CSF protein is derived from serum, patients with serum monoclonal proteins may also have corresponding CSF bands. In addition, serum oligoclonal bands are present in some patients with Hodgkin's disease and in up to 5% of normal individuals. Therefore, CSF electrophoretic patterns cannot be interpreted without corresponding serum patterns.