No abstract available.
Oligoclonal Bands*

BACKGROUND AND PURPOSE: McDonald criteria for multiple sclerosis diagnosis have been revised over the years, diagnostic procedures have been simplified and earlier diagnosis facilitated. The new 2017 revision introduces other important changes, with a further simplification for the diagnosis. Oligoclonal bands reassume a more relevant role in the workup. METHODS: We describe 3 typical cases of patients admitted for clinically isolated syndrome and illustrate how the application of the new criteria can change the diagnostic approach with respect to the previous criteria. RESULTS: In two of the three cases a diagnosis of multiple sclerosis is now possible. CONCLUSIONS: The new 2017 Multiple Sclerosis criteria may have an important impact in clinical practice with an earlier treatment to avoid the risk of disease dissemination. Their application requires a careful assessment to avoid misdiagnosis and mistreatments.
Diagnosis ; Diagnostic Errors ; Humans ; Multiple Sclerosis* ; Oligoclonal Bands

The authors studied the diagnostic value of the oligoclonal band in cerebrospinal fluid in various neurological disorders. Cerebrospinal fluid of thirty-one patients including eight cases of multiple sclerosis was tested for oligoclonal band by agarose gel electrophoresis using the Helena Titan Gel High Resolution Protein System. Oligoclonal bands were detected in eleven cases of various disorders (two cases of optic neuritis, three cases of multiple sclerosis, three cases of CNS cysticercosis, and three cases of other disorders). This study suggested that detection of oligoclonal band in CSF was of usdful diagnostic aid in multiple sclerosis in addition to CSF IgG/Albumin ratio and CSF IgG index.
Cerebrospinal Fluid* ; Cysticercosis ; Electrophoresis, Agar Gel ; Humans ; Immunoglobulin G ; Multiple Sclerosis ; Nervous System Diseases ; Oligoclonal Bands* ; Optic Neuritis ; Saturn

OBJECTIVE: To investigate the clinical value of oligoclonal bands (OB) in patients with multiple myeloma (MM). METHODS: The laboratory test and clinical data of 624 newly diagnosed MM patients admitted to Blood Diseases Hospital of Chinese Academy of Medical Sciences from January 2013 to December 2019 were retrospectively analyzed, including 30 patients with OB, and the clinical characteristics, treatment effects and survival of OB and non-OB patients were analyzed and compared. RESULTS: OB occurred in 11.8% (22/187) of patients who received autologous stem cell transplantation(ASCT) and only 1.8% (8/437) of patients who did not receive ASCT (P=0.000). The median time to the appearance of oligoclonal bands was 3.2(0.6-10.5) months after transplantation. The M protein types of oligoclonal bands mainly include IgG κ, IgG λ, IgM λ and λ light chains. In the presence of oligoclonal bands, 90% of patients were evaluated as complete remission (CR) and above. There were no statistically significant differences in disease stage, tumor burden, and genetic abnormalities between OB and non-OB patients. Among the all patients, the prognosis of OB patients was significantly better than that of non-OB patients, and OB patients showed deeper disease remission (significantly higher CR rate, MRD negative rate, and longer MRD negative duration). Among patients who underwent ASCT, OB patients showed earlier immune recovery, but the depth of treatment response and survival outcomes were similar between OB and non-OB patients, it was no statistically difference. Although OB patients showed earlier immune reconstitution, this did not translate into better survival, suggesting that the better prognosis of OB patients was mainly related to deeper and durable remission rather than early immune reconstitution. Further analysis in patients who received ASCT and obtained MRD negative indicated that there was no additional survival benefit in patients with OB. CONCLUSION The better prognosis of OB patients may be related to the deeper treatment response, but not to the early immune reconstitution. The appearance of OB is only a sign of deep remission and early immune reconstitution in patients, it cannot be translated into survival benefit of MM patients.
Hematopoietic Stem Cell Transplantation ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Multiple Myeloma ; Oligoclonal Bands ; Retrospective Studies ; Transplantation, Autologous

