# Comparison of the clinical and laboratory characteristics of neuromyelitis optica spectrum disorder with or without cerebrospinal fluid oligoclonal bands: a cohort with 36-month follow-up

## TL;DR

This study finds that cerebrospinal fluid oligoclonal bands in neuromyelitis optica spectrum disorder are linked to higher cell counts and more autoimmune conditions, but not worse long-term outcomes.

## Contribution

The study identifies a novel association between CSF oligoclonal bands and increased autoimmune comorbidities in AQP4-IgG-positive NMOSD patients.

## Key findings

- OCBs+ patients had higher CSF cell counts and IgG index compared to OCBs− patients.
- OCBs+ patients were more likely to have concomitant connective tissue disease and other autoimmune antibodies.
- OCBs+ patients experienced more relapses within 36 months but had similar disability scores.

## Abstract

This study aimed to explore the significance of cerebrospinal fluid (CSF) oligoclonal bands (OCBs) in the clinical diagnosis and evaluation of neuromyelitis optica spectrum disorder (NMOSD).

The demographic and clinical data of 143 aquaporin-4 immunoglobulin G (AQP4-IgG)-positive NMOSD patients were collected and analyzed, including the gender, age, clinical symptoms and signs, status of CSF OCBs, location and length of the affected spinal cord vertebral segments, Expanded Disability Status Scale (EDSS) at the first attack and at 36-month follow-up, relapse times within 36 months, concomitant connective tissue disease (CTD), and status of other autoimmune antibodies (oAIA).

There were 15 patients (10.5%) who were positive for OCBs (OCBs+). In contrast to those with negative OCBs (OCBs−), more OCBs+ cases had concomitant CTD [5/15 (33.3%) vs. 11/128 (8.6%), p = 0.014] and oAIA [9/15 (60.0%) vs. 37/128 (28.9%), p = 0.020]. OCBs+ patients had higher CSF cell counts [15.0 (27.0)/mm3
vs. 5.0 (12.0)/mm3, p = 0.008], higher IgG index [0.68 (0.23) vs. 0.52 (0.15), p < 0.001], and more relapses within 36 months [2.0 (3.0) vs. 1.0 (2.0), p = 0.039] than OCBs− patients. More OCBs+ patients had polynuclear cell predominance in the CSF than OCBs− patients (p = 0.032). There were no significant differences between the OCBs+ and the OCBs− patients in the distribution of lesion locations; the length of the affected spinal cord vertebral segments; the concentration of CSF protein and the albumin quotient; the EDSS score at the time of lumbar puncture and at 36-month follow-up, and the onset episode, the relapse, and cumulative clinical syndrome profiles (all p > 0.05).

For AQP4-IgG-positive NMOSD patients, positivity for CSF OCBs is associated with higher CSF cell counts and a higher likelihood to have concomitant CTD and oAIA. OCBs+ is not uncommon in NMOSD and may predict more frequent relapses, but not a more serious illness.