You are here

Article Text

Article menu
Download PDFPDF
Neuromuscular
Original research
Oligoclonal IgG bands in chronic inflammatory polyradiculoneuropathies
  1. Marta Ruiz1,
  2. Marco Puthenparampil1,
  3. Marta Campagnolo1,
  4. Francesca Castellani1,
  5. Alessandro Salvalaggio1,2,
  6. Susanna Ruggero1,
  7. Elisabetta Toffanin1,
  8. Mario Cacciavillani3,
  9. Paolo Gallo1,
  10. Diego Franciotta4,
  11. Chiara Briani1
  1. 1 Department of Neurosciences (DNS), University of Padova, Padova, Italy
  2. 2 Padova Neuroscience Center (PNC), Padova, Italy
  3. 3 EMG Lab, CEMES, Synlab, Padova, Italy
  4. 4 IRCCS, Ospedale Policlinico San Martino, Genova, Italy
  1. Correspondence to Dr Chiara Briani, University of Padua, 35128 Padova, Veneto, Italy; chiara.briani{at}unipd.it

Abstract

Background Cerebrospinal fluid (CSF) albumincytologic dissociation represents a supportive diagnostic criterion of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).Few studies have investigated possible systemic or intrathecal humoral immune response activation in CIDP.

Aim of our study was to investigate whether the search of oligoclonal IgG bands (OCBs) might provide additional data helpful in CIDP diagnostic work-up.

Methods Forty-eight consecutive patients with CIDP (34 men, mean age 59.4, range 16–83) were recruited. CSF analysis included nephelometric measurement of albumin and IgG concentrations, calculation of QALB, QAlbLIM and intrathecal IgG synthesis, and OCBs detection with isoelectric focusing. Data were compared with those from CSF and serum of 32 patients with Guillain-Barré syndrome (GBS), 18 patients with anti-myelin associated glycoprotein (MAG) antibody neuropathy, 4 patients with multifocal motor neuropathy and 32 patients with non-inflammatory neuropathies (NINPs).

Results Patients with CIDP and anti-MAG antibody neuropathy had significantly higher CSF albumin concentrations and QALB values than NINPs (p=0.0003 and p=0.0095, respectively). A total of 9 (19%) patients with CIDP presented identical serum and CSF OCBs (‘mirror pattern’) versus 3 patients (16.6%) with anti-MAG antibody neuropathy, 13 patients (40.6%) with GBS and 12.5% patients with NINPs. Only one patient with CIDP showed unique-to-CSF OCBs. First-line therapy was effective in 80.4% of patients with CIDP, irrespective of CSF findings.

Conclusions Compared with NINP, CIDP, GBS and anti-MAG antibody neuropathies had a significantly increased CSF protein and blood–spinal nerve root barrier damage. Intrathecal humoral immune response is rare in our patients with CIDP. Systemic oligoclonal activation is more frequent, but not significantly different from what was detected in the control groups.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data (deidentified participant data) are available upon reasonable request to the corresponding author.

https://doi.org/10.1136/jnnp-2020-325868

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Data (deidentified participant data) are available upon reasonable request to the corresponding author.

    View Full Text

    Footnotes

    • Contributors MR, MP, MCam, FC and AS had a major role in the acquisition of data, analysed the data and interpreted the data. MP performed the statistical analysis. SR and ET had a major role in the acquisition and interpretation of cerebrospinal fluid (CSF) data. MCac had a major role in the acquisition of neurophysiological data. PG had a major role in the interpretation of CSF data. DF interpreted the data and drafted the manuscript for intellectual content. CB designed and conceptualised the study, coordinated the study, interpreted the data and drafted the manuscript for intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    Linked Articles