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An initial attack of CNS demyelination is followed by uncertainty about whether conversion to multiple sclerosis (MS) will follow. MRI has some predictive value, but at the first attack stage fewer than 50% of patients fulfill the specific MRI criteria established for diagnosis of MS.1–4 Detection of intrathecal IgG synthesis at presentation has been described as a predictive indicator of conversion to clinically definite MS in patients presenting with isolated brainstem, spinal cord, or optic nerve syndromes.3,5,6 Previous studies indicated that oligoclonal band (OCB) testing has a high sensitivity and negative predictive value for future MS diagnosis.3 Most studies, however, do not include and interpret MRI data in parallel with CSF findings.
In this issue of Neurology®, Tintoré et al.1 extend their previous findings3 in a group of 415 individuals with clinically isolated syndrome (CIS) who had MRI and CSF studies within 3 months of clinical presentation. The CSF isoelectric focusing with immunofixation was performed according to international recommendations7 and the percentage of OCB positive patients (61%) was within the range observed by others (46 to 75%).1–3,8 After a mean follow-up of 50 months, the presence of OCB almost doubled the risk of developing clinically definite MS. The positive …
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