Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
Exploring the Type 4 Cerebrospinal Fluid Oligoclonal Band Pattern: Clinical and Paraclinical Features with Diagnostic Implications.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Mehdiyev Duygu Arslan, Sönmez Meryem Tuba, Şen Sedat, Koç Sümeyye, Arslan Gökhan, Yüceyar Nur, Sarıdaş Furkan, Koç Emine Rabia, Turan Ömer Faruk, Taşcı İrem, Doğan İpek Güngör, Oflazoğlu Aykan, Demir Serkan, Tunç Abdulkadir, Aksoy Dürdane, Akçalı Aylin, Uncu Gülgün, Ayas Zeynep Özözen, Batum Melike, Örün Muhammet Okay, Çınar Bilge Piri, Bülbül Nazlı Gamze, Bünül Sena Destan, Efendi Hüsnü, Bir Levent Sinan, Tekin Selma Bilgin, Boz Cavit, Seferoğlu Meral, Cilingir Vedat, Usta Nuray Can, Güllüoğlu Halil, Çam Mustafa, Terzi Murat
Аннотация
OBJECTIVE: Type 4 ("mirror-pattern") oligoclonal bands (OCBs) are commonly viewed as systemic immune activation indicators, but their clinical significance in demyelinating disorders remains uncertain. This study assessed features of patients with type 4 OCB positivity and determined variables associated with multiple sclerosis (MS).
METHODS: This multicenter retrospective study included 92 patients with type 4 OCB positivity detected during cerebrospinal fluid evaluation for suspected demyelinating disease. Patients were grouped as: MS, non-MS inflammatory disorders, and diagnostic evaluation ongoing (DEO). Demographic characteristics, relapse features, treatment response, Expanded Disability Status Scale (EDSS) scores, and magnetic resonance imaging (MRI) findings were analyzed. Logistic regression identified factors associated with MS diagnosis.
RESULTS: MS patients were younger and had higher relapse frequency than non-MS and DEO groups. Relapses with pyramidal and multisystem involvement were frequent in MS, while opticospinal attacks were more common in non-MS disorders. Periventricular and cortical/juxtacortical MRI lesions were associated with MS, whereas systemic autoimmune diseases occurred only in non-MS and DEO groups. Younger age and polysymptomatic presentation were independently associated with MS, whereas a higher relapse frequency and typical MS-related lesion distribution were associated with MS in the univariable analysis only.
CONCLUSION: Type 4 OCB positivity should not be viewed solely as a systemic immune activation marker. In patients with inflammatory demyelinating disease, the mirror pattern does not exclude MS and should be interpreted with clinical presentation and MRI findings. Its diagnostic relevance depends on patient age, relapse profile, and lesion distribution rather than OCB pattern alone. Type 4 OCB status may inform clinical reasoning but should not independently direct diagnostic decisions.
METHODS: This multicenter retrospective study included 92 patients with type 4 OCB positivity detected during cerebrospinal fluid evaluation for suspected demyelinating disease. Patients were grouped as: MS, non-MS inflammatory disorders, and diagnostic evaluation ongoing (DEO). Demographic characteristics, relapse features, treatment response, Expanded Disability Status Scale (EDSS) scores, and magnetic resonance imaging (MRI) findings were analyzed. Logistic regression identified factors associated with MS diagnosis.
RESULTS: MS patients were younger and had higher relapse frequency than non-MS and DEO groups. Relapses with pyramidal and multisystem involvement were frequent in MS, while opticospinal attacks were more common in non-MS disorders. Periventricular and cortical/juxtacortical MRI lesions were associated with MS, whereas systemic autoimmune diseases occurred only in non-MS and DEO groups. Younger age and polysymptomatic presentation were independently associated with MS, whereas a higher relapse frequency and typical MS-related lesion distribution were associated with MS in the univariable analysis only.
CONCLUSION: Type 4 OCB positivity should not be viewed solely as a systemic immune activation marker. In patients with inflammatory demyelinating disease, the mirror pattern does not exclude MS and should be interpreted with clinical presentation and MRI findings. Its diagnostic relevance depends on patient age, relapse profile, and lesion distribution rather than OCB pattern alone. Type 4 OCB status may inform clinical reasoning but should not independently direct diagnostic decisions.