One thing related to diagnosis which was mentioned to me in hospital a couple of times was oligoclonal bands. I'd never heard of these, had no idea what they were and didn't even know if having them was a good thing or a bad thing. Since reading some CLIPPERS papers I noticed they always comment about oligoclonal bands so they must be important; I've also seen them often mentioned in connection with Multiple Sclerosis diagnosis. So in case you were wondering ...
What Are They?
Oligoclonal bands are immunoglobulins (antibodies) found in serum in blood plasma or cerebrospinal fluid (CSF) when it is analysed using electrical based techniques such as protein electrophoresis. (CSF is obtained by lumbar puncture and is the fluid which bathes the spine and brain.) They appear as stripes on a slide like in the images here.
What's the Point?
Antibodies are produced to fight infection and so oligoclonal bands can indicate immune response. One band in CSF is often normal. More than one band is abnormal. Also if the level is higher in CSF than in blood collected at the same time then the source of the bands is likely to be in the brain rather than elsewhere in the body.
Oligoclonal Bands for Diagnosis
Around 95% of people with Multiple Sclerosis have oligoclonal bands so they represent a key piece of information in the diagnostic process for MS. Their importance for CLIPPERS is less clear.
- Gabilondo et al found no CSF oligoclonal bands in 1 patient.
- Jones et al found no CSF oligoclonal bands in 1 patient.
- Kastrup et al found no CSF oligoclonal bands in 3 of 3 patients.
- List et al first found CSF-specific oligoclonal bands, then none on a second examination of 1 patient.
- Pittock et al found elevated unique CSF oligoclonal bands in 3 out of 6 patients tested.
- Sempere et al found no CSF oligoclonal bands in 1 patient.
- Taieb et al found CSF oligoclonal bands present in 1 patient.
So the jury is out on this one it seems. With unanswered questions about whether CLIPPERS has sub-types, the nature of it's progression and response to treatment it is a bit too early to know how much significance to put on the presence of oligoclonal bands in CLIPPERS.
So Where Do I Fit In?
And in case you were wondering, I tested negative for CSF oligoclonal bands in August like the narrow majority of reported cases above.
Read other articles in this series at Living With CLIPPERS.
Living With CLIPPERS by Bill Crum is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
