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

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2 thoughts on “A question about oligoclonal bands (OCBs) in multiple sclerosis and a reply

  1. I am not sure if this is the proper place to post a question. I am a 46 yo female physician boarded in family practice and urgent care. I am in good health. In January of 2010, I was hospitalized for 10 days with presumed meningitis. WBC’s wer almost 900 in the CSV. All fungal, bacterial and viral cultures were negative. I had three subsequent bouts of “meningitis”. I amhave undergone two subsequent taps when I was asymptomatic. My WBC’s have gone to 18 with 98% lymphocytes. The initial, “post meningitis” tap showed oligoclonal bands in the CSF only. The follow up after imperic treatment with Diflucan (for possibility of indolent Cocci) revealed OCB’s in both the CSF and now the peripheral blood. I am being worked up at Barrow Neurologic Institute, testing included a brain biopsy which simply showed gliosis. I can not get a straight answer on what they even suspect that I have. They have pointed to both MS an primary brain non-hodgkins. Do you have any ideas?

    d

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