CSF protein electrophoresis test

Your healthcare practitioner may order a CSF protein electrophoresis test primarily to check for multiple sclerosis.

Multiple sclerosis is an autoimmune disorder in which our body mistakenly produces antibodies that destroy the protective covering around the brain cells. The symptoms of multiple sclerosis are:

• Numbness, tingling or pain
• Fatigue
• Disturbances in vision
• Muscle symptoms:
  • Loss of balance
  • Weakness 
  • Difficulty walking
  • Tremors 
  • Speech defects
  • Problems with bowel and bladder control
• Psychological symptoms:
  • Decreased attention span
  • Memory loss
  • Difficulty reasoning and solving problems
  • Depression

This test can also be ordered to check for:

• Inflammatory conditions of the central nervous system (CNS), such as meningitis, encephalitis and myelitis 
• Certain tumours which may secrete proteins into the CSF
• Bacterial and viral infections affecting the CNS

No preparation is needed before this test. You may be instructed to empty your bladder and bowels before the test. If you have recently undergone myelography (an imaging test of the spinal cord), inform your doctor before the test. Discuss with your doctor about any prescribed, non-prescribed or illicit medicines, vitamins or supplements you may be taking.

For this test, your healthcare practitioner will draw a CSF sample by a method called a spinal tap or lumbar puncture. He/she will explain to you the steps of this test before it is conducted. Here is the procedure for the spinal tap:

• Your healthcare practitioner will ask you to sit or lie on your side on an examination table. You must remain still during the procedure, as movement can cause injury.
• The doctor will clean your back using an antiseptic solution and numb the area by injecting an anaesthetic into your skin.
• When the area becomes numb, he/she will insert a thin, hollow needle between two bones of your lower spine. 
• A small amount of CSF will be collected and sent to the laboratory for analysis.
• After the procedure, you may be asked to lie on your back for at least an hour to avoid having a headache later.

A few risks associated with the test are:

• Headache
• Infection
• Bleeding
• Numbness

Normal results:

The following table shows the normal levels of various proteins in the CSF:

These reference ranges may vary slightly from one laboratory to another. Please speak to your doctor for an accurate interpretation of your results.

Abnormal results:

The following conditions are associated with increased protein levels in the CSF:

• Increase in the CSF IgG or IgG-to-albumin index is seen in:

  • Multiple sclerosis
  • Tumours of the brain and meninges
  • Subacute sclerosing panencephalitis (SSPE) (a neurological disease characterized by inflammation of the brain)
  • Prolonged CNS infections
  • Meningitis, Guillain-Barré syndrome (an autoimmune condition in which the immune system attacks the peripheral nerves) and lupus erythematosus (a long term condition which affects the cartilage and the lining of the blood vessels that give flexibility and strength to the structure of our body)
• Increase in the CSF albumin index is seen in:
  • Obstruction of CSF circulation
  • Systemic lupus erythematosus of the CNS
  • Guillain-Barré syndrome
  • Polyneuropathy
  • Cervical spondylosis
  • Damage to the BBB
  • Diabetes mellitus
• Increased CSF gamma-globulin along with the presence of oligoclonal bands occurs in:
  • Multiple sclerosis 
  • Neurosyphilis
  • Progressive rubella panencephalitis (a condition similar to SSPE caused due to a rubella virus)
  • Subacute sclerosing panencephalitis
  • Cerebral infarction
  • Viral and bacterial meningitis
  • Cryptococcal meningitis
  • Idiopathic polyneuritis
  • Burkitt's lymphoma (a type of cancer which starts from the B immune cell)
  • HIV-I (acquired immunodeficiency syndrome [AIDS])
  • Guillain-Barré syndrome
• Increased CSF synthesis of IgG occurs in:
  • Multiple sclerosis
  • Inflammatory neurologic diseases
  • Post-polio syndrome

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.