Diagnostic Value of Oligoclonal Bands in Children: A Nationwide Population-Based Cohort Study

Magnus Spangsberg Boesen; Alfred Peter Born; Poul Erik Hyldgaard Jensen; Finn Sellebjerg; Morten Blinkenberg; Magnus Christian Lydolph; Mikala Klok Jørgensen; Lene Rosenberg; Jesper Qvist Thomassen; Malene Landbo Børresen

doi:10.1016/j.pediatrneurol.2019.03.002

Diagnostic Value of Oligoclonal Bands in Children: A Nationwide Population-Based Cohort Study

Pediatr Neurol. 2019 Aug:97:56-63. doi: 10.1016/j.pediatrneurol.2019.03.002. Epub 2019 Mar 13.

Affiliations

¹ Department of Pediatrics, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: magnus.spangsberg.boesen@regionh.dk.
² Department of Pediatrics, Rigshospitalet, University of Copenhagen, Denmark.
³ Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark.
⁴ Department of Autoimmunity & Biomarkers, Statens Serum Institut, Denmark.
⁵ Department of Clinical Biochemistry, Hospitals of Region Zealand, Denmark.
⁶ Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
⁷ Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Denmark.

PMID: 31060768
DOI: 10.1016/j.pediatrneurol.2019.03.002

Abstract

Objective: We evaluated the diagnostic value of cerebrospinal fluid oligoclonal bands in individuals less than 18 years of age.

Methods: In a nationwide population-based setting, we retrieved data on 2055 children's oligoclonal band examination, including concordant cerebrospinal fluid biomarkers, during 1994 to 2017. Case ascertainment was by review of medical records and diagnostic codes. We used Fisher's exact test to explore distribution differences of oligoclonal band positivity in acquired demyelinating syndromes (ADS) before and after age 12 years and calculated the sensitivity, specificity, positive predictive value, and negative predictive value of oligoclonal bands to distinguish ADS from the other diagnostic groups.

Results: Median age at oligoclonal band examination was 15.2 years (range = 1.8 to 18.0), and 10% had presence of cerebrospinal fluid oligoclonal bands. Oligoclonal band positivity was the highest in ADS (52%), but it was age dependent: 21% in children with ADS before age 12 years and 68% in children aged 12 through 17 years (P < 0.0001) owing to the higher incidence of multiple sclerosis in the latter. Cerebrospinal fluid oligoclonal bands were not predictive of ADS before age 12 years compared with the other diagnostic groups. However, cerebrospinal fluid oligoclonal bands in children aged 12 through 17 years were highly predictive of ADS compared with central nervous system infections and non-ADS immune-mediated central nervous system diseases (positive predictive value: 0.89; 95% confidence interval = 0.82 to 0.94; P < 0.0001), but negative oligoclonal bands were not discriminatory (negative predictive value: P = 0.17).

Conclusions: In a clinical setting, cerebrospinal fluid oligoclonal band examination may be of higher yield in children aged 12 through 17 years if there is clinical suspicion of multiple sclerosis, and in such circumstances a positive test supports a diagnosis of multiple sclerosis.

Keywords: ADEM; Children; Multiple sclerosis; Oligoclonal bands; Population based.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Age of Onset
Child
Child, Preschool
Cohort Studies
Demyelinating Autoimmune Diseases, CNS / cerebrospinal fluid
Demyelinating Autoimmune Diseases, CNS / diagnosis
Demyelinating Autoimmune Diseases, CNS / epidemiology
Demyelinating Diseases / cerebrospinal fluid
Demyelinating Diseases / diagnosis*
Demyelinating Diseases / epidemiology
Denmark / epidemiology
Diagnosis-Related Groups
Female
Humans
Infant
Male
Multiple Sclerosis / cerebrospinal fluid
Multiple Sclerosis / diagnosis
Multiple Sclerosis / epidemiology
Oligoclonal Bands / cerebrospinal fluid*
Predictive Value of Tests
Registries
Sensitivity and Specificity

Substances

Oligoclonal Bands