Early differential diagnosis of multiple sclerosis using a new oligoclonal band test.
BACKGROUND
Intrathecal IgG synthesis (ITGS), in conjunction with magnetic resonance imaging, can help in the early diagnosis of multiple sclerosis (MS). Recently, we developed a new oligoclonal IgG band (OCGB) test for ITGS detection that is more sensitive and easier to interpret than previously described methods.


OBJECTIVE
To assess the accuracy of a new OCGB detection test in the diagnosis of MS.


METHODS
Prospective observational study.


METHODS
A hospital neurology department. Patients A total of 385 patients with various neurologic disorders.


METHODS
The sensitivity and specificity of the OCGB detection test for MS diagnosis.


RESULTS
Intrathecal IgG synthesis was found in 127 patients with MS (96.2%), 18 (35.3%) with central nervous system infections, and 1 with motor neuron disease. Two patterns reflected ITGS. One pattern, showing OCGBs restricted to cerebrospinal fluid, was predominantly found in MS. The other pattern, with OCGBs in serum and additional bands in cerebrospinal fluid, was mostly found in central nervous system infections. No patients with other inflammatory neurologic diseases showed ITGS. These patients frequently displayed a mirror pattern, with identical bands in serum and cerebrospinal fluid. Considering all patients, the sensitivity for the diagnosis of MS was 96.2%, and the specificity was 92.5%. Excluding infections, which usually do not present a differential diagnosis problem with MS, the sensitivity was still 96.2%, and the specificity increased to 99.5%.


CONCLUSIONS
The accuracy of this OCGB method reinforces the value of cerebrospinal fluid studies in the early differential diagnosis of MS.
Villar
Luisa M
LM
Department of Immunology, Hospital Ramón y Cajal, Madrid, Spain. lvillar.hrc@salud.madrid.org
Masjuan
Jaime
J
Sádaba
María C
MC
González-Porqué
Pedro
P
Plaza
José
J
Bootello
Alfredo
A
Alvarez-Cermeño
José C
JC
D000469:Alkaline Phosphatase / Q000737:chemistry; D002493:Central Nervous System Diseases / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000276:immunology*; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D006801:Humans; D007118:Immunoassay / Q000379:methods* / Q000592:standards; D009103:Multiple Sclerosis / Q000097:blood / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D043025:Oligoclonal Bands / Q000097:blood / Q000134:cerebrospinal fluid*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D043025:Oligoclonal Bands; D000469:Alkaline Phosphatase