helpful interpretation

[Teresa542]

I'm interested in interpretation of my CSF tap info.  On the oligoclonal banding, it says "...contains restriction bands that are also present in the patient's corresponding serum sample.  We are unable to define whether these gammaglobulins are of systemic or intracerebral origin.  The clinical significance of a numerical band count, determined by isoelectric focusing, has not been definitively defined.  The data should be interpreted in conjunction with all pertinent clincial and laboratory data for this patient."   On the CSF test of albumin, IGG, IGG Index, Synthesis Rate IGG and Albumin serum, there was the "results" listed within the "Units Range" and at the bottom it says "The IgG synthesis rate, CSF and IgG index, CSF are two formulae for estimating the amount of IgG produced in the central nervous system.  Evidence of increased synthesis of IgG provides support for the diagnosis of multiple sclerosis."

Do these mean that the test was negative for MS, as my neurologist told me?   THANKS!

[immisceo]

Hi there. You appear to have posted on a very old/inactive thread. You will likely get more response if you post a fresh question. This puts you 'front of the line' so to speak. You will find the orange button to do so at the top of this page.

Also, if you repost, please bear in mind that many of us with MS have vision issues. It helps to break down large blocks of text into short paragraphs. I would love to help address your concerns, but at the moment, I'm unable to tackle the block of text.

[SLE_Spinal]

I have had an undiagnosed medial problem for a very long time, since 1988 when I was 32. It started out as dizziness. Not room spinning vertigo, but the feeling of imbalance like pitching to and fro, up and down, left and right. I began seeing an ENT who performed 3 seperate ENGs over the period of about 3 months. All showed that yes, something was affecting my balance system. About 2 months after the onset of dizziness, I started to get fascillations all over my body, random, (usually) non-repetitive twitches that would occur everywhere. I also developed a strange sensory feeling of water droplets, like rain, randomly falling on me, a drop here, a drop there they'd happen from to to head. I developed anxiety, depression and early morning - actually middle of the night waking and unable to get back to sleep for the first time in my life. I developed fatigue and muscle aches, vibrating sensations in my head, no true weakness. I bought a riding lawnmower instead of the walk behind I had. I started seeing a Neurologist and had several tests performed. Normal brain MRI, brainstem audio evoked testing suggested a peripheral disorder, lumbar puncture showed high protien (don't know the number) and as far as I know all other results in normal range. Neuro tested for lupus - negative ( I guess that was an ANA screen??) Saw the Neuro a few more times and it came down to, without the development of more definitive symptoms. I'd just have to live with it. That's what I did, I had a young family to raise. I eventually felt "better", but not completely. My symptoms waxed and waned over the years sometimes worse and sometimes better. In May of 2012 I had a heart attack due to coronary artery disease at age 55. In November of 2012, my symptoms flared with a vengance. In December of 2012, my Cardio diagnosed me with small vessel disease after testing for complaint of numbness in my feet. In Janurary of '13? I developed constant tinnitus. As this flare was particularly nasty and long lasting, I decided it was time to start looking again. I started with a Neurotoligist at Duke medical center. In April 2013, ENG and rotational chair testing showed I had an 40% weakness on one side of my vestibular system which was described as significant. Reason was undetermined. A clean, enhanced brain MRI was done at Duke. The Neurotoligist wanted to refer me to a Neurologist at Duke for an ALS evaluation because of fascillations he observed in my tongue. I declined having had them for some 25 years at this point. I did, however start seeing a local neurologist as my symptoms were not isolated to my vestibular system. In December '13 a lumbar puncture was performed. 3 well defined O-bands present in the CSF also present in the corresponding serum sample, but some bands in the CSF are more prominent. Protein high - 85 (12-60). Albumin high - 58.8 (8.0 to 42.0). Nothing else out of range. Nerve conduction velocities/EMG pretty much normal - carpal tunnel syndrome, neuralgia/neuritis/radiculitis. ANA testing positive 1:640 but anti DNA negative and anti-smith negative => no lupus diagnosis. Thanks for reading, all responses welcome and appreciated.

[sllowe]

Min33gn,

Hi there. I see you are a new member here. I'm afraid all will not see you here at the end of this discussion. So, if you can, please copy what you've posted here and paste into a new discussion using the "post a question" green button. That way, we can welcome you properly and hopefully help out!

