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Clinical laboratory test utilization of CSF oligoclonal bands and IgG index in a tertiary pediatric hospital
Rachel K Vanderschelden1, Nicholas L Benjamin2, Michael R Shurin3
1University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, PA, USA.
Insights
Pediatric-onset multiple sclerosis (POMS) diagnosis is aided by IgG index and oligoclonal bands (OCB). Elevated IgG index and OCBs are more common in demyelinating diseases than other pediatric conditions.
Area of Science:
- Neurology
- Pediatric Neurology
- Clinical Diagnostics
Background:
- Pediatric-onset multiple sclerosis (POMS) diagnosis relies on criteria used for adults, but differential diagnosis differs.
- Limited literature exists on using oligoclonal bands (OCB) and IgG index to distinguish POMS from other childhood diseases with similar symptoms.
Purpose of the Study:
- To investigate the clinical utility of IgG index and OCB in differentiating POMS from other conditions in pediatric patients.
- To identify trends in abnormal markers to improve diagnostic practices for POMS.
Main Methods:
- Retrospective review of 85 MS panels from patients ≤18 years old at a tertiary care pediatric hospital.
- Collaboration with pediatric neurology to analyze clinical utility of diagnostic markers.
Main Results:
- Demyelinating diseases were diagnosed in 36.5% of cases (14% POMS).
- Elevated IgG index was observed in 67% of demyelinating disease cases versus 13% in others.
- Unique OCBs were found in 41% of demyelinating disease cases versus 9% in others. Psychiatric conditions showed normal MS panels in 93.3% of cases.
Conclusions:
- Elevated IgG index and OCBs are more prevalent in pediatric patients with demyelinating diseases compared to those with other conditions.
- In-house IgG index testing can serve as a rapid screening tool for demyelinating diseases in pediatric hospitals lacking OCB evaluation, pending OCB results.
Background:
Criteria developed for the diagnosis of multiple sclerosis (MS) in adults are also used in the pediatric setting. However, differential diagnosis in pediatric-onset MS (POMS) is distinct from that of adult-onset MS. There is little literature characterizing the utility of oligoclonal bands (OCB) and IgG index in differentiating POMS from other childhood diseases with overlapping clinical presentation which can require immediate treatment.
Methods:
A retrospective review of all MS panels resulted between March 2022 and May 2023 on patients age ≤ 18 years at one tertiary care pediatric hospital in the northeastern United States was performed with pediatric neurology collaboration to characterize clinical utility (n = 85 cases).
Results:
Demyelinating diseases accounted for 31 of 85 total cases (36.5%), 12 of these cases were POMS (14%). Other diagnoses consisted of psychiatric etiologies (17.6%), infectious meningitis/encephalitis (5.9%), and migraine (5.9%). Elevated IgG index was seen in 67% of those with demyelinating diseases, versus only 13% of those with other conditions. Unique OCBs were found in 41% of those with demyelinating diseases, versus only 9% of those with other conditions. Fourteen of 15 patients (93.3%) with psychiatric conditions had normal MS panels.
Conclusions:
Patients with demyelinating diseases were more likely to have elevated IgG index and unique OCBs versus patients with other conditions. For pediatric hospitals without in-house OCB evaluation, implementation of an in-house IgG index may serve as a rapid screen for differentials that include demyelinating diseases while awaiting OCB results, in the appropriate clinical context.
Impact Statement:
IgG index and CSF oligoclonal bands are important tools in the diagnosis of patients with suspected Multiple Sclerosis (MS). In the pediatric population, these markers are used to differentiate pediatric-onset MS (POMS) from other neurologic, psychiatric, and inflammatory diseases that display clinical overlap. The use of these markers in differentiating these conditions has not been thoroughly investigated. We examined the associations between abnormal markers and final diagnoses in pediatric patients undergoing testing for POMS in order to identify trends that may enhance ordering and reporting practices.
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