Oligoclonal bands

Oligoclonal bands in the CSF are IgG and are associated with multiple conditions, including: 

• Infections 
• subacute sclerosing panencephalitis (after measles) 
• mumps meningitis
• rubella panencephalitis 
• HSV encephalitis 
• progressive multifocal leukoencephalopathy 
• neurosyphilis 
• lyme neuroborreliosis 
• cryptococcal meningitis
• Inflammation
• neurosarcoidosis 
• SLE 
• RA 
• rarely: Behcets disease 
• Other 
• Multiple sclerosis (MS)
• Gullian-Barre Syndrome (GBS)
• neoplasia

Oligoclonal bands should be looked for in both CSF and serum. There are 3 possible patterns:

• systemic only response = identical bands in both serum and CSF 
• intrathecal-systemic response = at least one clone identical in the CSF and serum AND at least one unique CSF clone 
• intrathecal only response = bands in CSF only 

The table below summarises the links between the patterns and possible aetiologies:

 

With regard specifically to MS: 

• characteristically MS causes oligoclonal bands in CSF but not in the serum 
• however, a proportion of MS patients do have oligoclonal bands in both CSF and serum 
• but, it is very rare for this bands to be identical, so identical oligoclonal bands in both CSF and serum should prompt the diagnosis of MS to be reconsidered 

References

Djukic, M. et al. Cerebrospinal fluid findings in adults with acute Lyme neuroborreliosis. J Neurol. 2012; 4: 630-636.  

McLean, B., Miller, D. and Thompson, E. Oligoclonal banding of IgG in CSF, blood-brain barrier function, and MRI findings in patients with sarcoidosis, systemic lupus erythematosus and Behcets disease involving the nervous system. J Neurol Neurosurg Psychiatry. 1995; 58(5): 548-554. 

Owens, G. et al. Viruses and multiple sclerosis. Neuroscientist. 2011; 17(6): 659-676.  

Zeman, A. et al. The significance of serum oligoclonal bands in neurological diseases. J Neurol neurosurg Psychiatry. 1993; 56(1): 32-25.