BACKGROUND: Oligoclonal bands or isotype switch detectable by serum immunofixation electrophoresis (IFE) has been reported following chemotherapy and stem cell transplantation in patients with multiple myeloma (MM). We studied the significance of oligoclonal bands appearing after chemotherapy and autologous stem cell transplantation (ASCT) in Korean MM patients, and its impact on relapse. And we investigated the serial serum free light chain (FLC) ratio to establish its possible relationship with the relapse of MM. METHODS: We conducted a retrospective analysis of the serial serum IFE and FLC ratio in 16 MM patients treated with chemotherapy and ASCT. RESULTS: Eleven out of 16 patients (68.8%) had oligoclonal bands with or without isotype switch after ASCT and the median interval from transplantation was 2.0 months. And relapse or persistence rate of monoclonal gammopathy was lower in patients with oligoclonal bands (27.3% vs. 60.0%), though without statistical significance (P=0.299). In eight patients who developed oligoclonal bands and did not relapse, the serial serum FLC ratio was normal in range. But one patient who developed oligoclonal bands and showed increase of plasma cells in bone marrow, the serial serum FLC ratio was abnormal in range. CONCLUSIONS: The occurrence of oligoclonal bands after chemotherapy and ASCT in Korean MM patients is not significantly associated with adverse consequence of relapse or persistence of monoclonal gammopathy. Therefore oligoclonal bands may be not bad prognostic criterion. And the measurement of serum FLC ratio may be a useful indicator to predict relapse in MM patients who developed oligoclonal bands.
Bone Marrow ; Electrophoresis ; Humans ; Light ; Multiple Myeloma ; Oligoclonal Bands ; Paraproteinemias ; Plasma Cells ; Recurrence ; Retrospective Studies ; Stem Cell Transplantation ; Stem Cells ; Transplants

PURPOSE: Subacute sclerosing panencephalitis(SSPE) is a severe and usually fatal neurodegenerative disorder of childhood and adolescence. The etiology is related to previous measles infection especially during the first 2 years of life. Since recent measles epidemics in Korea may increase the late risk of SSPE, the authors investigated the clinical characteristics of SSPE focusing on brain MRI. METHODS: Six cases(4 males, 2 females) of SSPE patients were retrospectively reviewed for clinical, EEG, laboratory and brain MRI findings. RESULTS: Four of 6 had a history of measles infection in the first year of life. Clinical manifestations were as follows:myoclonus(6), falling(4), ataxia(4), dysarthria(3), seizures (2), involuntary movements(2), tremor(2), head drop(1), sleep disturbance(1). In all cases, CSF IgG, CSF IgG/albumin ratio, and CSF/serum IgG index increased, oligoclonal bands were positive, and CSF antimeasles antibodies were positive. Frontal high amplitude sigma activities and anteriorly-accentuated multifocal epileptiform discharges were noted on EEG. Brain MRI revealed T2-weighted high signal intensity of the deep white matter. CONCLUSION: The diagnosis of SSPE depends on characteristic clinical features and elevation of measles antibodies in CSF, supported by others including EEG, CSF and brain MRI findings. We hope the clinical characteristics we mentioned may be useful for the early diagnosis and active management of SSPE in Korea.
Adolescent ; Antibodies ; Brain ; Diagnosis ; Early Diagnosis ; Electroencephalography ; Head ; Hope ; Humans ; Immunoglobulin G ; Korea ; Magnetic Resonance Imaging ; Male ; Measles ; Neurodegenerative Diseases ; Oligoclonal Bands ; Retrospective Studies ; Seizures ; Subacute Sclerosing Panencephalitis*

