Abstract: EP1292
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background and objectives: A cerebrospinal fluid (CSF) analysis is not mandatory for the diagnosis of multiple sclerosis (MS) in patients with a clinical syndrome suggestive of MS. However, in the 2017 McDonald diagnostic criteria presence of >2 oligoclonal IgG bands (OCB) in the CSF, but absence in the corresponding serum, can be used to fulfill the distribution in time (DIT) criteria, possibly leading to an earlier diagnosis. However, the finding of an elevated IgG index (CSF IgG:serum IgG/CSF albumin: serum albumin) > 0.7 should be interpreted with caution. The aim of the study was to investigate the diagnostic value of IgG index versus OCB in suspected MS in a population based real life setting.
Methods: 2141 MS patients according to the McDonald criteria with known OCB status and/or IgG index from the three Norwegian counties Buskerud, Oslo and Telemark (“BOT-database”) from 1972-2018 were included. CSF-OCB analyses were for the earlier years performed by agarose gel electrophoresis (AGE) and since 2005 by isoelectric focusing with immunoblotting (IEF).
Results: 1785 (87.2%) of the patients were OCB positive and 263 (12.8%) were OCB negative. Of the 384 patients with known IgG index 294 (76.6 %) had a value >0.7, and 90 (23.4%) < 0.7. 285 (74.2%) of the patients had both an IgG index >0.7 and were OCB positive. Only 9 of 294 patients (3.1%) with IgG index > 0.7 were OCB negative whereas 28 of 90 (31.1%) with IgG index < 0.7 were OCB negative.
Conclusions: The frequency of OCB positive patients in our population was as expected. The vast majority of patients with IgG index > 0.7 were also OCB positive. Thus both presence of >2 OCB or an IgG index >0. 7 may be used as a supplement to fulfill the diagnostic criteria for DIT in MS.
Disclosure: P.B-H has received funding for travel or speaker's fees from Novartis, UCB and Teva.
CSS has received funding from The Odd Fellow Research Fund for Multiple Sclerosis as well as travel and/or speakers fees from Biogen Idec, Merck, Teva and Sanofi.
HØF has received funding from The Odd Fellow Research Fund for MS, research grants from Novartis and Biogen Idec as well as speaker honoraria from Biogen and Sanofi.
SMM has received speaker honoraria from Biogen Idec.
EGC has participated in advisory boards and/or received speaker honoraria from Biogen Idec, Merck, Roche, Novartis, Genzyme and Teva as well as unrestricted research grants from Novartis and Genzyme.
Abstract: EP1292
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background and objectives: A cerebrospinal fluid (CSF) analysis is not mandatory for the diagnosis of multiple sclerosis (MS) in patients with a clinical syndrome suggestive of MS. However, in the 2017 McDonald diagnostic criteria presence of >2 oligoclonal IgG bands (OCB) in the CSF, but absence in the corresponding serum, can be used to fulfill the distribution in time (DIT) criteria, possibly leading to an earlier diagnosis. However, the finding of an elevated IgG index (CSF IgG:serum IgG/CSF albumin: serum albumin) > 0.7 should be interpreted with caution. The aim of the study was to investigate the diagnostic value of IgG index versus OCB in suspected MS in a population based real life setting.
Methods: 2141 MS patients according to the McDonald criteria with known OCB status and/or IgG index from the three Norwegian counties Buskerud, Oslo and Telemark (“BOT-database”) from 1972-2018 were included. CSF-OCB analyses were for the earlier years performed by agarose gel electrophoresis (AGE) and since 2005 by isoelectric focusing with immunoblotting (IEF).
Results: 1785 (87.2%) of the patients were OCB positive and 263 (12.8%) were OCB negative. Of the 384 patients with known IgG index 294 (76.6 %) had a value >0.7, and 90 (23.4%) < 0.7. 285 (74.2%) of the patients had both an IgG index >0.7 and were OCB positive. Only 9 of 294 patients (3.1%) with IgG index > 0.7 were OCB negative whereas 28 of 90 (31.1%) with IgG index < 0.7 were OCB negative.
Conclusions: The frequency of OCB positive patients in our population was as expected. The vast majority of patients with IgG index > 0.7 were also OCB positive. Thus both presence of >2 OCB or an IgG index >0. 7 may be used as a supplement to fulfill the diagnostic criteria for DIT in MS.
Disclosure: P.B-H has received funding for travel or speaker's fees from Novartis, UCB and Teva.
CSS has received funding from The Odd Fellow Research Fund for Multiple Sclerosis as well as travel and/or speakers fees from Biogen Idec, Merck, Teva and Sanofi.
HØF has received funding from The Odd Fellow Research Fund for MS, research grants from Novartis and Biogen Idec as well as speaker honoraria from Biogen and Sanofi.
SMM has received speaker honoraria from Biogen Idec.
EGC has participated in advisory boards and/or received speaker honoraria from Biogen Idec, Merck, Roche, Novartis, Genzyme and Teva as well as unrestricted research grants from Novartis and Genzyme.