title: A multicenter study on the diagnostic significance of a single cerebrospinal fluid IgG band.
abstract: The analysis of paired cerebrospinal fluid (CSF) and serum samples with isolectric focusing (IEF) can yield different patterns which can be of aid in the differential diagnosis of central nervous system (CNS) disorders. Rarely, a single CSF-restricted IgG band, which is not included within these patterns, can be detected in association with inflammatory disorders, multiple sclerosis (MS) above all. However, the diagnostic meaning of this abnormality is still uncertain. The main aim of our multicenter study was to establish the frequency and disease associations of single CSF IgG bands. Differences in the CSF profiles between MS and other diseases, and the follow-up patterns were also evaluated. Medical records of patients who underwent CSF analysis, which included IEF, over a 11.5-year period were retrospectively scrutinized at the participating centers, which used similar IEF techniques. One hundred and fifty-one of 9422 CSF reports (1.6%) showed single CSF-restricted IgG bands. Of the 129 patients with a definite diagnosis, 58.2% had CNS inflammatory-demyelinating diseases (the most frequent being MS: 21.7%), 6.2% tumours, 5.4% inflammatory peripheral nervous system diseases and 30.2% miscellaneous diseases. At follow-up, 3 out of the 10 patients with a repeated CSF analysis had developed an oligoclonal band pattern. Our findings indicate that single CSF IgG bands tend to associate with diseases characterized by the involvement of intrathecal humoral immune responses, and strongly support the notion that this abnormality should be regularly reported, thus alerting clinicians of possible inflammatory disorders of the CNS.
authors.affiliation: Neurology Unit, Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile Sant'Agostino Estense, Via Pietro Giardini, 1355, 41126, Modena, Italy. diana.ferraro@unimore.it.
authors.forename: Diana
authors.identifier: http://orcid.org/0000-0003-4818-3806
authors.initials: D
authors.lastname: Ferraro
authors.affiliation: Laboratory of Neuroimmunology, IRCCS, National Neurological Insitute C. Mondino Foundation, Via Mondino 2, Pavia, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Franciotta
authors.affiliation: Neurology Unit, Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile Sant'Agostino Estense, Via Pietro Giardini, 1355, 41126, Modena, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Bedin
authors.affiliation: Neurology Unit, Department of Head and Neck, ASL3 Genovese, L.go Rosso, 2, Genoa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Solaro
authors.affiliation: Department of Medical Sciences and Public Healths, Cittadella di Monserrato, University of Cagliari, Cagliari, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Cocco
authors.affiliation: Neurology Unit, Ospedale Ramazzini, Via G. Molinari, 2, Carpi, Modena, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Santangelo
authors.affiliation: Neurology Unit, Department of Specialistic Medicine, G. da Saliceto Hospital, Via T. Giuseppe, 49, Piacenza, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Immovilli
authors.affiliation: Department of Neuroscience, Biomedicine and Movement, University Hospital of Verona, P.le Scuro 10, Verona, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Gajofatto
authors.affiliation: Department of Neuroscience, Biomedicine and Movement, University Hospital of Verona, P.le Scuro 10, Verona, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Calabrese
authors.affiliation: Neurology Unit, Medicine Department, University of Perugia, P.za Menghini, 1, Perugia, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Di Filippo
authors.affiliation: Department of Neuroscience, Biomedicine and Movement, University Hospital of Verona, P.le Scuro 10, Verona, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Orlandi
authors.affiliation: Neurology Unit, Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile Sant'Agostino Estense, Via Pietro Giardini, 1355, 41126, Modena, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Simone
authors.affiliation: Neurology Unit, Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile Sant'Agostino Estense, Via Pietro Giardini, 1355, 41126, Modena, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vitetta
authors.affiliation: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova and IRCCS AOU San Martino-IST, Largo R. Benzi, Genoa, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Capello
authors.affiliation: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova and IRCCS AOU San Martino-IST, Largo R. Benzi, Genoa, Italy.
authors.forename: Debora
authors.initials: D
authors.lastname: Giunti
authors.affiliation: Unit of Neurology, IRCCS San Martino University Hospital IST, Largo R. Benzi, Genoa, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Murialdo
authors.affiliation: Department of Medical Sciences and Public Healths, Cittadella di Monserrato, University of Cagliari, Cagliari, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Frau
authors.affiliation: Department of Neuroscience, Biomedicine and Movement, University Hospital of Verona, P.le Scuro 10, Verona, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Mariotto
authors.affiliation: Neurology Unit, Medicine Department, University of Perugia, P.za Menghini, 1, Perugia, Italy.
authors.forename: Antongiulio
authors.initials: A
authors.lastname: Gallina
authors.affiliation: Neurology Unit, Ospedale San Camillo Forlanini, Circonvallazione Gianicolense, 87, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gasperini
authors.affiliation: Neurology Unit, Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile Sant'Agostino Estense, Via Pietro Giardini, 1355, 41126, Modena, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Sola
mesh_terms: D000328:Adult; D000368:Aged; D002493:Central Nervous System Diseases / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid*; D007525:Isoelectric Focusing; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D043025:Oligoclonal Bands / Q000134:cerebrospinal fluid*; D012189:Retrospective Studies
chemical_list: D007074:Immunoglobulin G; D043025:Oligoclonal Bands
keywords: Cerebrospinal fluid; Isoelectric focusing; Multiple sclerosis; Single IgG band