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- Title
OLIGOCLONAL BANDING AND CSF MARKERS IN MULTIPLE SCLEROSIS: ASSOCIATIONS WITH DISEASE COURSE AND PROGRESSION.
- Authors
Lourenco, Pedro; Shirani, Afsaneh; Saeedi, Jameelah; Oger, Joel; Schreiber, William; Tremlett, Helen
- Abstract
Background: Oligoclonal bands (OCBs) and CSF markers are useful in the diagnosis of MS. However, their role in disease course determination and prognosis is poorly defined. Here, we studied the association of OCB status and CSF markers with disease-course and progression. We also examined the impact of ethnicity and selection bias on our findings. Methods: In a cohort of definite MS patients (Poser or McDonald criteria), registered at BC MS Clinics between 1982-2010, we retrospectively investigated the association between OCB status, IgG-index, IgG-synthesis rate, total CSF IgG, total CSF protein, disease course (relapsing-onset (RO) vs. primary-progressive (PP)) and disability progression. Disability outcomes included time to sustained Expanded Disability Status Scale (EDSS) 6 from MS onset and birth; the proportion of patients to reach EDSS 6 within 10 years after onset; and the progression index. Analysis was repeated in Caucasians only. Selection bias was examined by comparing the characteristics of those tested vs. those not tested. Results: Of the 6935 patients with definite MS, 1,120 had CSF testing, of which 957 were tested for OCBs. A total of 694/957 (72.5%) patients had detectable OCBs. OCB positivity was marginally higher in PP (107/134; 79.8%) compared to RO (587/823; 71.3%) patients (p=0.047); this association was stronger when Caucasians only were examined (69/79; 87.3% in PP vs. 346/481; 71.9% in RO; p=0.003). Total CSF IgG (64.1±44.6 vs. 52.0±37.4 mg/L) and total protein (502±276 vs. 418±174 mg/L) levels were higher in PPMS compared to RO patients, respectively (p<0.001). Other CSF markers were not associated with disease course. Disease progression outcomes were independent of OCB status. Patients tested were significantly more likely to be male (32.4 vs. 27.1%, p<0.001), older at onset (35.0±10.9 vs. 31.5±10.0 years, p<0.001) and have a PPMS (14.2 vs. 8.8%, p<0.001) than those not tested. Conclusions: Presence of OCBs was higher among PP compared to RO patients; this association was stronger in Caucasians. Higher total CSF protein and IgG levels were associated with a PPMS, suggesting different immunological etiologies for RO and PPMS. Disease progression was not associated with OCB status. However, a selection bias was observed, warranting caution when comparing different OCB studies.
- Subjects
CEREBROSPINAL fluid; MULTIPLE sclerosis diagnosis; IMMUNOGLOBULIN G; DISEASE progression; BIOMARKERS
- Publication
UBC Medical Journal, 2011, Vol 2, Issue 2, p16
- ISSN
1920-7425
- Publication type
Abstract