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What is Oligoclonal Bands Cerebrospinal Fluid (CSF) and Serum test? 

The oligoclonal bands CSF test, also known as CSF immunofixation, detects the presence of immunoglobulins (a type of proteins) in the cerebrospinal fluid. The presence of these bands implies inflammation in the central nervous system (CNS) which may be caused by an infection or a disease. CNS comprises the spinal cord and the brain. CSF is a clear, colourless fluid found in your CNS. It protects the CNS against injury and sudden impact.

The word oligoclonal band comes from the fact that the immunoglobulins appear as separate bands when the CSF is put in a gel plate under the effect of an electric current.

Along with the CSF test, the serum (the liquid component of blood without clotting proteins) is also tested for oligoclonal bands. 

Bands present only in the CSF indicate local CNS disorders, especially multiple sclerosis, and sometimes other conditions such as CNS infection, inflammation or neoplasia (tumours or cancers). Bands found in both serum and CSF indicate a generalised infection, sarcoidosis (an inflammatory disease affecting many organs), neoplasia or an autoimmune disorder (a condition where the immune system damages normal body tissue).

  1. Why is an Oligoclonal Bands CSF and Serum test performed?
  2. How do you prepare for an Oligoclonal Bands CSF and Serum test?
  3. How is an Oligoclonal Bands CSF and Serum test performed?
  4. What do Oligoclonal Bands CSF and Serum test results mean?

Why is an Oligoclonal Bands CSF and Serum test performed?

Your doctor may order this test if he/she suspects that you have multiple sclerosis. Multiple sclerosis is a CNS disorder in which the immune system damages myelin (a protective sheath around nerves), the nerves and the cells that produce myelin. 

The symptoms of multiple sclerosis are unpredictable, varying from person to person and fluctuating over time. Some common symptoms of multiple sclerosis are:

  • Difficulty in walking
  • Fatigue
  • Stiffness and muscle spasms that may occur in any limb but are more common in the legs
  • Numbness in the face, body, arms or legs
  • Problems with vision
  • Pain
  • Weakness
  • Dizziness
  • Sexual problems
  • Bowel problems
  • Bladder problems
  • Emotional changes
  • Cognitive changes
  • Depression

Some of the less common symptoms include:

  • Swallowing problems
  • Speech problems
  • Tremor
  • Seizures
  • Breathing problems
  • Loss of hearing

Doctors may also order this test to diagnose other neurological diseases and inflammatory conditions like:

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How do you prepare for an Oligoclonal Bands CSF and Serum test?

Give your healthcare provider complete information about all the medicines you are consuming. Tell him/her if you:

  • have a history of back problems
  • are taking blood thinners
  • have any rash or infection on your back
  • have any neurological conditions

If you do strenuous work that involves your back, inform your doctor.

How is an Oligoclonal Bands CSF and Serum test performed?

The test requires both CSF and serum samples.

The CSF sample is collected by a lumbar puncture or spinal tap. Here is how a spinal tap is done:

  • You will be made to wear a hospital gown with an open back. The doctor may ask you to sit on the exam table or lie down on your side.  
  • He/she will then clean an area on your back with an antiseptic and will inject a local anaesthetic to numb the area. 
  • The doctor will then insert a hollow needle between two bones in your lower spine and into your spinal canal to withdraw a small quantity of CSF.
  • Once the required sample is collected, he/she will cover the site of puncture with a bandage.

After the test, your doctor may give you a mild painkiller and ask you to rest for an hour or two. 

Spinal tap is generally considered safe but is associated with a few risks, such as:

  • Allergic reaction to the anaesthetic
  • Infection
  • Bleeding into the spine
  • Damage to your spinal cord if you move during the procedure

You may feel some discomfort during or after the test, or you may have a headache after the procedure. This should subside in 24 hours.

For a serum test, your healthcare practitioner will withdraw some blood from a vein in your arm. After the test, you may notice a bruise at the needle insertion site - it will subside on its own in a few days.

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What do Oligoclonal Bands CSF and Serum test results mean?

Normal results:

One or no oligoclonal bands in the CSF is considered normal.

Abnormal results:

If there are two or more oligoclonal bands present in your CSF with no corresponding bands in the serum, the result is considered positive. It means that the immunoglobulins are being produced in your CNS. Although an abnormal result supports a diagnosis of multiple sclerosis, it does not confirm the diagnosis. The doctor may order other tests to confirm the diagnosis.