We studied on 263 patients (20 with multiple sclerosis (MS); 243 with other neurological diseases (OND), I.e., 87 with myelopathy of unknown origin (MUO), 27 with central nervous system (CNS) infection, 31 with peripheral neuropathy (PN), 23 with cerebrovascular accident (CVA), and 75 with miscellaneous diseases (MD)), who were admitted to the Keimyung University Dongsan Hospital between January 1985 and April 1991 to analyze the clinical values of the cerebrospinal fluid (CSF) Ig G in MS and OND with quantitative CSF Ig G, Ig G-albumin ratio and Ig index by immunodiffusion method, and to detect oligoclonal bands in CSF of 21 patients (2 with MS, 15 with MUO, 1 with PN, 1 with CVA and 2 with MD) by agarose-gel electrophoresis. The results were summarized as follows: 1) In the frequency of elevated quantitative CSF Ig G measurements in patients with MS, the Ig G index was 64% (9 of 14 patients), higher than those of the Ig G and Ig G-albumin ratio, but in OND, the Ig G-albumin ratio was 30% (73 of 240 patients), higher than those of the Ig G and Ig G index. 2) In the frequencies of elevated quantitative CSF Ig G measurements, the Ig G levels in CNS infection, CVA and PN were 67%, 35% and 29%, respectivelyl higher than 25% in MS, and the Ig G-albumin ratio in CNS infection and CVA were 63% and 35%, respectively, higher than 32% in MS, but the Ig G index was the highest in MS (64%) followed by CNS infection (54%). 3) In validity of the various CSF Ig G measurements for diagnosis of MS, the Ig G index was the most sensitive test at 064, the Ig G was the most specific test at 0.76, and the Ig G index had the most positive and negative predictive values at 0.16 and 0.96, respectively. 4) Oligoclonal bands in CSF are not detected in all of 21 patients.
Central Nervous System ; Cerebrospinal Fluid* ; Diagnosis ; Electrophoresis ; Humans ; Immunodiffusion ; Immunoglobulins* ; Multiple Sclerosis ; Oligoclonal Bands ; Peripheral Nervous System Diseases ; Spinal Cord Diseases ; Stroke

Multiple Sclerosis (MS) is the most common demyelinating disease affecting the central nervous system of young adults living in western countries. The clinical suspicion of demyelination, as a pathological process, is high when a young adult develops one or more neurological episodes indicating a damage to white matter tracts within the central nervous system, especially when the optic nerve, brainstem, or spinal cord is involved. The patient with episodes disseminating in time, each of which can be attributed to demyelination, requires no investigation prior to establishing the diagnosis of clinically definite MS, if the age of clinical presentation falls between 20 and 50 years, if different anatomical sites within the central nervous system have necessarily been affected on separate occasions, and if the clinical manifestation is typical for MS. MS in Asian populations is characterized by selective and dominant involvement of the optic nerve and spinal cords, as well as some incidence of brainstem lesion and symptoms. About 35~40% of cases of MS in Korea are of this optico-spinal type. Optico-spinal MS (OSMS) generally has a higher female-to-male ratio than conventional MS. OSMS is also characterized by frequent relapses, severe disability, few brain lesions on MRI, and a very lower incidence of oligoclonal bands in CSF. Neuromyelitis Optica (NMO) (Devic syndrome), which causes severe optic neuritis (ON) and longitudinally extensive transverse myelits either with a monophase or relapse-remitting pattern, is rare in Korean. NMO- IgG was reported to be helpful for the diagnosis of early-stage NMO and differential diagnoses of MS.
Asian Continental Ancestry Group ; Brain ; Brain Stem ; Central Nervous System ; Demyelinating Diseases ; Diagnosis ; Diagnosis, Differential ; Humans ; Immunoglobulin G ; Incidence ; Korea ; Magnetic Resonance Imaging ; Multiple Sclerosis* ; Neuromyelitis Optica ; Oligoclonal Bands ; Optic Nerve ; Optic Neuritis ; Recurrence ; Spinal Cord ; Young Adult

