A question about oligoclonal bands (OCBs) in multiple sclerosis and a reply

Recently one of the readers of my blog asked me a question about the presence of oligoclonal bands (OCBs) in multiple sclerosis. I am reproducing her question here and my reply to is follows. Hope it helps some of you out there.

 

Hello Dr. Sethi:
I found your informative blog Brain Care Foundation online, and I wanted to get in touch with you about the neurological symptoms I have been experiencing in hopes that you can provide some guidance to me.

I am a 28-year-old Indian-American female who was recently diagnosed with optic neuritis. An MRI of my brain showed one unspecified speck and a lumbar puncture showed three oligoclonal bands that were also present in the blood, ruling out multiple sclerosis, according to my doctor. All other blood work is normal.

She has recommended that I see a rheumatologist to rule out other autoimmune diseases.

I have been very concerned about underlying diseases that may have causes the optic neuritis and my question to you is whether I should be concerned about the presence of three oligoclonal bands in the cerebral spinal fluid. Ideally, I understand there would be none, but it seems somewhat arbitrary to me that 1 or 2 would be considered normal and 3 would be considered an abnormally high level.

I specifically wanted to seek your advice because I read in your blog that “greater than 3” would be the amount of concern.

Thank you in advance for any insight you can provide.

Sincerely,
R

p.s. please feel free to post this question on your blog without using my name

Dear R,

thank you for writing in to me. You ask me a very specific question regarding the presence of OCBs in multiple sclerosis (MS) and I shall be happy to answer it for you. OCBs can be seen in multiple other conditions apart from MS. What we look for in MS is that the oligoclonal bands should be only present in the cerebrospinal fluid (CSF) and not in the blood. As you are aware MS is a demyelination disease of the central nervous system (brain and spinal cord). So it reasons that the bands should only be present in the spinal fluid and not in the blood. We refer to this as intrathecal synthesis of OCBs. If OCBs are present in both the spinal fluid and the blood, one needs to rule out diseases that may cause passive transfer of OCBs from the blood into the spinal fluid. Now to your second question. Just how many OCBs are considered abnormal or worrisome for MS? This is a tough one to answer as studies have shown conflicting results. Some studies have indicated that a higher number of OCBs in the spinal fluid is more specific for MS (aka increases the risk for conversion of a clinically isolated syndrome into a clincally definite MS). In other studies this has not been conclusively proven.

Hope that answers your queries. I wish you my ver best.

 

Personal Regards,

Nitin Sethi, MD

Few Multiple Sclerosis questions and their answers

Nitin K Sethi, MD

Assistant Professor of Neurology

NYP-Weill Cornell Medical Center

New York, NY 10065

One of my readers Lisa asked me some very specific MS questions. Since I feel these questions shall be on many MS patients minds I am reproducing them here. Here are the questions followed by my answers. Thank you Lisa!!!

  1. Lisa on September 17, 2008 said:

Hi, I have enjoyed reading the information you posted. I have a few questions of my own:

At this point, I have an MRI with 8 lesions, one possibly of which is tumefactive MS, a postive LP for oligoclonal bands, and my neurologist has diagnosed me with “clinically isolated syndrome”…not full blown MS at this point, but still wants to begin treatment.

1. Is tumefactive MS considered more fatal or harder to treat than “regular” MS?

2. How many oligoclonal bands are needed for a low amount? High amount? My report states greater than 3 bands. Why is there not a specific number given?

3. I have been given the choice between Rebif and Copaxone. Which is the better treatment?

  1. 7 braindiseases on September 18, 2008 said:

Dear Lisa,
thank you for writing in. You ask some very specific questions and that is what I shall attempt to answer. I am not sure why your doctor has stil labelled you as a clinically isolated syndrome (likely it is because you have had only one clinical attack suggestive of MS). Your MRI though does show dissemination of the disease in space (you can read more about the clinical diagnosis of MS on my website
http://braindiseases.info) and you have more than 3 oligoclonal bands in your CSF. Now to answer your first question. Some patients have large sized demyelinating plaques (lesions) on their MRI. This is commonly referred to as tumefactive MS (because on the MRI, the lesion is large and resembles a tumor more which it has to be differentiated). There is some data to suggest that MS patients with tumefactive disease have a more aggressive disease course. Though I have to add that this data is not robust.
Oligoclonal bands are frequently present in the CSF of MS patients. Here I have to add that oligoclonal bands can be seen in many other conditions other than MS hence one has to make sure that they are present only in the CSF and not in the blood (In MS these bands are produced intrathecally meaning present only in CSF but not in blood). One study suggested that low or absent number of oligoclonal bands in the cerebrospinal fluid at the time of diagnosis predicts a better prognosis. However quantification of oligoclonal bands in the CSF remains an insensitive prognostic indicator and hence should not be used to influence decisions regarding treatment.
Now to your third question. There is some evidence to suggest that higher dose interferon (Betaseron/ Rebif) are more effective as compared to lower dose interferon. The interferons as well as Copaxone are recommened for initial treatment of relapsing remitting MS. Most of the times it is the patient’s lifestyle, easy of administration and side-effect profile which determines the choice between them.
I hope that helps you out and feel free to write again. I wish you the best.


Personal Regards,
Nitin Sethi, MD