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Principles for Demonstration and Interpretation Based on Findings in 1114 Neurological Patients

Vasilios K. Kostulas, MD, PhD; Hans Link, MD, PhD; Ann-Karv Lefvert, MD, PhD

Arch Neurol. 1987;44(10):1041-1044.

Abstract
• Unconcentrated cerebrospinal fluid (CSF) and serum samples from 1114 consecutive patients were examined for presence of oligoclonal IgG bands (OB) by agarose isoelectric focusing (AIF) followed by protein transfer to nitrocellulose membrane, immunolabeling, and avidinbiotin-peroxidase staining (avidin-biotin AIF). Oligoclonal bands were demonstrated in CSF from all 58 patients with multiple sclerosis (MS), eight of 29 with aseptic nervous sytem infections, and 9% of 1014 with other neurological disorders (OND) considered as noninflammatory at primary clinical evaluation. Comparative examination of all specimens in another laboratory by conventional AIF after concentration of CSF revealed lower frequencies of OB in all diagnostic groups. In addition to the high sensitivity of avidinbiotin AIF, which enables detection of OB by separation of 5 µL of unconcentrated CSF even when the CSF IgG level is around the lower normal range, the procedure also has optimal specificity since IgG exclusively is detected. Avidin-biotin AIF may be the method preferred for routine examination of CSF for OB. Demonstration of OB in CSF is valuable especially in MS, where, in contrast to diagnostic aids such as evoked potentials and neuroimaging, it establishes inflammatory type of nervous system involvements. Oligeclonal IgG bands in CSF from patients with OND reflect intrathecal immune response and should lead to investigations of infectious etiology.

Author Affiliations
From the Departments of Neurology (Drs Kostulas and Link) and Clinical Chemistry (Dr Lefvert), Karolinska Institutet Medical School, Huddinge University Hospital, Stockholm.

Footnotes
Accepted for publication April 25, 1987.

Reprint requests to Karolinska Institutet, Department of Neurology, Huddinge University Hospital, S-141 86 Huddinge, Stockholm, Sweden (Dr Kostulas).

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