The diagnosis of multiple sclerosis (MS) is dependent on clinical, radiological, and laboratory findings. The detection of increased intrathecal immunoglobulin (Ig) synthesis is the basis for current diagnostic laboratory tests for MS. These tests include the CSF index, IgG synthesis rate and CSF oligoclonal band detection. Abnormal CSF indexes and oligoclonal banding patterns have been reported in 70% to 80% of MS patients. At least 1 of these tests has been reported to be positive in 90% of MS patients when both tests are performed.
Newer methodologies for oligoclonal band detection have been reported to be more sensitive, with sensitivities of 90% to 95% in CSF from MS patients.
Increased intrathecal Ig synthesis may occur in other inflammatory CSF diseases and, therefore, this assay is not specific for MS (specificity = 95%).
CSF IgG synthesis rate
Blood contaminated CSF collects.
A paired CSF AND Serum sample are always required. Serum should preferrably be collected at the time of the spinal tap, however serum collected 3 days before or after the collection of CSF is also acceptable. In the absence of a suitable serum sample, plasma is acceptable.
Chilled (2 - 8 degrees Celsius)
Preferred volumes: 0.5 mL CSF and 0.5 mL serum.
When the oligoclonal band assay detects 2 or more unique IgG bands in the CSF, with no corresponding bands in the serum, the result is positive.
An IgG Synthesis rate of > 4.0 mg/day is also strongly supportive of oligoclonal banding, but can also be elevated by the presence of blood in the CSF, or other causes of inflammation.
|CSF IgG||<0.08 g/L|
|CSF Albumin||<0.40 g/L|
|Serum IgG||7.0-14.0 g/L|
|Serum Albumin||32-48 g/L|
|IgG Synthesis||<4.0 mg/day|
A comment will also be made on the presence or absence of oligoclonal banding.
Quantitation of CSF IgG, CSF Albumin, Serum IgG and Serum Albumin is performed by immunoassay on Siemens BNII.
These values are used to calculate the CSF Index and IgG Synthesis rate.
Oligoclonal Band detection is performed by agarose gel isoelectric focusing followed by immunofixation with peroxidase labelled anti-IgG antisera. Assay is performed on a Sebia Hydrasys.
$227.37 (Exclusive of GST)
Refer to Biochemistry - Protein Laboratory ext 80334
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