The prognostic significance of cerebrospinal fluid in multiple sclerosis

Background: Multiple Sclerosis (MS) patients lacking CSF oligoclonal hands are Purported to have a milder course of disease. We reviewed the natural history of oligoclonal hand (OCB) - negative (OCB-) compared to OCB positive (OCB+) patients. Method: A retrospective study of 451 MS patients. Results: Only 48/451 patients (10.6%) were CSF OCB-. The mean age at onset was 37.1 +/- 8.8 years with female: male ratio=2. First CNS location presentation was less well defined in OCB- vs. OCB+ patients with significantly more supratentorial presentation. The clinical course of OCB- vs OCB+ was somewhat different; 22.9 vs 15.1% PPMS: 18.8 vs 12.4% SPMS: and 56.3 vs 71% RRMS, respectively. There were significantly fewer WBC, less IgG and a lower IgG index in OCB- cases. Fewer OCB- cases fulfilled McDonald MRI criteria. There were no discernable differences in disease severity between the two groups as determined by the EDSS, progression index, MSSS, number of relapses or annualized relapse rate. Conclusion: The presence of OCB correlates better with other indications of acute inflammatory MS. especially an RR course. This study Suggests that the simple lack of OCB positivity does not necessarily insure a more benign disease course. (C) 2008 Elsevier B.V. All rights reserved.