Research Article| Volume 279, ISSUE 1-2, P21-25, April 15, 2009

The prognostic significance of cerebrospinal fluid in multiple sclerosis

Published:February 02, 2009DOI:



      Multiple Sclerosis (MS) patients lacking CSF oligoclonal bands are purported to have a milder course of disease. We reviewed the natural history of oligoclonal band (OCB) — negative (OCB−) compared to OCB positive (OCB+) patients.


      A retrospective study of 451 MS patients.


      Only 48/451 patients (10.6%) were CSF OCB−. The mean age at onset was 37.1±8.8 years with female:male ratio=2. First CNS location presentation was less well defined in OCB− vs. OCB+ patients with significantly more supratentorial presentation. The clinical course of OCB− vs OCB+ was somewhat different; 22.9 vs 15.1% PPMS; 18.8 vs 12.4% SPMS; and 56.3 vs 71% RRMS, respectively. There were significantly fewer WBC, less IgG and a lower IgG index in OCB− cases. Fewer OCB− cases fulfilled McDonald MRI criteria. There were no discernable differences in disease severity between the two groups as determined by the EDSS, progression index, MSSS, number of relapses or annualized relapse rate.


      The presence of OCB correlates better with other indications of acute inflammatory MS, especially an RR course. This study suggests that the simple lack of OCB positivity does not necessarily insure a more benign disease course.


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        • Poser C.M.
        • Paty P.W.
        • Scheinberg L.
        • et al.
        New diagnostic criteria for multiple sclerosis: guidelines for research protocols.
        Ann Neurol. 1983; 13: 227-231
        • Polman C.H.
        • Reingold S.C.
        • Edan G.
        Diagnostic criteria for multiple sclerosis: 2005 revisions to the McDonald criteria.
        Ann Neurol. 2005; 58: 840-846
        • Bourahoui A.
        • De Seze J.
        • Guttierez R.
        CSF isoelectrofocusing in a large cohort of MS and other neurological diseases.
        Eur J Neurol. 2004; 11: 525-529
        • Farrell M.A.
        • Kaufmann J.C.E.
        • Gilbert J.J.
        • et al.
        Oligoclonal bands in multiple sclerosis : clinicopathologic correlation.
        Neurology. 1985; 35: 212-218
        • Poser C.M.
        • Brinar V.V.
        The accuracy of prevalence rates of multiple sclerosis: a critical review.
        Neuroepidemiology. 2007; 29: 150-155
        • Kuroiwa Y.
        • Hung T.P.
        • Landsborough D.
        • Park C.S.
        • Signhal B.S.
        Multiple sclerosis in Asia.
        Neurology. 1997; 27: 188-192
        • Stendahl-Brodin L.
        • Link H.
        Relation between benign course of multiple sclerosis and low-grade humoral immune response in cerebrospinal fluid.
        J Neurol Neurosurg Psychiatry. 1980; 43: 102-105
        • Zeman A.Z.
        • Kidd D.
        • McLean B.N.
        • et al.
        A study of oligoclonal band negative multiple sclerosis.
        J Neurol Neurosurg Psychiatry. 1996; 60: 27-30
        • Annunziata P.
        • Giorgio A.
        • De Santi L.
        • et al.
        Absence of cerebrospinal fluid oligoclonal bands is associated with delayed disability progression in relapsing–remitting MS patients treated with interferon-β.
        J Neurol Sci. 2006; 244: 97-102
      1. Electronic Multiple Sclerosis Monitor System (Imed 4.6) Software Program Serono International SA. Copyright 2006.

