The frequency of CSF oligoclonal banding in multiple sclerosis increases with latitude

Lechner‐Scott, Jeannette; Spencer, Benjamin T.; Malmanche, Theo de; Attia, John; Fitzgerald, Michael; Trojano, María; Grand’Maison, F.; Gomez, J. Antonio C; Izquierdo, Guillermo; Duquette, Pierre; Girard, Marc; Grammond, Pierre; Oreja‐Guevara, Celia; Hupperts, Raymond; Bergamaschi, Roberto; Boz, Cavit; Giuliani, G.; Pesch, Vincent Van; Iuliano, Gerardo; Fiol, Marcela; Cristiano, Edgardo; Verheul, Freek; Saladino, Maria Luisa; Slee, Mark; Barnett, Michael; Deri, Norma; Flechter, Shlomo; Vella, Norbert; Shaw, Cameron; Herbert, Joseph; Moore, Fraser; Petkovska‐Boskova, Tatjana; Jokubaitis, Vilija; Butzkueven, Helmut

doi:10.1177/1352458511431729

Cited by 64 publications

(44 citation statements)

References 33 publications

(47 reference statements)

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“…Two of these studies specified ON,27 28 and one study specified a brainstem syndrome as the CIS 29. Twelve studies used conversion to clinically definitive multiple sclerosis (CDMS) as the outcome, one used radiological conversion to MS27 and one used the number of patients reaching EDSS 6 at 5 years 7. The study using EDSS 6 as the outcome measures was excluded given the very different outcome measure, leaving 13 studies in the analysis (see online supplementary appendix).…”

Section: Resultsmentioning

confidence: 99%

“…There are a large number of studies examining this as either a primary or a secondary research question. The largest of these enrolled around 3000 patients 7. Although the advent of large MS databases has enabled population-based studies, there are limitations to using these, as different centres often use different techniques for detecting OCBs.…”

Section: Introductionmentioning

confidence: 99%

“…It has recently been suggested that the latitude at which a patient resides is related to the probability of being OCB positive 7. The reasons behind this variability are unclear, and this finding requires replication.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude

Dobson

Ramagopalan

Davis

et al. 2013

Journal of Neurology, Neurosurgery & Psychiatry

318

184

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude

Dobson

Ramagopalan

Davis

et al. 2013

Journal of Neurology, Neurosurgery & Psychiatry

318

184

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show abstract

“…It is unclear whether the latitudinal gradient of MS also affects clinical characteristics, although some recent studies11 12 have demonstrated a significant relationship between latitude and positivity for cerebrospinal fluid (CSF) oligoclonal bands (OCBs). A recent study in Japan has also confirmed this relationship between latitude and abnormal CSF findings, with a significant association of positive CSF findings (OR=4.08) and OCB positivity (OR=2.57) when comparing northern to southern Japan 13…”

Section: Introductionmentioning

confidence: 99%

Higher latitude is significantly associated with an earlier age of disease onset in multiple sclerosis

Tao

Simpson

Mei

et al. 2016

J Neurol Neurosurg Psychiatry

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“…8,9 It is clear that the frequency of OB varies between countries and populations, and averages 80% globally. 10 One trivial reason for these differences is the quality of assays performed. However, other factors may also be in play.…”

Section: Diagnostic Valuementioning

confidence: 99%

Cerebrospinal fluid oligoclonal bands are important in the diagnosis of multiple sclerosis, unreasonably downplayed by the McDonald criteria 2010: Yes

Sandberg‐Wollheim

Olsson

2013

Mult Scler

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ProposalIn the absence of a diagnostic test specific for multiple sclerosis (MS), the neurological community has adopted diagnostic criteria for MS. The Schumacher criteria 1 were followed by the Poser criteria, 2 which were replaced in 2000 by what have become known as the McDonald criteria. 3 The criteria reaffirmed the necessity to demonstrate dissemination of clinical events and lesions in space and time and, importantly, to exclude other reasons or diseases explaining the neurological deficits and symptoms. In the McDonald criteria, it was acknowledged that 'MRI [magnetic resonance imaging], analysis of cerebrospinal fluid (CSF), and visual evoked potentials (VEP), can add to a clinical diagnosis' but that each has limitations of sensitivity and specificity 3 . However, with each successive revision of the McDonald criteria, 4,5 MRI has gained and CSF has lost in importance.With the availability of disease-modifying drugs, early diagnosis has become increasingly important and neurologists are exploring ways of diagnosing not only established or clinically definite (CD) MS but also clinically isolated syndrome (CIS) with high risk for conversion to MS, and even radiologically isolated syndrome (RIS) which can perhaps be thought of as a diagnosis in search of its patient. Admittedly, MRI can show dissemination in space and time which CSF cannot. However, MRI is often inconclusive, especially at early stages of the disease. CSF analysis adds a different type of information -inflammation and immunological disturbance. In addition, one important aspect of CSF analysis is to exclude other diagnoses. We discuss why analysis of CSF still is important and should be resuscitated within the diagnostic criteria of MS. Diagnostic valueKabat et al. demonstrated in 1942 that 'gamma globulin' was significantly increased in CSF from patients with MS and subsequently demonstrated that 'restricted heterogeneity' or oligoclonal bands (OB) on electrophoresis were present in CSF but not in serum. 6 Since then many publications have shown the diagnostic value of CSF analysis and also, that in certain clinical situations, it can have predictive value.In patients with CDMS an elevated IgG-index is present in 70-80% and OB are demonstrated in CSF but not serum in almost every patient, provided the analysis is carried out in a good laboratory with the recommended method of isoelectric focusing. 7 Recent estimates in the Nordic countries suggest that around 90-95% of patients with CDMS have OB. 8,9 It is clear that the frequency of OB varies between countries and populations, and averages 80% globally. 10 One trivial reason for these differences is the quality of assays performed. However, other factors may also be in play. For example, the MS-predisposing DRB1*15:01 class II gene variant is correlated with a high frequency of OB, while DRB1*04 is correlated with OB negative CSF, 8,9 and the frequency of these class II gene variants differs considerably between populations. Still, if present and if other causes of OB are excluded such...

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The frequency of CSF oligoclonal banding in multiple sclerosis increases with latitude

Abstract: The results of this study indicate that latitude could explain some of the inconsistencies in OCB status reported in different populations. The study confirms that OCB positivity in MS is associated with a worse long-term prognosis.

Cited by 64 publications

References 33 publications

Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude

Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude

Higher latitude is significantly associated with an earlier age of disease onset in multiple sclerosis

Cerebrospinal fluid oligoclonal bands are important in the diagnosis of multiple sclerosis, unreasonably downplayed by the McDonald criteria 2010: Yes

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