The diagnosis of OCB-negative MS-patients - an inventory of the Swedish MS register in Uppsala, Sweden
ECTRIMS Online Library. Landtblom A. Oct 27, 2017; 200506
Anne-Marie Landtblom
Anne-Marie Landtblom
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Abstract: P851

Type: Poster

Abstract Category: Clinical aspects of MS - 2 MS Variants

Introduction: Up to 5 % of the patients with MS lack oligoclonal bands (OCB) in cerebrospinal fluid (CSF) according to several studies. Our previous studies have shown more frequent HLA DRB1*04:04 in OCB-negative patients. When collecting OCB-negative patients in a local part of the Swedish MS registry, we encountered several cases where doubts about their MS-diagnosis arose.
Objectives: We therefore wanted to analyse the precision of MS diagnosis in the MS register for Uppsala, and evaluate the contamination of other conditions.
Method: Patients with MS and their OCB-status and IgG-index were identified in the MS registry. Then the medical records of the OCB-negative patients were scrutinized with support of an experienced MS neurologist. Several patients then underwent further investigations with update of magnetic resonance tomography (MRT), CSF investigation, and when indicated also neurogenetic investigation and/or samples for differential diagnostics regarding for example rheumatoid diseases and sarcoidosis.
Results: This investigation is ongoing and the figures are interimistic. In the Uppsala MS-registry, 555 active patients were identified, and 42 of these had an OCB-negative status and IgG-index under 0,63. After careful scrutinizing of these cases, only 22 patients were considered true OCB-negative MS patients (=4%). We excluded two patients where MS had been ruled out and 3 patients that were OCB-positive. One patient had NMO. For 15 patients, MS was still a possible diagnosis although atypical. One OCB-negative patient was missed initially, because of a registration error concerning IgG index, and was later added to the study. Consequently, in total 16 patients had a possible/atypical MS diagnosis and some were reinvestigated: Two of these now seem to have adrenomyeloneuropati based on genetic investigation. Both reported relatives with 'atypical MS'. Finally, one patient may have two neurologic conditions, including late appearing OCBs and spinal demyelination. Two of these patients have received immunomodulating drugs.
Conclusion: OCB negative MS is a challenging diagnosis, which can be mixed up with other conditions. Immunomodulating pharmacotherapy obviously demands an accurate MS diagnosis because of the risk for side effects and also for ecomonical reasons. Therefore, updated and repeated investigations including genetic techniques should be considered in the diagnostic work up of OCB-negative MS.
AM Landtblom has received honoraria from Teva, Biogen, Merck, Sanofi Genzyme.
I Boström has received honoraria from Biogen.
A Kristoffersson has no disclosures.
L Jansson has no disclosures
S Ghaderi has no disclosures
J Burman has honoraria/grants from Almirall, Biogen, Genzyme a Sanofi Company, Hospira and Merck Serono.

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