Tintoré M et al. (2007) Do oligoclonal bands add information to MRI in first attacks of multiple sclerosis? Neurology [doi:10.1212/01.wnl.0000280576.73609.c6]

Oligoclonal bands (OBs) seen on protein electrophoresis analyses of cerebrospinal fluid are considered to be the best biological marker for predicting whether individuals with a clinically isolated syndrome will progress to clinically definite multiple sclerosis (CDMS). Tintoré et al. investigated whether OB testing adds information to that provided by MRI for predicting progression to CDMS and development of disability.

This prospective study enrolled patients who had experienced a single monosymptomatic MS-like attack that suggested demyelination of the optic nerve, brainstem or spinal cord. MRI and testing for OBs were performed within 3 months of the first attack. MRI scans were evaluated for abnormalities at baseline according to the number of positive Barkhof criteria (0–4) and the number of observed lesions. Patients were considered to have progressed to CDMS if they experienced a second MS-like attack with a new neurological abnormality at least 1 month after testing.

OBs were present in 61% of patients and were independently associated with development of CDMS (P = 0.0001). Of the patients with no Barkhof criteria or no lesions (low-risk MRI scans), 31% and 27%, respectively, were OB-positive, and 10% and 9%, respectively, developed CDMS. Adjusted analyses showed that presence of OBs was not associated with the likelihood of a patient reaching an Expanded Disability Status Scale score ≥3.0.

The authors conclude that the presence of OBs predicts progression to CDMS but not the development of disability, and is clinically useful in patients with a normal MRI scan who would otherwise be considered to be at low risk of progression.