Diseases Associated with Oligoclonal Bands
Oligoclonal bands (OCBs) are most strongly associated with multiple sclerosis (MS), occurring in approximately 95% of MS patients, but they are also found in various other inflammatory, infectious, and autoimmune disorders affecting the central nervous system. 1
Primary Associations
Multiple Sclerosis
- Present in 90-98% of MS patients 1, 2
- Considered a hallmark laboratory finding in MS diagnosis
- Included in the McDonald diagnostic criteria for MS, particularly for primary progressive MS diagnosis 2
- OCBs represent intrathecally synthesized IgG antibodies that appear as discrete bands on cerebrospinal fluid (CSF) electrophoresis but are absent in serum 2
Neuroinfectious Diseases
Viral infections:
Bacterial infections:
Other Inflammatory/Autoimmune CNS Disorders
- Neurosarcoidosis 2
- Behçet syndrome with CNS involvement 2
- Vasculitis affecting the CNS 2
- MOG antibody-associated disease (MOGAD) - though less frequently than in MS 2, 3
- Neuromyelitis optica spectrum disorders (NMOSD) - though much less frequently than in MS 2
Less Common Associations
- CNS lymphoma 2
- Paraneoplastic neurological disorders 2, 4
- Gliomatosis cerebri 2
- Some cases of Alzheimer's disease 1
- Cerebrovascular accidents (typically transient) 1, 4
- Amyotrophic lateral sclerosis (infrequent) 1
- Some polyneuropathies 4
Characteristics of OCBs in Different Conditions
In Multiple Sclerosis
- Typically CSF-restricted (present in CSF but absent in serum) 2
- Persist throughout the disease course 4
- Composed primarily of IgG1 and IgG3 antibodies 5
- May target ubiquitous intracellular self-proteins rather than brain-specific antigens 6
- Associated with increased disease burden and severity 5
In Infectious Diseases
- Often target specific pathogens (e.g., Borrelia in neuroborreliosis) 6
- May disappear after resolution of the infection 4
- Can include IgA bands in addition to IgG (particularly in SSPE) 7
Clinical Significance
- For MS diagnosis: Evidence of OCBs can substitute for MRI criteria of dissemination in space for primary progressive MS diagnosis 2
- Prognostic value: Presence of OCBs in MS correlates with higher disease burden 5
- Differential diagnosis: Absence of OCBs in a suspected MS case should prompt consideration of alternative diagnoses, particularly MOGAD 3
- In MOGAD: Absence of CSF-restricted OCBs is a characteristic feature that helps distinguish it from MS 2, 3
Important Considerations
- The detection method matters - cell-based assays and isoelectric focusing techniques are most sensitive 3
- OCBs may be transient in acute conditions like stroke but persistent in chronic inflammatory diseases 4
- The presence of OCBs indicates an immunological response but is not specific to any single condition 1
- In some cases, oligoclonal IgA bands may be present even when IgG bands are absent 7
Understanding the pattern of OCB presence across different neurological disorders helps in differential diagnosis, particularly when distinguishing between MS and its mimics like MOGAD, where the absence of OCBs is a distinguishing feature.