BACKGROUND AND PURPOSE: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that predominantly affects children. Previous studies have mostly involved children in Western developed countries. METHODS: This study retrospectively reviewed the clinical profiles of ADEM in adult Chinese patients. RESULTS: ADEM occurred during summer and autumn in about two-thirds of the 42 included patients. Prior infection was found in five patients and no preimmunization was recorded. The most frequent clinical presentations were alterations in consciousness (79%) and behavior changes (69%), followed by motor deficits (64%) and fever (50%). About one-quarter (26%) of the patients showed positive results for oligoclonal bands, and about half of them exhibited increases in the IgG index and 24-hour IgG synthesis rate. Magnetic resonance imaging showed white- and gray-matter lesions in 83% and 23% of the patients, respectively. Steroids were the main treatment, and full recovery occurred in 62% of the patients, with residual focal neurological deficits recorded in a few patients. After a mean follow-up period of 3.4 years, two patients exhibited recurrence and one patient exhibited a multiphasic course. One patient was diagnosed with multiple sclerosis (MS). CONCLUSIONS: With the exception of the seasonal distribution pattern and prior vaccine rate, the clinical profiles of ADEM in adult Chinese patients are similar to those in pediatric populations. No specific markers are available for distinguishing ADEM from MS at the initial presentation. Careful clinical evaluations, cerebrospinal fluid measurements, and neuroradiological examinations with long-term follow-up will aid the correct diagnosis of ADEM.
Adult* ; Asian Continental Ancestry Group* ; Cerebrospinal Fluid ; Child ; Consciousness ; Demyelinating Diseases ; Developed Countries ; Diagnosis ; Encephalomyelitis, Acute Disseminated* ; Fever ; Follow-Up Studies ; Humans ; Immunoglobulin G ; Magnetic Resonance Imaging ; Multiple Sclerosis ; Oligoclonal Bands ; Recurrence ; Retrospective Studies ; Seasons ; Steroids

BACKGROUND AND PURPOSE: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that predominantly affects children. Previous studies have mostly involved children in Western developed countries. METHODS: This study retrospectively reviewed the clinical profiles of ADEM in adult Chinese patients. RESULTS: ADEM occurred during summer and autumn in about two-thirds of the 42 included patients. Prior infection was found in five patients and no preimmunization was recorded. The most frequent clinical presentations were alterations in consciousness (79%) and behavior changes (69%), followed by motor deficits (64%) and fever (50%). About one-quarter (26%) of the patients showed positive results for oligoclonal bands, and about half of them exhibited increases in the IgG index and 24-hour IgG synthesis rate. Magnetic resonance imaging showed white- and gray-matter lesions in 83% and 23% of the patients, respectively. Steroids were the main treatment, and full recovery occurred in 62% of the patients, with residual focal neurological deficits recorded in a few patients. After a mean follow-up period of 3.4 years, two patients exhibited recurrence and one patient exhibited a multiphasic course. One patient was diagnosed with multiple sclerosis (MS). CONCLUSIONS: With the exception of the seasonal distribution pattern and prior vaccine rate, the clinical profiles of ADEM in adult Chinese patients are similar to those in pediatric populations. No specific markers are available for distinguishing ADEM from MS at the initial presentation. Careful clinical evaluations, cerebrospinal fluid measurements, and neuroradiological examinations with long-term follow-up will aid the correct diagnosis of ADEM.
Adult* ; Asian Continental Ancestry Group* ; Cerebrospinal Fluid ; Child ; Consciousness ; Demyelinating Diseases ; Developed Countries ; Diagnosis ; Encephalomyelitis, Acute Disseminated* ; Fever ; Follow-Up Studies ; Humans ; Immunoglobulin G ; Magnetic Resonance Imaging ; Multiple Sclerosis ; Oligoclonal Bands ; Recurrence ; Retrospective Studies ; Seasons ; Steroids