Oligoclonal Banding

Oligoclonal Banding

Number
	019216
CPT
	83916
Synonyms
	CSF Protein
Specimen
	Cerebrospinal fluid and serum, collected at the same time, frozen
Volume
	0.5 mL CSF and 0.5 mL serum
Minimum Volume
	0.1 mL CSF and 0.1 mL serum
Container
	Red-top tube or gel-barrier tube and plastic (CSF) tube
Collection
	Spinal tap and venipuncture. Transfer serum specimen to a plastic transport tube before freezing. Freeze CSF. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.
Storage Instructions
	Freeze (samples may be refrigerated up to 72 hours but should be transported frozen).
Patient Preparation
	Spinal tap
Causes for Rejection
	Plasma instead of serum specimen since fibrinogen band may obscure the beta gamma electrophoretic zone; serum and CSF not collected within 8 hours of each other; CSF not received frozen
Reference Interval
	None found
Use
	Diagnose diseases of the central nervous system including meningitis, tumor, syphilis, and multiple sclerosis
Methodology
	Isoelectric focusing (IEF) and immunoblotting on agarose gel
Additional Information
	Most of the clinical interest in CSF electrophoresis is focused on the gamma region. Oligoclonal bands are multiple distinct bands in the gamma zone of the CSF pattern which are not present in serum. These bands in the CSF pattern are produced by a limited number of immunocompetent cell clones, each producing IgG with its own specificity. More than 90% of patients with multiple sclerosis show oligoclonal banding at some time during the course of their disease. The presence of oligoclonal bands in CSF from patients with multiple sclerosis does not correlate with the activity of the demyelinating process. Oligoclonal bands can be present even when the CSF IgG level is normal. Increased IgG production by the central nervous system is not specific for multiple sclerosis, but is an indication of chronic neural inflammation. Oligoclonal bands in CSF have been reported in cases of neurosyphilis, acute bacterial or viral meningitis, progressive multifocal leukoencephalopathy, subacute sclerosing panencephalitis, progressive rubella panencephalitis, polyneuritis, optic neuritis, trypanosomiasis, and other infectious or autoimmune diseases. The oligoclonal band pattern is blurred when a concomitant inflammatory response causes increased protein leakage of plasma proteins into the CSF. If the CSF protein concentration is >200 mg/dL, even high immunoglobulin production in the central nervous system can be obscured by the presence of plasma proteins. Since 80% of normal CSF protein is derived from serum, patients with serum monoclonal proteins may also have corresponding CSF bands. In addition, serum oligoclonal bands are present in some patients with Hodgkin disease and in up to 5% of normal individuals. Therefore, CSF electrophoretic patterns cannot be interpreted without corresponding serum patterns.