Contributions
Abstract: EP1319
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Paediatric MS
Background: Oligoclonal bands (OCB) are increasingly being examined in children, but their diagnostic value remains uncertain owing to numerous and age-dependent differential diagnoses.
Aim: To evaluate the diagnostic value of OCB and cerebrospinal fluid (CSF) leucocytes in children (< 18 years).
Methods: In a nationwide population-based setting, we retrieved data on first OCB examination in 2,002 children, including CSF leucocytes and differential count, protein, albumin ratio, erythrocytes, glucose ratio and lactate from Danish laboratory databases during 1994-2018. We categorized the children into diagnostic groups based on hospital discharge diagnoses from 2 month before and 1 year after the date of OCB examination.
Results: Median age at OCB examination was 14.2 years (range=0.02-18.0). Among 2,002 children, 200 children (10%) were OCB positive, and 21% had CSF pleocytosis (>4 CSF leucocytes). Among children with central nervous system (CNS) disease, 165 (18%) were OCB positive. The proportion was higher in the subgroup of children with inflammatory CNS diseases (48%), while only 5% had positive OCBs among non-inflammatory CNS diseases. The distribution of OCB positivity for CNS diseases was: epilepsy (3%), hypersomnia syndromes (6%), malignancy (15%), movement disorders (4%), progressive (3%) and static (8%) encephalopathy, stroke (3%), demyelinating (51%), immune- and infection-mediated disease (both 13%), and other CNS diseases (2%). However, only 14% of children with demyelinating disease younger than 12 years of age had positive OCBs. For CNS diseases we found: a) positive OCBs without pleocytosis were rare (4%), but mostly seen in CNS demyelinating diseases (10%) and malignancies (11%); b) positive OCBs with pleocytosis were more common (11%) and mostly seen in demyelinating diseases (43%), immune- or infection-mediated disease (both 11%); c) negative OCBs and pleocytosis were seen in CNS infections (54%), immune-mediated CNS disease (32%) and stroke (29%), but rarer in demyelinating disease (19%). 4% of children with non-CNS disease had positive OCBs.
Conclusion: OCB positivity was related to CNS demyelinating disease, but less often so in children before age 12, presumably due to lower incidence of multiple sclerosis and higher incidence of acute disseminated encephalomyelitis; therefore caution is advised in interpreting OCB in children< 12 years. Negative OCBs and pleocytosis favoured infection, immune or cerebrovascular disease.
Disclosure: Dr. Boesen has served on scientific advisory board for Teva; has received speaker honoraria for lecturing from Novartis and support for congress participation from Teva, Novartis and Roche.
Dr. Jensen, Dr. Rosenberg, Dr. Thomassen, Dr. Børresen, Dr. Jørgensen and Dr. Lydolph report no disclosures.
Dr. Born has received speaker honoraria from Novartis and has served on an advisory board for Biogen.
Dr. Sellebjerg has served on scientific advisory boards, been on the steering committees of clinical trials, served as a consultant, received support for congress participation, received speaker honoraria, or received research support for his laboratory from Biogen, EMD Serono, Genzyme, Lundbeck, Merck Serono, Novartis and Teva.
Abstract: EP1319
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Paediatric MS
Background: Oligoclonal bands (OCB) are increasingly being examined in children, but their diagnostic value remains uncertain owing to numerous and age-dependent differential diagnoses.
Aim: To evaluate the diagnostic value of OCB and cerebrospinal fluid (CSF) leucocytes in children (< 18 years).
Methods: In a nationwide population-based setting, we retrieved data on first OCB examination in 2,002 children, including CSF leucocytes and differential count, protein, albumin ratio, erythrocytes, glucose ratio and lactate from Danish laboratory databases during 1994-2018. We categorized the children into diagnostic groups based on hospital discharge diagnoses from 2 month before and 1 year after the date of OCB examination.
Results: Median age at OCB examination was 14.2 years (range=0.02-18.0). Among 2,002 children, 200 children (10%) were OCB positive, and 21% had CSF pleocytosis (>4 CSF leucocytes). Among children with central nervous system (CNS) disease, 165 (18%) were OCB positive. The proportion was higher in the subgroup of children with inflammatory CNS diseases (48%), while only 5% had positive OCBs among non-inflammatory CNS diseases. The distribution of OCB positivity for CNS diseases was: epilepsy (3%), hypersomnia syndromes (6%), malignancy (15%), movement disorders (4%), progressive (3%) and static (8%) encephalopathy, stroke (3%), demyelinating (51%), immune- and infection-mediated disease (both 13%), and other CNS diseases (2%). However, only 14% of children with demyelinating disease younger than 12 years of age had positive OCBs. For CNS diseases we found: a) positive OCBs without pleocytosis were rare (4%), but mostly seen in CNS demyelinating diseases (10%) and malignancies (11%); b) positive OCBs with pleocytosis were more common (11%) and mostly seen in demyelinating diseases (43%), immune- or infection-mediated disease (both 11%); c) negative OCBs and pleocytosis were seen in CNS infections (54%), immune-mediated CNS disease (32%) and stroke (29%), but rarer in demyelinating disease (19%). 4% of children with non-CNS disease had positive OCBs.
Conclusion: OCB positivity was related to CNS demyelinating disease, but less often so in children before age 12, presumably due to lower incidence of multiple sclerosis and higher incidence of acute disseminated encephalomyelitis; therefore caution is advised in interpreting OCB in children< 12 years. Negative OCBs and pleocytosis favoured infection, immune or cerebrovascular disease.
Disclosure: Dr. Boesen has served on scientific advisory board for Teva; has received speaker honoraria for lecturing from Novartis and support for congress participation from Teva, Novartis and Roche.
Dr. Jensen, Dr. Rosenberg, Dr. Thomassen, Dr. Børresen, Dr. Jørgensen and Dr. Lydolph report no disclosures.
Dr. Born has received speaker honoraria from Novartis and has served on an advisory board for Biogen.
Dr. Sellebjerg has served on scientific advisory boards, been on the steering committees of clinical trials, served as a consultant, received support for congress participation, received speaker honoraria, or received research support for his laboratory from Biogen, EMD Serono, Genzyme, Lundbeck, Merck Serono, Novartis and Teva.