The presence of oligoclonal bands confined to the CSF is indicative of intrathecal immunoglobulin synthesis. Oligoclonal bands are suggestive, but not pathognomic of Multiple Sclerosis, being found in infective and inflammatory diseases of the CNS e.g. viral encephalitis, bacterial meningitis, neurosyphilis, sarcoid and lupus. Since serum derived IgG can cross into the CSF, paired CSF and serum samples are required for analysis. Comparison of the patterns allows assessment of intrathecal synthesis. Oligoclonal bands can be found in serum in a number of infections (e.g. HIV, EBV) and autoimmune diseases.
Detection of localised neuronal synthesis of immunoglobulin. Most useful in diagnosis of multiple sclerosis.
5 patterns recognised:
- Normal CSF pattern polyclonal IgG
- Oligoclonal CSF normal serum pattern – consistent with MS
- Oligoclonal bands in CSF not seen in serum but some common oligoclonal bands found in both – consistent with MS but can have other causes.
- Identical oligoclonal bands in serum and CSF – no local synthesis, pattern seen in Guillain Barre, HIV infection and other chronic inflammatory states.
- Monoclonal band in CSF and serum – myeloma or MGUS.
Paired CSF and serum samples are required for accurate interpretation. Single CSF samples will be stored in laboratory for 14 days awaiting serum. CSF will not be referred without matching serum.
Assay range notes
Description of serum and CSF patterns.
UCL Neuroimmunology Laboratory