Oligoclonal aspect in the CSF of multiple sclerosis patients: a statistical and physiopathological study

Oligoclonal aspect (O.A.) is observed in 51 per cent of 468 MS patients investigated. Elevation of gammaglobulins and lymphocytic pleiocytosis increase significantly its frequency. O.A. is more frequent in presence of an inflammatory transsudate. Clinical aggravation and O.A seem significantly connected. In the first years of the MS, when the course is intermittent, the frequency of O.A. is significantly influenced by the proximity of the last bout. No such differences exist in patients with continuous course. In conclusion O.A. appears as intermittent expression of a local and general immunity reaction, in connection with the progression of the disease and as a very probable manifestation of persistant virus. We proposed 3 years ago in Göteborg a physiopathological hypothesis suggesting multiple sclerosis (MS) is a two-phase disease. In this first paper, we demonstrated the existence of two successive immunological reactions: The first one is an intermittent synthesis of IgG obviously linked to a lymphocytic pleiocytosis which is also intermittent. This firs CSF pattern appears in the same time of a bout and disappears quickly like the clinical symptoms. It may represent the manifestation of a brief and only infectious aggression. After a few years (more than 5 in average) a second mechanism progress slowly: The synthesis of IgG appears continuous, in remission as in aggravation, the lymphocyte count becomes normal and the level of albumin increases progressively. This second pattern suggests, contrary to the first, a continuous auto-immune processus with the intervention of the general (systemic) immunity. The purpose of this second paper is an attempt to elucidate the signification of oligoclonal aspect in relation to this schema.