Oligoclonal Bands Support Pediatric MS Diagnosis When High Clinical Suspicion Exists

Examination of CSF oligoclonal bands may be more effective for diagnosing MS in children between the ages of 12 and 17 years.

Examination of oligoclonal bands (OCBs) in cerebrospinal fluid may be more effective at identifying pediatric multiple sclerosis (MS) in children between the ages of 12 and 17 years, a study found. The findings from this study were published in Pediatric Neurology.

Pediatric OCB examination findings from 2055 Danish children were collected from the Danish Civil Registration System between the years 1994 and 2017. These data also included concordant cerebrospinal fluid biomarkers available for evaluation.

Children were categorized into diagnostic groups, including central nervous system (CNS) diseases and non-CNS diseases. Further categorization included acquired demyelinating syndromes (ADS), non-ADS immune-mediated CNS diseases, CNS infection, epilepsy, sleep disorders, and cerebrovascular disease.

Examinations were performed to identify differences of OCB positivity in ADS prior to and after 12 years of age.

The median age of patients at time of OCB assessment was 15.2 years (range, 1.8-18.0 years). Approximately 10% of patients had evaluable cerebrospinal fluid OCB. The diagnostic group with the highest proportion of patients with OCB positivity was the ADS group (52%).

A higher percentage of those in the ADS group with OCB positivity were between the ages of 12 and 17 years vs <12 years (68% vs 21%, respectively; P <.0001). This difference was primarily attributable to the higher incidence of MS in the 12- to 17-year age group.

No predictive value was found for ADS with cerebrospinal fluid OCBs in patients age <12 years compared with other diagnostic groups. Despite this finding, the researchers discovered that cerebrospinal fluid OCBs in patients between the ages of 12 and 17 years were predictive of ADS when compared with both non-ADS immune-mediated CNS diseases and CNS infections (positive predictive value, 0.89; 95% CI, 0.82-0.94; P <.0001).

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The reliance on diagnostic codes in the National Patient Register rather than on medical records represents a potential limitation of the study.

“In the clinical setting,” the researchers concluded, “OCB examination may be of higher yield in children aged 12 to 17 years if there is clinical suspicion of MS, and in such circumstances a positive test supports a diagnosis of MS.”

Disclosures: Several study authors report financial relationships with the pharmaceutical industry. Please refer to original reference for full list of disclosures.


Boesen MS, Born AP, Jensen PEH, et al. Diagnostic value of oligoclonal bands in children: A nationwide population-based cohort study [published online March 13, 2019]. Pediatr Neurol. doi: 10.1016/j.pediatrneurol.2019.03.002