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Clinically isolated syndromes

A new oligoclonal band test accurately predicts conversion to MS

From the Departments of Neurology (J.M., J.C.A.-C., N.G.-B., M.D.-S.), Immunology (M.E., M.C.S., P.G.-P., L.M.V.), and Neuroradiology (J.M.S.), Hospital Ramón y Cajal, Madrid; and Department of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain.

Address correspondence and reprint requests to Dr. Jaime Masjuan, Servicio de Neurología, Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, 28034 Madrid, Spain; e-mail: jmasjuan.hrc{at}salud.madrid.org

Background: Patients with a clinically isolated demyelinating syndrome (CIS) are at risk of developing a second attack, thus converting into clinically definite multiple sclerosis (CDMS). Therefore, an accurate prognostic marker for that conversion might allow early treatment. Brain MRI and oligoclonal IgG band (OCGB) detection are the most frequent paraclinical tests used in MS diagnosis. A new OCGB test has shown high sensitivity and specificity in differential diagnosis of MS.

Objective: To evaluate the accuracy of the new OCGB method and of current MRI criteria (MRI-C) to predict conversion of CIS to CDMS.

Methods: Fifty-two patients with CIS were studied with OCGB detection and brain MRI, and followed up for 6 years. The sensitivity and specificity of both methods to predict conversion to CDMS were analyzed.

Results: OCGB detection showed a sensitivity of 91.4% and specificity of 94.1%. MRI-C had a sensitivity of 74.23% and specificity of 88.2%. The presence of either OCGB or MRI-C studied simultaneously showed a sensitivity of 97.1% and specificity of 88.2%.

Conclusions: The presence of oligoclonal IgG bands is highly specific and sensitive for early prediction of conversion to multiple sclerosis. MRI criteria have a high specificity but less sensitivity. The simultaneous use of both tests shows high sensitivity and specificity in predicting clinically isolated demyelinating syndrome conversion to clinically definite multiple sclerosis.

Supported by grants PI020043 and PI020726 from the Fondo de Investigaciones Sanitarias (Spain) and from Fundación Salud 2000, Madrid.

Disclosure: The authors report no conflicts of interest.

Received June 27, 2005. Accepted in final form October 25, 2005.

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