CSF oligoclonal banding

Cerebrospinal fluid - immunofixation

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

Oligoclonal bands are proteins called immunoglobulins. The presence of these proteins indicates inflammation of the central nervous system. The presence of oligoclonal bands may point to a diagnosis of multiple sclerosis.

Central nervous system

The central nervous system is composed of the brain and spinal cord. Your brain and spinal cord serve as the main "processing center" for your entir...

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How the Test is Performed

A sample of CSF is needed. A lumbar puncture (spinal tap) is the most common way to collect this sample.

Lumbar puncture

Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...

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Other methods for collecting CSF are rarely used, but may be recommended in some cases. They include:

Cisternal puncture
Ventricular puncture
Removal of CSF from a tube that is already in the CSF, such as a shunt or ventricular drain.

After the sample is taken, it is sent to a lab for testing.

Why the Test is Performed

This test helps support the diagnosis of multiple sclerosis (MS). However, it does not confirm the diagnosis. Oligoclonal bands in the CSF may also be seen in other illnesses such as:

Multiple sclerosis

Multiple sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord (central nervous system).

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Systemic lupus erythematosus
Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the immune system of the body mistakenly attacks healthy tissue. It c...
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Infections, such as Lyme disease and human immunodeficiency virus (HIV) infection
Lyme disease
Lyme disease is a bacterial infection that is spread through the bite of one of several types of ticks.
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Human immunodeficiency virus
Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). When a person becomes infected with HIV, the ...
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Stroke
Stroke
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
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Normal Results

One or no bands should be found in the CSF.

Normal value ranges may vary slightly among different labs. Talk to your health care provider about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some labs use different measurements or may test different specimens.

What Abnormal Results Mean

There are two or more bands found in the CSF and not in the blood. This may be a sign of multiple sclerosis or other diseases causing inflammation in the central nervous system.

Open References

References

De Luca GC, Griggs RC, Johnston SC. Approach to the patient with neurologic disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 366.

Karcher DS, McPherson RA. Cerebrospinal, synovial, serous body fluids, and alternative specimens. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 30.

Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 88.

Schnapp BH, Jewell C. Central nervous system infections. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 95.

CSF oligoclonal banding - series
Presentation

<strong>CSF oligoclonal banding - series</strong><p>The cerebrospinal fluid (CSF) serves to supply nutrients to the central nervous system (CNS) and collect waste products, as well as provide lubrication.</p>

<strong>Indications</strong><p>Why the test is performed. This test helps confirm the diagnosis of multiple sclerosis (MS). The laboratory procedure is called CSF electrophoresis, which is a method used to study the levels of protein in the cerebrospinal fluid (CSF).
In electrophoresis, a CSF sample is applied to a gel (solid medium allowing the movement of proteins), and a voltage is applied. The proteins migrate along the gel based on their charge (roughly on their size). The gel is stained, and significant amounts of similar proteins will cause a visible band to be present. The term oligoclonal bands refers the presence in CSF of two or more protein bands of a specific immunoglobin (IgG) that have greater intensity than in the concurrent serum sample. This pattern of banding is seen in patients with MS, and other conditions.</p>

<strong>Procedure, part 1</strong><p>A sample of the CSF will be taken from the lumbar area of the spine. This is called a lumbar puncture. How the test will feel. The position used during lumbar puncture may be uncomfortable, but you must remain in the curled position to avoid moving the needle and possibly injuring the spinal cord. There also may be some discomfort with the needle prick and the insertion of the lumbar puncture needle. When the fluid is withdrawn, there may be a feeling of pressure. Risks of lumbar puncture include Allergic reaction to the anesthetic, Discomfort during the test, Headache after the test, Bleeding into the spinal canal, Brain herniation (if performed on a patient with increased intracranial pressure), which can result in brain damage and/or death, Damage to the spinal cord (particularly if the patient moves during the test).</p>

<strong>Procedure, part 2</strong><p>A blood sample will also be drawn.</p>

<strong>Procedure, part 3</strong><p>Both the samples are added to a gel, which is then filtered through a cartridge. The gel separates the proteins in each sample and the lab looks for oligoclonal banding. If results are normal one or less bandings will be found in the CSF. If results are abnormal there are 2 or more bandings found in the CSF and not in the blood serum. This may indicate multiple sclerosis (MS). CSF oligoclonal bands are found in 83% to 94% of patients with definite MS. Other causes of oligoclonal banding in CSF include encephalitis, meningitis, Guillain-Barre syndrome, polyneuritis, headache, and other conditions. </p>

Lumbar puncture (spinal tap) - illustration
A lumbar puncture, or spinal tap, is a procedure to collect cerebrospinal fluid to check for the presence of disease or injury. A spinal needle is inserted, usually between the third and fourth lumbar vertebrae in the lower spine. Once the needle is properly positioned in the subarachnoid space (the space between the spinal cord and its covering, the meninges), pressures can be measured and fluid can be collected for testing.
Lumbar puncture (spinal tap)
illustration

CSF oligoclonal banding - series
Presentation

Lumbar puncture (spinal tap) - illustration
A lumbar puncture, or spinal tap, is a procedure to collect cerebrospinal fluid to check for the presence of disease or injury. A spinal needle is inserted, usually between the third and fourth lumbar vertebrae in the lower spine. Once the needle is properly positioned in the subarachnoid space (the space between the spinal cord and its covering, the meninges), pressures can be measured and fluid can be collected for testing.
Lumbar puncture (spinal tap)
illustration

Tests for CSF oligoclonal banding

Review Date: 4/16/2025

Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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CSF oligoclonal banding

Central nervous system

How the Test is Performed

Lumbar puncture

Why the Test is Performed

Multiple sclerosis

Systemic lupus erythematosus

Lyme disease

Human immunodeficiency virus

Stroke

Normal Results

What Abnormal Results Mean

References

CSF oligoclonal banding - series

Lumbar puncture (spinal tap) - illustration

Lumbar puncture (spinal tap)

CSF oligoclonal banding - series

Lumbar puncture (spinal tap) - illustration

Lumbar puncture (spinal tap)

Tests for CSF oligoclonal banding

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