Does idiopathic transverse myelitis with oligoclonal bands and a normal brain Magnetic Resonance Imaging (MRI) meet diagnostic criteria for Multiple Sclerosis (MS)?

From the Guidelines

No, idiopathic transverse myelitis with oligoclonal bands and a normal brain MRI does not meet the diagnostic criteria for multiple sclerosis. Multiple sclerosis diagnosis requires evidence of central nervous system lesions that are disseminated in both space and time, as outlined in the 2015 Magnims consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process 1. While the presence of oligoclonal bands in cerebrospinal fluid suggests inflammatory activity and is supportive of MS, a single episode of transverse myelitis without any lesions on brain MRI fails to demonstrate dissemination in space.

Key Points for Diagnosis

• The diagnosis of MS requires objective evidence of dissemination of lesions in both time and space, as emphasized by the International Panel on the Diagnosis of MS 1.
• A normal brain MRI, in the context of a single episode of transverse myelitis, does not fulfill the criteria for dissemination in space.
• Oligoclonal bands in cerebrospinal fluid are indicative of inflammatory activity but are not sufficient on their own for an MS diagnosis.
• Close monitoring with follow-up MRIs of both brain and spine is recommended to detect any new lesions that might indicate progression to MS in the future.

Classification and Monitoring

This case would more appropriately be classified as isolated transverse myelitis or clinically isolated syndrome, which may or may not develop into MS over time. The presence of oligoclonal bands suggests an increased risk of developing MS, but the current clinical and radiological findings do not meet the diagnostic criteria for MS as per the guidelines 1. Therefore, regular follow-up and monitoring are crucial to assess for any changes that might indicate the development of MS, allowing for early intervention if necessary.

From the Research

Idiopathic Transverse Myelitis with Oligoclonal Bands and Normal Brain MRI

• Idiopathic transverse myelitis (ITM) with oligoclonal bands and a normal brain MRI may meet diagnostic criteria for multiple sclerosis (MS) in some cases, as suggested by several studies 2, 3, 4, 5.
• A study published in 2008 found that 29% of patients with acute transverse myelitis and normal brain MRI developed MS, with all 17 patients who developed MS having positive CSF analysis, including oligoclonal bands 2.
• Another study published in 2018 proposed that radiological dissemination in space at any time plus positive oligoclonal bands could be an additional criterion for diagnosing MS, highlighting the importance of oligoclonal bands in the diagnostic process 3.
• The presence of oligoclonal bands in the cerebrospinal fluid (CSF) has been identified as a predictive factor for conversion to MS in patients with isolated myelitis, with a study published in 2024 finding that CSF-specific oligoclonal bands were the sole predictive factor of subsequent MS diagnosis 5.

Diagnostic Criteria for Multiple Sclerosis

• The 2010 McDonald criteria for diagnosing MS include dissemination in space and time, which can be demonstrated through clinical attacks or MRI lesions 3.
• A study published in 2008 found that patients with acute partial transverse myelitis who had a family history of MS, higher expanded disability status scale (EDSS) at onset, lesions on brain MRI, CSF-specific oligoclonal bands, or abnormal IgG-index were more likely to convert to MS 4.
• The presence of oligoclonal bands in the CSF has been shown to be a highly predictive factor of subsequent MS diagnosis, emphasizing the importance of conducting timely CSF analysis in patients with isolated myelitis 5.

Clinical Implications

• Patients with ITM and oligoclonal bands should be closely monitored for signs of MS, as they may be at increased risk of developing the disease 2, 3, 4, 5.
• The presence of oligoclonal bands in the CSF should be considered a key factor in the diagnostic process for MS, particularly in patients with isolated myelitis 3, 5.
• Further research is needed to fully understand the relationship between ITM, oligoclonal bands, and MS, and to develop more effective diagnostic and treatment strategies for these patients 2, 3, 4, 6, 5.