title: Early differential diagnosis of multiple sclerosis using a new oligoclonal band test.
abstract: 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.
authors.affiliation: Department of Immunology, Hospital Ramón y Cajal, Madrid, Spain. lvillar.hrc@salud.madrid.org
authors.forename: Luisa M
authors.initials: LM
authors.lastname: Villar
authors.forename: Jaime
authors.initials: J
authors.lastname: Masjuan
authors.forename: María C
authors.initials: MC
authors.lastname: Sádaba
authors.forename: Pedro
authors.initials: P
authors.lastname: González-Porqué
authors.forename: José
authors.initials: J
authors.lastname: Plaza
authors.forename: Alfredo
authors.initials: A
authors.lastname: Bootello
authors.forename: José C
authors.initials: JC
authors.lastname: Alvarez-Cermeño
mesh_terms: 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
chemical_list: D043025:Oligoclonal Bands; D000469:Alkaline Phosphatase