Abstract
Introduction/Aim: Detection of intrathecal oligoclonal bands of immunoglobulin G (OB IgG), in addition to diagnostic, has a predictive significance in multiple sclerosis (MS). The aim of the study was to determine the prognostic significance of OB IgG and to correlate the presence of OB IgG with the progression of disability in MS patients. Methods: A retrospective-prospective cohort study included 177 MS patients examined at the Centre for MS, Clinic of Neurology, University Clinical Centre of the Republic of Srpska. In all patients, demographic data, clinical parameters, Expanded Disability Status Scale (EDSS) score, isoelectric focusing (IEF) of cerebrospinal fluid (CSF), cyto-biochemical analysis of CSF, evoked potentials (EP) and magnetic resonance (MR) of the head were analysed. MS patients were divided in two groups: with and without intrathecal synthesis of oligoclonal IgG. According to the EDSS determined in both groups, the relation between the degree of functional disability and the presence of OB in the CSF and also with characteristics of the cyto-biochemical profile were analysed. Methods of descriptive and analytical statistics, analysis of variance, chi-square test, Bonferroni's post hoc test, correlation and regression analysis were used in the analysis of the results. Results: In the examined cohort of MS patients, the sensitivity of IEF was 96.6 %. There was a statistically significant association between the detectability of intrathecally synthesised IgG and EDSS score (p = 0.004) so that individuals who do not have intrathecally synthesised IgG had lower EDSS scores. MS patients with a CSF protein concentration > 0.40 g/L were 2.45 times more likely to enter secondary progression and 2.51 times more likely to achieve EDSS 4.0. Conclusion: IEF is a very sensitive diagnostic and prognostic method for MS patients, which indicates a more benign course of MS in patients without oligoclonal bands in the CSF.
Highlights
By analysing the quantitative and qualitative disorders of cerebrospinal fluid (CSF) IgG in patients with multiple sclerosis (MS), it is possible to obtain very significant diagnostic and prognostic data.[1]
isoelectric focusing (IEF) of CSF and serum was done in all patients, and out of 177 MS patients, intrathecal synthesis was detected in 171 patients (96.6 %), which indicates a very high sensitivity of the method
From the above mentioned clinical parameters of the MS patients with oligoclonal bands (OB), it can be seen that in the group without local synthesis there are no patients in SP and PP form of MS, that the disease lasted shorter, the mean Expanded Disability Status Scale (EDSS) score was lower and that the disease activity was lower in the first year
Summary
By analysing the quantitative and qualitative disorders of cerebrospinal fluid (CSF) IgG in patients with multiple sclerosis (MS), it is possible to obtain very significant diagnostic and prognostic data.[1] Recommended criteria for CSF analysis indicate that isoelectric focusing (IEF) on agarose gel with immunofixation and the use of specific antiserum for human IgG are ”gold standard” for oligoclonal bands (OB) detection.[2]. This article should be cited as follows: Grgić S, Dominović Kovačević A, Đajić V, Vukojević Z, Tadić D,Račić D, Vujković Z. Prognostic significance of intrathecal oligoclonal immunoglobulin G in multiple sclerosis.
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