CSF Oligoclonal Banding

SOURCE: www.NLM.NIH.gov

CSF oligoclonal banding is a test to look for inflammation-related substances in the cerebrospinal fluid (CSF), the clear fluid that flows in the space surrounding the spinal cord and brain.

Oligoclonal bands are substances called immunoglobulins, which suggest inflammation of the central nervous system. The presence of oligoclonal bands may be a sign of multiple sclerosis.

How the Test is Performed

A lumbar puncture (spinal tap) is performed and the fluid is sent to the laboratory for analysis.

How the Test Will Feel

Patients will be asked to either sit up or lie down on their side with back parallel to the bed and chin tucked under and legs curled in the fetal position. The healthcare provider will use the bony protrusions of the hip to determine the most appropriate location to remove fluid. This is usually at the lower lumbar area.

A germ-killing solution is used to clean off the area and a sterile sheet is draped over the surrounding area. In infants and small children, a local numbing cream is applied to the skin about 1 hour prior to the procedure. In adults, numbing medicine is injected under the skin.

A thin needle is inserted into the space between the vertebra. You may hear a popping sound when the needle goes through the tissue surrounding the spinal cord and fluid.

The fluid flows out of the needle and into a plastic container. The spinal fluid is sent to a laboratory for examination under a microscope.

Under experienced hands there should not be any pain. There may be a feeling of pressure when the needle is inserted but with appropriate anesthetic, this should not hurt. Occasionally, some people may feel numbness shooting down the leg. This may be due to irritation of a nerve root and subsides when the needle is withdrawn.

Following the procedure, the patient is advised to remain lying down for a short time to prevent low-pressure headache. The entire procedure takes approximately 20 minutes.

Why the Test is Performed

This test helps support, but does not confirm, the diagnosis of multiple sclerosis (MS). The presence of oligoclonal bands in the CSF must be interpreted in the context of clinical findings and other laboratory results.

Normal Results

Negative result -- one or less bandings found in the CSF is normal.

What Abnormal Results Mean

There are two or more bandings found in the CSF and not in the blood. This may be a sign of multiple sclerosis.

Risks

Risks of lumbar puncture include:

Brain herniation may occur if a lumbar puncture is performed on a person with a mass in the brain such as an abscess or tumor. This can result in brain damage or death. Lumbar puncture is not done if other tests show signs of a brain tumor or abscess.

Damage to the spinal cord does not occur because the needle is inserted below the level at which the spinal cord ends. The needle may irritate a nerve root which results in transient numbness or tingling in the leg. This goes away when the needle is re-adjusted.