Oligoclonal Bands, CSF

What is multiple sclerosis?

This condition, also known as, encephalomyelitis disseminate, is a demyelinating condition of the nervous system, where the insulating coverings of nerve cells of the brain and spinal cord are damaged. Due to such damage, there is a disruption in the signal transduction system of the nervous system. 

What are the symptoms of Multiple sclerosis?

Symptoms could be physical, mental, or even psychiatric disturbances. 

Specific ones could be double vision, blindness in one eye, muscle weakness and trouble with sensation and coordination.

Symptoms can occur as relapsing forms( new symptoms occurring in isolated attacks) or progressive forms ( symptoms building up gradually over time). Usually, in between the attacks, symptoms may disappear, however, permanent neurological problems remain and grow as the disease process progresses

What is the age of onset of this disease?

The usual age of onset is between 20 to 50 years.

What is the underlying cause of multiple sclerosis?

Multiple sclerosis has three important characteristics, they are:

a)    Formation of lesions in the central nervous system ( called plaques)
b)   Inflammation
c)    Myelin sheath destruction of nerve cells

All these interact in a complex way resulting in the destruction of nerve tissue and signs and symptoms of multiple sclerosis.

Multiple sclerosis is supposed to be an immune-mediated disorder occurring following the interaction of genetics and environmental factors.

Environmental Factors responsible for this could be following a viral infection, most commonly. Human herpes virus, Epstein-Barr virus, measles, mumps rubella, influenza, or gastroenteritis.

Another triggering factor could be stress. Pregnant women who have been diagnosed with multiple sclerosis, experience fewer relapses during pregnancy, however after delivery, in the first few months, the risk of relapses increases

What are the risk factors for multiple sclerosis?

Smoking, stress, occupational exposure to toxins and solvents, vaccinations, hormonal intakes. Few studies have shown that uric acid is protective, however, its exact importance is still not found.

How is multiple sclerosis diagnosed?

Diagnosis is based on the correlation of signs and symptoms with imaging studies and pathological investigations.

MRI of the brain and spine shows areas of demyelination( lesions or plaques)

CSF has tested for IgG oligoclonal bands on electrophoresis and evidence of chronic inflammation 

What are the other conditions in which oligonal bands are found in CSF?

Apart from multiple sclerosis, oligoclonal bands are found in

a)    Neuromyelitis Optica ( Devic’s disease)
b)   Systemic lupus erythematosus(SLE) 
c)    Lyme disease
d)   Neurosarcoidosis
e)    Syphilis
f)     Primary central nervous lymphoma
g)    Subarachnoid hemorrhage

What is Neuromyelitis Optica Spectrum Disorder?

NMOSD is an etiologically heterogeneous syndrome characterized predominantly by acute optic neuritis ON( optic nerve inflammation) and spinal cord myelitis. Symptoms of ON and myelitis can occur at the same time or be successive. If patients remain untreated, it can present as a relapsing disease. In rare conditions, it can be associated with other autoimmune disorders like Connective tissue disorders, paraneoplastic diseases, or infections. Sometimes the cause may remain unknown (idiopathic NMO).

What is the differential diagnosis of Neuromyelitis Optica?

The most common differential is multiple sclerosis and less often other autoimmune disorders like connective tissue disorders, paraneoplastic disorders, etc.

What is the role of MOG antibodies in ruling out demyelinating conditions of the CNS?

Myelin oligodendrocyte glycoprotein(MOG) is a membrane protein expressed on the oligodendrocyte cell surface, located on the outermost surface of myelin sheaths. It is the primary target antigen involved in immune-mediated demyelination in patients with NMOSD- Neuromyelitis Optica Spectrum Disorder.

Approximately 80% of patients with Neuromyelitis Optica are seropositive for Aquaporin -4(AQP4 /NMOIgG). Of the remaining 20%about to one third harbor MOGIgG .30 TO 40% of pediatric patients with inflammatory demyelinating disease of the CNS exhibit autoantibodies against MOG at disease onset. Seropositivity with MOG IgG predicts a relapsing phenotype and warrants immunosuppressive therapy.

It is important to differentiate NMOSD from Multiple Sclerosis as MS therapies may worsen MOG IgG-associated inflammatory demyelinating disorders.