Diagnostic value of oligoclonal bands in children

Magnus Spangsberg Boesen, Alfred Peter Born,Poul Erik Hyldgaard Jensen, Finn Sellebjerg, MortenBlinkenberg, Magnus Christian Lydolph, Mikala Klok Jørgensen, Lene Rosenberg, Jesper Qvist Thomassen, Malene Landbo Børresen.  Diagnostic value of oligoclonal bands in children: A nationwide population-based cohort study.  Pediatric  Neurology.  In press. 

ABSTRACT

Objective

To evaluate the diagnostic value of cerebrospinal fluid oligoclonal bands (OCBs) in children (<18 years).

Methods

In a nationwide population-based setting, we retrieved data on 2,055 children’s OCB examination including concordant cerebrospinal fluid biomarkers during 1994–2017. Case ascertainment was by review of medical records and diagnostic codes. We used Fisher’s exact test to explore distribution differences of OCB positivity in acquired demyelinating syndromes (ADS) before and after 12 years of age and calculated sensitivity, specificity, positive predictive value, and negative predictive value of OCBs to distinguish ADS from the other diagnostic groups.

Results

Median age at OCB examination was 15.2 years (range=1.8–18.0), and 10% had presence of cerebrospinal fluid OCB. OCB positivity was the highest in ADS (52%), but it was age-dependent: 21% in children with ADS before age 12 years and 68% in children 12–17 years (p<0.0001) due to the higher incidence of multiple sclerosis in the latter. Cerebrospinal fluid OCBs were not predictive of ADS before age 12 years compared with the other diagnostic groups. However, cerebrospinal fluid OCBs in children aged 12–17 years were highly predictive of ADS compared with CNS infections and non-ADS immune-mediated CNS diseases (positive predictive value: 0.89; 95% confidence interval=0.82–0.94; p<0.0001), but negative OCBs were not discriminatory (negative predictive value: p=0.17).

Conclusions

In a clinical setting, cerebrospinal fluid OCB examination may be of higher yield in children aged 12–17 years if there is clinical suspicion of multiple sclerosis, and in such circumstances a positive test supports a diagnosis of multiple sclerosis.

Courtesy of Doximity