The Importance of CSF Oligoclonal Bands in the Diagnosis of Primary Progressive Multiple Sclerosis (P01.139)

Abstract

Objective: To evaluate the importance of CSF OCBs in determining a diagnosis of PPMS. Background The 2010 McDonald revisions to the diagnosis of primary progressive MS (PPMS) have amended the criteria for evidence of dissemination in space (DIS) in the brain and spinal cord. Either of the latter may be replaced by the presence of CSF oligoclonal bands (CSFOBs). Visually evoked responses (VERs) are no longer useful in confirming DIS by reducing the number of T2 lesions on brain MRI. MRI brain changes due to small vessel disease may simulate MS lesions and spinal cord lesions may be too small to visualise on standard MRI. Thus the presence of CSFOBs may have high diagnostic importance in PPMS. Design/Methods: A retrospective review of all patients with a diagnosis of PPMS seen from 1985-2010. The age and mode of presentation, results of brain and spinal cord MRI were documented. Patients who had failed to satisfy the revised McDonald criteria on baseline imaging and identified patients in whom CSF contributed to establishing the diagnosis. Results: Of 118 PPMS patients, mean age at onset 41 years, baseline imaging data (brain or cord or both) was available in 99 (84%). Of 27/99 satisfying both imaging criteria, 21/27 had CSF; 86% had CSFOBs. Only 48 patients had MRI brain, cord & CSF. Of these, 39 patients had imaging which failed to meet the revised McDonald criteria (12 brain, 27 cord MRI). In 19 of these 39 patients the presence of CSFOBs satisfied the criteria. Five patients who did not meet either brain or cord MRI criteria had positive CSFOBs. VERs were performed in 10/39, two had a positive result; both had CSFOBs. Conclusions: In our PPMS cohort, 49% did not satisfy the McDonald criteria by MRI alone and CSFOBs aided the diagnosis. CSFOBs have significant utility in confirming DIS in PPMS. Disclosure: Dr. Kelly has received personal compensation for activities with Novartis, Biogen-Idec and Tysabri as a speaker. Dr. Kinsella has received personal compensation for activities with Sanofi-Aventis Pharmaceuticals & Biogen Idec. Dr. Duggan has received personal compensation for activities with Novartis. Dr. McGuigan has received personal compensation for activities with Biogen Idec and Merck Serono. Dr. Tubridy has received research support from Bayer Pharmaceuticals Corporation, the Health Research Board of Ireland and MS Ireland. Dr. Hutchinson has received personal compensation for activities with Biogen Idec as a speaker.