Oligoclonal bands may be observed in the following conditions:

  • Multiple sclerosis
  • Viral and bacterial meningitis
  • HIV (AIDS)
  • Cerebral infarction (death of brain tissue due to insufficient blood flow)
  • Guillain-Barré syndrome (an autoimmune condition that affects the nerves)
  • Neurosyphilis
  • Idiopathic polyneuritis (inflammation of multiple nerves without an obvious cause)
  • Cryptococcal meningitis (infection in the brain due to Cryptococcus fungus)
  • Burkitt’s lymphoma (a type of cancer)
  • Subacute sclerosing panencephalitis (a slowly progressive neurological disorder caused by measles virus)
  • Progressive rubella panencephalitis (a neurological condition caused by rubella virus)

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Autoimmune disorders. in: Wallach, J. B. (2007). Interpretation of diagnostic tests. 7th ed., Philadelphia, PA: Lippincott Williams and Wilkins. p. 319
  2. Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders. ch. 396.
  3. Correale J, de los Milagros Bassani Molinas M. Oligoclonal bands and antibody responses in multiple sclerosis. J Neurol. 2002 Apr;249(4):375-89. PMID: 11967640.
  4. Amato, A. A., & Russell, J. A. Neuromuscular disorders. New York: McGraw-Hill Medical.
  5. Peterson R, Graff-Radford J. Alzheimer disease and other dementias. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 95.
  6. Lechner-Scott J et al. The frequency of CSF oligoclonal banding in multiple sclerosis increases with latitude. Mult Scler. 2012 Jul;18(7):974-82. PMID: 22185806.
  7. UW Health: American Family Children's Hospital [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2017. Kids Health: Spinal Tap
  8. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Diagnostic Tests for Neurological Disorders
  9. Dean A. Seehusen et al. Cerebrospinal Fluid Analysis. Am Fam Physician. 2003 Sep 15;68(6):1103-1109.
  10. Kottil W. Rammohan. Cerebrospinal fluid in multiple sclerosis. Ann Indian Acad Neurol. 2009 Oct-Dec; 12(4): 246–253. PMID: 20182572.
  11. National Multiple Sclerosis Society [Internet]. New York (U.S.A.); Cerebrospinal Fluid (CSF)
  12. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co. Inc.; c2018. Tests for Brain, Spinal Cord, and Nerve Disorders
  13. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co. Inc.; c2018. Spinal Cord
  14. Lab Tests Online. Washington D.C.: American Association for Clinical Chemistry; Multiple Sclerosis:Tests
  15. Lab Tests Online. Washington D.C.: American Association for Clinical Chemistry; Cerebrospinal Fluid (CSF) Testing
  16. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Lumbar Puncture
  17. Cerebrospinal Fluid Analysis. Hinkle J, Cheever K. link]. 2nd Ed, Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. p144
  18. Science Direct (Elsevier) [Internet]; Oligoclonal band
  19. University of Utah Health School of Medicine [internet]; U.S.A. Definition of Neoplasia
  20. Austin Community College [Internet]. U.S.A. Serum or Plasma?
  21. National Multiple Sclerosis Society [Internet]. New York (U.S.A.); Definition of MS
  22. South Tees Hospitals. NHS Foundation trust. National Health Service, U.K. Oligoclonal Band Analysis
  23. National Health Service [internet]. UK; Blood Tests
  24. Fischbach FT. A Manual of Laboratory and Diagnostic Tests, 7th ed, 2003 Lippincott Williams & Wilkins Publishers pp 208,209
  25. National Health Service [internet]. UK; Guillain-Barré syndrome
  26. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Idiopathic Polyneuropathy
  27. Center for Disease Control and Prevention [internet], Atlanta (GA): US Department of Health and Human Services; Preventing Deaths from Cryptococcal Meningitis
  28. National Institute of Neurological Disorders and Stroke [internet]: US Department of Health and Human Services; Subacute Sclerosing Panencephalitis Information Page
  29. Jacob ValkMarjo S. van der Knaap. Progressive Rubella Panencephalitis. Magnetic Resonance of Myelin, Myelination, and Myelin Disorders pp 225-226.
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