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The contribution of cerebrospinal fluid oligoclonal bands to the early diagnosis of multiple sclerosis

Department of Neurology, University of Florence, Florence, Italy valentina.zipoli{at}unifi.it

B Hakiki

Department of Neurology, University of Florence, Florence, Italy

E Portaccio

Department of Neurology, University of Florence, Florence, Italy

F Lolli

Department of Neurology, University of Florence, Florence, Italy

G Siracusa

Department of Neurology, University of Florence, Florence, Italy

M Giannini

Department of Neurology, University of Florence, Florence, Italy

L Pantoni

Department of Neurology, University of Florence, Florence, Italy

F Pescini

Department of Neurology, University of Florence, Florence, Italy

S Sorbi

Department of Neurology, University of Florence, Florence, Italy

MP Amato

Department of Neurology, University of Florence, Florence, Italy

Background

McDonald Criteria (MDC) have been validated in selected patients at high risk for multiple sclerosis (MS). However, possible overdiagnosis of MS can represent critical issues in less controlled clinical settings.

Objective

To assess the contribution of oligoclonal bands (OB) to MS diagnosis in current clinical practice.

Methods

We included all the patients admitted to our Department since 2001 who had undergone diagnostic workup for a possible MS diagnosis, followed up for at least 1 year. We assessed the accuracy of MDC, OB, and two MDC definitions of dissemination in space (DIS-MRI: fulfillment of MRI criteria, DIS-OB: two MRI lesions+OB).

Results

We included 118 patients (median follow-up 4.0 years). Twenty-eight cases received an alternative diagnosis, whereas none of these presented OB, 43% fulfilled the DIS-MRI criteria. OB were present in 70% of the remaining 90 patients. By the end of the follow-up, 56% of the diagnoses had converted to clinically definite MS and OB showed higher accuracy than DIS-MRI fulfillment (70% vs 58%). Moreover, after 1 year and at the end of the follow-up, DIS-OB yielded a higher Specificity level in comparison with DIS-MRI.

Conclusion

OB can improve overall diagnostic Accuracy by increasing Specificity and negative predictive value.

Key Words: cerebrospinal fluid • clinically isolated syndrome • diagnostic criteria • MRI • multiple sclerosis • oligoclonal bands

This version was published on April 1, 2009

Multiple Sclerosis, Vol. 15, No. 4, 472-478 (2009)
DOI: 10.1177/1352458508100502


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