The 2 immune markers were present- oligoclonal (sp?)bands an immunoglobulin (not sure of name)
Neurologist says "one would expect to find these 2 markers in the spinal fluid of a person w/ MS"
Could one expect to find these in a person w/ LD?
Posted by cjnelson (Member # 12928) on :
From my understanding spinal is a terrible test for LD. Very unreliable, even more so than blood.
As for the specifics you stated, I dont know to be honest, hopefully someone else can come along with knowledge!
UP!!!!
Posted by Sojourner (Member # 9424) on :
If the doctor was more knowledgable he might also have said that one might expect these findings in a person with neuroborreliosis as well.
There is much documentation on those two markers showing up in CSF of both MS and Lyme sufferers.
I wouldn't sweat the results as diagnostic of MS.
Posted by amk33 (Member # 13206) on :
The oligoclonal bands are present in persons w/MS. My doctor ordered a spinal tap for me to see if I had any of these. It is my understanding that they show evidence of demyelation (damage to the nerve covering).
Posted by Michelle M (Member # 7200) on :
Neurologists know very little about CNS lyme disease, unfortunately.
Since I don't know much about your posting history, I don't know if you have lyme. But if you have reason to believe you have lyme or already have a diagnosis of lyme from an LLMD, then please don't feel that the presence of oligoclonal banding in your cerebrospinal fluid is a sentence of MS. It isn't. In fact it is rather prevalent in neuroborreliosis. Your neurologist SHOULD know this, but they never do, because they refuse to read. This is sad.
The literature is BRIMMING with documentation of this. It lacks only the neurologist willing to read it.
I hope you have an LLMD!
Michelle
_________________________________________________ Final Diagnosis -- Lyme disease (White Matter Lesions)
DIAGNOSIS: CONSISTENT WITH CNS LYME DISEASE
Contributor's Note:
Lyme disease develops following infection with the tick-borne spirochete, Borrelia burgdorferi. The disease course proceeds through three stages.
* I. Days to weeks post-tick bite -- erythema migrans * II. Weeks to months post-tick bite -- cardiac and neurologic effects * III. Months to years post-tick bite -- arthritis and CNS involvement(1)
Adults are more likely to manifest symptoms of neuroberreliosis than are children. These symptoms can include peripheral nerve parasthesias, a Guillain-Barre-like syndrome and Bannwarth's syndrome (lymphocytic meningoradiculitis).(2) A study by Hansen et al. showed that patients with neuroborreliosis demonstrate a blood brain barrier disturbance with 62 % showing an elevated albumin ratio and 60 % revealing an increased IgG index, indicative of intrathecal IgG synthesis.
In addition, 51 % of patients exhibited oligoclonal IgG bands and these bands were more likely to be present with a longer time since onset of neurologic symptoms. (3)
Immune complexes can be recognized by their distinctive staining pattern on zone electrophoresis. B cells in the CNS may give rise to a clonal proliferation of immunoglobulins within the CSF which will appear as a distinct, restricted band in the gamma region of the zone electrophoresis gel. Immune complexes occur when the antibody binds an antigen which results in a slight shift in antibody migration on the gel resulting in blurring or "bridging" of the band (4,5). As can be seen in the CSF protein electrophoresis pattern, there are immune complexes present in this patient's CSF. The immune complexes are indicated by arrows.
Neuroimaging studies may demonstrate discrete, hyperintense, deep white matter of periventricular lesion best visualized on proton density and T2 weighted images.
In this patient, a possible diagnosis of multiple sclerosis (MS) must also be considered based on the neurologic, immunologic and radiologic presentation.
However, the increased permeability of the blood brain barrier and the oligoclonal band bridging (immune complex formation) favor an infectious process over a demyelinating process.
REFERENCES:
1. Garcia-Monco, JC, Villar, BF, Alen, JC, Benach, JL. Borrelia burgdorferi in the central nervous system: Experimental and clinical evidence for early invasion. J of Infect Dis 1990; 161:1187-1193.
2. Belman, AL, Iyer, M, Coyle, PK, Dattwyler, R. Neurologic manifestations in children with North American Lyme disease. Neurology 1993; 43:2609-2614. 3. Hansen, K, Cruz, M, Link, H. Oligoclonal Borrelia burgdorferi- specific IgG antibodies in cerebrospinal fluid in Lyme neuroborreliosis. J of Infect Dis 1990; 161:1194-1202.
4. Kelly, RH, Scholl, MA, Harvey, VS, Devenyi, AG. Qualitative testing for circulating immune complexes by use of zone electrophoresis on agarose. Clin Chem 1980; 26(3):396-402.
5. Seibold, JR, Buckingham, RB, Medsger, TA, Kelly, RH. Cerebrospinal fluid immune complexes in systemic lupus erythematosus involving the central nervous system. Sem Arth Rheum 1982; 12:68-76.
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Posted by Michelle M (Member # 7200) on :
The clinical picture of Lyme disease in neurology
Pavlović D, Lević Z, Dmitrović R.
Neuroborreliosis of central and peripheral nervous system was found in 24 patients with typical and atypical clinical syndromes. Information about tick bite was obtained in only 1/3 of our patients. Specific antibodies were found in 3/4 by flourescent antibody test, oligoclonal bands in 1/2, and signs of inflammation in cerebrospinal fluid in 1/3 of patients. The majority had favourable reaction to antibiotic therapy.
It is necessary to investigate every case of suspected neuroborreliosis because it can imitate many neurological diseases. One must insist on information about the tick bite and/or erythema migrans and search for specific antibody production, both in blood and cerebrospinal fluid.
PMID: 8262408 [PubMed - indexed for MEDLINE]
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