        • Kurtzke J.F.
        Rating neurological impairment in multiple sclerosis: an expanded disability status scale (EDSS).
        Neurology. 1983; 33: 1444-1452
        • Confavreux C.
        • Vukusic S.
        • Moreau T.
        • et al.
        Relapses and progression of disability in multiple sclerosis.
        N Engl J Med. 2000; 343: 1430-1438
        • Roburgh R.H.
        • Seaman S.R.
        • Masterman T.
        • et al.
        Multiple sclerosis severity score: using disability and disease duration to rate disease severity.
        Neurology. 2005; 64: 1144-1151
        • Lunding J.
        • Midgrad R.
        • Vedeler C.A.
        Oligoclonal bands in cerebrospinal fluid: a comparative study of isoelectric focusing, agarose gel electrophoresis and IgG index.
        Acta Neurol Scand. 2000; 102: 322-325
        • Hans L.
        • Yu-Min H.
        Oligocloal bands in multiple sclerosis cerebrospinal fluid: an update on methodology and clinical usefulness.
        J Neuroimmunol. 2006; 180: 17-28
        • Freedman M.S.
        • Thompson E.J.
        • Deisenhammer F.
        • et al.
        Recommended standard of cerebrospinal fluid analysis in the diagnosis of multiple sclerosis.
        Arch Neurol. 2005; 62: 865-870
        • Barkhof F.
        • Filippi M.
        • Miller D.H.
        Comparison of MR imaging criteria at first presentation to predict conversion to clinically definite MS.
        Brain. 1997; 120: 2059-2069
        • Rodeghier M.
        Surveys with confidence: a practical guide to survey research using SPSS. SPSS Inc., 1996
        • Pirttila T.
        • Nurmikko T.
        CSF oligoclonal bands, MRI, and the diagnosis of multiple sclerosis.
        Acta Neurol Scand. Dec 1995; 92: 468-471
        • Jose M.
        • Sequeira L.
        • Edite Rio M.
        Oligoclonal IgG bands in the cerebrospinal fluid of Portuguese patients with multiple sclerosis: negative results indicate benign disease.
        Arq Neuro-Psiquiatr. 2005; 63 (Sao Paulo June 2005)
        • Kikuchi S.
        • Fukazawa T.
        • Niio M.
        HLA-related subpopulations of MS in Japanese with and without oligoclonal IgG bands.
        Neurology. 2003; 60: 647-651
        • Nakashima I.
        • Fujihara K.
        • Misu T.
        • et al.
        Significant correlation between IL-10 levels and IgG indices in the cerebrospinal fluid of patients with multiple sclerosis.
        J Neuroimmunol. Nov 1 2000; 111: 64-67
        • Avasarala J.R.
        • Cross A.H.
        • Trotter J.L.
        Oligoclonal band number as a marker for prognosis in multiple sclerosis.
        Arch Neurol. 2001; 58: 2044-2045
        • Fukazawa T.
        • Kikuchi S.
        • Sasaki H.
        • et al.
        The significance of oligoclonal bands in multiple sclerosis in Japan: relevance of immunogenic backgrounds.
        J Neurol Sci. 1998; 158: 209-214
        • Imrell K.
        • Landtblom A.M.
        • Hillert J.
        • et al.
        Multiple sclerosis with and without CSF bands: clinically indistinguishable but immunogenetically distinct.
        Neurology. 2006; 67: 1062-1064
        • Trojano M.
        • Logroscino G.C.
        • Pisicchio L.
        • et al.
        The multiple sclerosis cooperative etiological study in Italy : preliminary analysis of CSF findings.
        Ital J Neurol Sci. 1987; : 71-76
        • Nakashima I.
        • Fujihara K.
        • Misu T.
        A comparative study of Japanese multiple sclerosis patients with and without oligoclonal IgG bands.
        Mult Scler. 2002; 8: 459-462
        • Nakashima I.
        • Fujihara K.
        • Miyazawa H.
        Relevance of colossal and periventricular MRI lesions to oligoclonal bands in multiple sclerosis.
        Acta Neurol Scand. 2006; 113: 125-131
        • Muller F.A.
        • Hanny P.E.
        • Wichmann W.
        • et al.
        Cerebrospinal fluid immunoglobulins and multiple sclerosis. Correspondence with magnetic resonance imaging and visually evoked potential changes.
        Arch Neurol. Apr 1989; 46: 367-371
        • Baumhefner R.W.
        • Tourtellotte W.W.
        • Syndulko K.
        • et al.
        Quantitative multiple sclerosis plaque assessment with magnetic resonance imaging. Its correlation with clinical parameters, evoked potentials, and intra-blood-brain barrier IgG synthesis.
        Arch Neurol. Jan 1990; 47: 19-26
        • Bartoloni S.
        • Inzitari D.
        • Castagnoli A.
        • et al.
        Correlation of isotopic cisternographic patterns in multiple sclerosis with CSF IgG values.
        Ann Neurol. Nov 1982; 12: 486-489
      2. Brown. Ellis Horwood Chichester 1986;ch.14:188–203.

        • Marrosu M.G.
        • Murru M.R.
        • Costa G.
        • et al.
        Sardinian multiple sclerosis is associated with HLA-DR4.
        Neurology. 1988; 38: 1749-1753
        • Rudick R.A.
        • Cookfair D.L.
        • Simonian N.A.
        • et al.
        Cerebrospinal fluid abnormalities in a phase III trial of Avonex (IFN beta-1a) for relapsing multiple sclerosis.
        J Neuroloimmunol. 1999; 93: 8-14
        • Sellebjerg F.
        HLA-DR 15 is associated with female sex and younger age at diagnosis in multiple sclerosis.
        Tissue Antigens. 2000; 55: 312-318
        • Zu X.H.
        • McFarlin D.E.
        Oligoclonal bands in CSF: twins with MS.
        Neurology. 1984; 34: 769-774
        • Freedman M.S.
        • Atkins H.L.
        Clinical and MRI outcome after autologous hematopoietic stem cell transplantation in MS.
        Neurology. 2004; 62: 168-169
        • Saiz A.
        • Carreras E.
        • Berenguer J.
        • et al.
        MRI and CSF oligoclonal bands after autologous hematopoietic stem cell transplantation in MS.
        Neurology. Apr 24 2001; 56: 1084-1089