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CSF oligoclonal banding

Cerebrospinal fluid - immunofixation

CSF oligoclonal banding is a test to look for inflammation-related proteins in the cerebrospinal fluid (CSF). CFS is the clear fluid that flows in the space around the spinal cord and brain.

Oligoclonal bands are proteins called immunoglobulins. The presence of these proteins indicates inflammation of the central nervous system. Oligoclonal bands may be a sign of multiple sclerosis.

How the Test is Performed

A sample of CSF is needed. A lumbar puncture (spinal tap) is the most common way to collect this sample.

Lumbar puncture

Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...

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Other methods for collecting CSF are rarely used, by may be recommended in some cases. They include:

Cisternal puncture
Ventricular puncture
Removal of CSF from a tube that is already in the CSF, such as a shunt or ventricular drain.

After the sample is taken, it is sent to a lab for testing.

Why the Test is Performed

This test helps support the diagnosis of multiple sclerosis (MS). However, it does not confirm the diagnosis. Oligoclonal bands in the CSF can also be seen in other illnesses.

Multiple sclerosis

Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system).

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Normal Results

Normally, one or no bands should be found in the CSF.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your health care provider about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What Abnormal Results Mean

There are two or more bandings found in the CSF and not in the blood. This may be a sign of multiple sclerosis or other inflammation.

Open References

References

Griggs RC, Jozefowicz RF, Aminoff MJ. Approach to the patient with neurologic disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 396.

Houtchens MK, Lubin FD, Miller AE, Khoury SJ. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice . 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 54.

Lechner-Scott J, Spencer B, de Malmanche T, et al. The frequency of CSF oligoclonal banding in multiple sclerosis increases with latitude. Mult Scler . July 2012;18:974-82. PMID: 22185806 www.ncbi.nlm.nih.gov/pubmed/22185806 .

CSF oligoclonal banding - series

Presentation

<strong>Normal anatomy</strong><p>The cerebrospinal fluid (CSF) serves to supply nutrients to the central nervous system (CNS) and collect waste products, as well as provide lubrication. </p>

<strong>Indications</strong><p>Why the test is performed: This test helps confirm the diagnosis of multiple sclerosis (MS). The laboratory procedure is called CSF electrophoresis, which is a method used to study the levels of protein in the cerebrospinal fluid (CSF). In electrophoresis, a CSF sample is applied to a gel (solid medium allowing the movement of proteins), and a voltage is applied. The proteins migrate along the gel based on their charge (roughly on their size). The gel is stained, and significant amounts of similar proteins will cause a visible "band" to be present. The term oligoclonal bands refers the presence in CSF of two or more protein bands of a specific immunoglobin (IgG) that have greater intensity than in the concurrent serum sample. This pattern of banding is seen in patients with MS, and other conditions. </p>

<strong>Procedure, part 1</strong><p>A sample of the CSF will be taken from the lumbar area of the spine. This is called a lumbar puncture. How the test will feel: The position used during lumbar puncture may be uncomfortable, but you must remain in the curled position to avoid moving the needle and possibly injuring the spinal cord. There also may be some discomfort with the needle prick and the insertion of the lumbar puncture needle. When the fluid is withdrawn, there may be a feeling of pressure. Risks of lumbar puncture include: Allergic reaction to the anesthetic.Discomfort during the test.Headache after the test.Bleeding into the spinal canal.Brain herniation (if performed on a patient with increased intracranial pressure), which can result in brain damage and/or death.Damage to the spinal cord (particularly ithe patient moves during the test). Allergic reaction to the anesthetic. Discomfort during the test. Headache after the test. Bleeding into the spinal canal. Brain herniation (if performed on a patient with increased intracranial pressure), which can result in brain damage and/or death. Damage to the spinal cord (particularly ithe patient moves during the test). </p>

<strong>Procedure, part 2</strong><p>A blood sample will also be drawn. </p>

<strong>Procedure, part 3</strong><p>Both the samples are added to a gel, which is then filtered through a cartridge. The gel separates the proteins in each sample and the lab looks for oligoclonal banding. Results: Normal: One or less bandings found in the CSF is normal. Abnormal: Results are considered abnormal if there are 2 or more bandings found in the CSF and not in the blood serum. This may indicate multiple sclerosis (MS). CSF oligoclonal bands are found in 83% to 94% of patients with definite MS. Other causes of oligoclonal banding in CSF include encephalitis, meningitis, Guillain-Barré syndrome, polyneuritis, headache, and other conditions. </p>

CSF oligoclonal banding - series

Presentation

Talking to your MD

Self Care

Tests for CSF oligoclonal banding

Review Date: 6/1/2015

Reviewed By: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and immediate past president of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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