Abstract Details

Title Positive Predictive Value of Elevated Unique Cerebrospinal Fluid Oligoclonal Bands

Topic Multiple Sclerosis

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-022

Objective This retrospective study determines the positive predictive value of elevated cerebrospinal fluid (CSF) oligoclonal bands (OCBs) and characterizes diagnoses of patients in which they were found.

Background Unique CSF OCBs are clonally restricted immunoglobulins seen in patients with multiple sclerosis (MS) and other neuroinflammatory conditions and infections. The positive predictive value (PPV) of elevated OCBs for MS is difficult to determine; many studies have evaluated the PPV of OCBs within clinically isolated syndrome (CIS), but few have formally evaluated presence of OCBs in other disorders.

Design/Methods The database of patients within our hospital system was queried for patients who had greater than 3 CSF OCBs between 2010 and 2017, inclusive. Those patients’ charts were reviewed, and patients who had greater than 3 unique CSF OCBs were included, in line with our clinical laboratory’s cutoff for positive test. The number of CSF OCBs, serum OCBs, and unique CSF OCBs were collected along with the patients’ diagnoses and demographics.

Results 218 patients resulted from the query, and 138 patients were included in analysis. 77 patients had 3 or fewer unique OCBs, and 3 patients had no diagnostic workup at our institution excluding CSF studies. Of the 138 patients who met inclusion criteria, 85 patients were ultimately diagnosed with multiple sclerosis. The positive predictive value of >3 unique CSF OCBs for diagnosing MS was 0.62. Other diagnoses included neuromyelitis optica, anti-NMDA receptor encephalitis, transverse myelitis, Leber’s hereditary optic neuropathy, chronic fungal meningitis, and neurosyphilis.

Conclusions Recent studies have shown that physicians overestimate PPV for common tests and have difficulty understanding the clinical implications of a positive test for any one patient. At our institution, OCBs are frequently ordered during CSF evaluation, including in cases where MS is not suspected. While OCBs can be helpful in specific clinical scenarios, this test is likely overused in our institution.

Authors/Disclosures
Casey F. Jeffreys, MD (Raleigh Neurology Associates) PRESENTER	The institution of Dr. Jeffreys has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. The institution of Dr. Jeffreys has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. The institution of Dr. Jeffreys has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Jeffreys has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Clinical Neurological Society of America Inc.. Dr. Jeffreys has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Hall Booth Smith PC. The institution of Dr. Jeffreys has received research support from Novartis.
Christopher P. Eckstein, MD	The institution of Dr. Eckstein has received research support from Biogen. The institution of Dr. Eckstein has received research support from Genzyme.
Mark B. Skeen, MD, FAAN	Dr. Skeen has received personal compensation for serving as an employee of VeraSci. Dr. Skeen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Skeen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion. Dr. Skeen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Skeen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD/Serono. Dr. Skeen has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Skeen has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Skeen has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Dr. Skeen has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Bristol Myers Squib. Dr. Skeen has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD/ Serono. The institution of Dr. Skeen has received research support from National MS Society. Dr. Skeen has received personal compensation in the range of $50,000-$99,999 for serving as a Retiree with US Navy.

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