Thanks for joining us!
-Shell

[min33gn]

My neurologist wants to see me.  He said that I have Oligcolcal? Bands and WBC count norm is 0-5 in CSF and mine is 10.   I have MRI's that show demyelinaton at some point, appx 5 areas.  I have severe fatigue, depression, bowel problems, supposed micro-nystagmus (LensCrafters..appt with Opthalmalic Neurologist this coming Friday), frequent headaches and dizziness with occasional nausea, change in speech (like a feeling of weakness with speaking), tremors, weakness, poor balance, weird feeling (almost like a heaviness) in my legs, heat intolerance (makes me sick for days), occasional (monthly) severe itching all of my body that feels almost like needles that itch? if that makes since, and so on.  
I have had two neurologists over the last 6 years tell me its probably not MS.  And my current neurologist felt the same way until I did the spinal tap, now "he wants to see me sooner than later..." secondary to the current CSF results.  However, my evoked potential and somatosensory tests were negative.
At this point, I am so frustrated and almost ready to give up.  I feel like everyday gets harder to deal with this not knowing and not sure how many more times I can deal with a doctor telling me nothing is wrong.  
HELP!  Please...anyone with ideas or suggestions or opinions are greatly appreciated!

[Teresa542]

Thanks to you for sending that.  My neuro and PCP are saying stroke, since I have lesions but neg. spinal tap.  I'm confused, as it would seem with a stroke your symptoms would stay equal or improve, but not multiply.  I'm guessing it will be months before I have a full picture...  I've added a new post if you have any insight.  Thaks!

[patientx]

Could someone explain to me the difference between the various IgG measures (index, synthesis rate, etc). and the oligoclonal banding in regard to an LP?  I thought the O-banding was a way of breaking out the different IgG antibody proteins present in the CSF.  But some of the stuff I've read refer to the O-bands and IgG as two different things.

Thanks.

[sllowe]

Hi Teresa,
I'm going to point you to our HP's like Julei suggested.  I think you will find it informative...

http://www.medhelp.org/health_pages/Multiple%20Sclerosis/Can-you-Diagnose-MS-with-an-LP-that-is-Negative-for-O-bands/show/142?cid=36

[sllowe]

Hi Teresa,

Welcome to the forum.  You bring up something that we've heard a lot of and most recently. That is neg. O-bands does NOT mean NO MS.

Doc Q posted something recently to someone else about this very thing.  I'm going to bump it up for you, or I may just add the link to your post here...

Thanks for joining us.  I hope your Dr. is a good one and not one to just rule out MS based on a negative LP.

Thanks for joining us,
shell

[Teresa542]

Thanks for your help.  That's what I didn't know, if the statement was just an explanation of the test.  It appeared that the numbers were in the normal range.  The WBC and lymphocyte were within normal range as well.

I have had an MRI which has "multiple subcentimeter foci of T2/Flair hyperintensity involving the periventricular and deep and subcortical white matter with some of the lesions perpendicular to the callosal septal interface" with the differential diagnosis being MS and everything else under the sun.

I know MS is hard to diagnose.  As I've researched it in the past couple months, I'm amazed others' symptoms that are right on point with mine.  I guess I'll just have to have patience...

Thank you so much!
Teresa

[Sarahsmom46]

Without seeing the report in its entirety, it does sound like a negative report for MS.  The IgG statement that was at the end of the report is just an explanation for what a high IgG would signify, but it appears your IgG index was in the normal range, is that right?  

The ologioclonal bands result sounds like the "mirror" pattern and that does not support an MS diagnosis either, but it does show that something perhaps inflammatory was going on at the time you had the spinal tap.  Did the report mention a white bood cell count or lymphocyte count?  

Did your doctor say that the CSF tests were negative for MS?  A negative CSF is not necessarily an end all when diagnosing MS as there are several other tests that are done in order to get the big picutre about what is going on such as MRIs and evoked potential tests. Probably you have already had these tests.

I would recommend reading the MS heath pages for more information if you haven't already done so. The link to the articles in at the upper right side of this webpage. Click on "health pages" under the "Discussion" button.  I hope this is helpful.  

Take care.

Julie

[ashlee3131]

I just had the exact same thing done and it said the same thing, only difference is my was high and The patient's CSF contains multiple restriction bands that
are also present in the patient's corresponding serum
sample. We are unable to define whether these
gammaglobulins are of systemic or intracerebral origin. my oligoclonal bands were absent.
my csf-No malignant cells
Rare small, mature lymphocyte.  I want to know what this means.