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Presence of ≥2 or ≥3 Oligoclonal Bands as a Criterion for MS Diagnosis
TAKE-HOME MESSAGE
- The presence of two or more unmatched CSF oligoclonal bands (OCBs) supports a diagnosis of MS. It can be a replacement for the occurrence of a second attack to meet the dissemination in time criterion listed in the revised 2017 McDonald criteria for MS diagnosis. However, concerns have been raised regarding the number of OCBs needed for diagnosis, and some authors have previously suggested using the presence of at least three OCBs instead. This study assessed the utility of the presence of two or more and three or more CSF OCBs as a criterion for MS diagnosis and to determine how useful CSF OCBs are for MS diagnosis. Interestingly, in the study cohort, only 3 of 22 patients (13.6%) with two unmatched OCBs had MS, whereas 184 of 230 patients (80.0%) with three or more OCBs had MS. The presence of OCBs, however, shortened the time to diagnosis by approximately 14 months.
- This study provides evidence to alert clinicians that the presence of two unmatched CSF OCBs only supports a diagnosis of MS in a small number of cases. Clinicians should be careful when interpreting such findings, especially in people with atypical features (red flags) of MS. The presence of three or more unmatched CSF OCBs, however, supports a diagnosis of MS in most cases.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
CSF-specific oligoclonal bands (CSF-OCBs) can be used for dissemination in time (DIT) in the 2017 multiple sclerosis (MS) diagnostic criteria. A cut-off of ≥2 CSF-OCBs was recommended but studies have suggested ≥3 CSF-OCBs may be superior.
OBJECTIVES
To assess utility of ≥2 and ≥3 CSF-OCBs as a cut-off for MS diagnosis.
METHODS
Paired serum and CSF-OCBs sent to the Walton Centre, UK between July 2018 and June 2020 were included. CSF-OCBs were assessed using isoelectric focussing and reviewed by two blinded raters. Case records were reviewed.
RESULTS
Of 1334 paired serum and CSF-OCB requests, 945 cases had sufficient clinical information. More than 1 CSF-OCB was detected in 268/945(28%) cases. Of these, 252 had ≥2 and 230 had ≥3 CSF-OCBs. The sensitivity and specificity for MS with ≥2 and ≥3 CSF-OCBs were 91.7%, 91.2%, 90.2% and 93.8% respectively. Only 3/22 patients with 2 CSF-OCBs had MS. In 25% of patients, CSF-OCBs reduced time to MS diagnosis (median 437.5 days (28-1332)).
CONCLUSION
Although cut-offs of ≥2 or ≥3 CSF-OCBs performed similarly well, 2 CSF-OCBs were frequently seen with non-inflammatory pathology. Use of ≥3 CSF-OCBs for MS diagnosis should be considered. CSF analysis reduced time to MS diagnosis by approximately 14 months.
Additional Info
Disclosure statements are available on the authors' profiles:
Do we still need OCBs in MS diagnosis and how many?
Mult Scler Relat Disord 2023 Sep 30;[EPub Ahead of Print], M Forcadela, K Birch, C Rocchi, G Campagna, E Jackson, C Chadwick, S Hamid, A Jacob, S HudaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.