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214 Analysis of CSF IgG index, IgG synthesis and clinical presentation among CSF OCBs negative patients
  1. Tatiana Mihalova,
  2. Jing Ling Kwong,
  3. Hannah Alachkar
  1. Salford Royal Hospital


Background Multiple sclerosis, an autoimmune condition, is characterised by high incidence of CSF positive oligoclonal bands (OCBs). Positive OCBs are now used for diagnosis of clinically definite MS. The clinical course of CSF OCBs negative neurological patients can differ.

Method From total of 987 CSF OCBs negative samples, processed in immunology laboratory 2015–2016, 76 CSF OCBs negative samples have shown other CSF abnormalities – raised CSF IgG index, raised CSF IgG synthesis and reduced blood brain barrier ratio (BBBR). We retrospectively reviewed their clinical presentation, CSF protein, WBC and CSF IgG index, IgG synthesis and BBBR.

Results 4 distinctive clinical groups were identified: inflammatory peripheral nerve disease, neurosarcoidosis, other CNS inflammatory disorders (SLE, vasculitis, ADEM, MS) and degenerative disorders.

CSF OCBs negative patients with neurosarcoidosis presented with significantly raised CSF protein (on average 1.76 g/dl), CSF IgG synthesis (125.3), and IgG index (0.995) and low BBBR (33). Other CNS inflammatory disorders had mildly raised CSF protein (0.74 g/dl), IgG synthesis (30), IgG index (0.835) and reduced BBBR (70), but not as significant as seen in neurosarcoidosis.

Conclusion The distinctive CSF pattern despite of negative CSF OCBs may be helpful if suspecting diagnosis of neurosarcoidosis, hence performing CSF IgG synthesis and IgG index may be helpful.

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