The clinical value of commonly used spinal fluid diagnostic studies in the evaluation of patients with suspected multiple sclerosis.

OBJECTIVE

This study was designed to evaluate the diagnostic value of cerebrospinal fluid (CSF) oligoclonal banding and immunoglobulin G (IgG) production in the diagnosis of multiple sclerosis.

STUDY DESIGN

Spinal fluid changes in patients with suspected multiple sclerosis were compared with clinical data to determine sensitivity, specificity, and predictive value of the procedures. The results were evaluated in terms of cost compared with clinical utility in the managed care environment.

PATIENTS AND METHODS

The CSF oligoclonal banding and CSF IgG index were measured in 50 patients being evaluated for possible multiple sclerosis at a multispecialty group practice clinic.

RESULTS

CSF oligoclonal banding had a sensitivity of 75% and a specificity of 92% in the diagnosis of multiple sclerosis. The CSF IgG index had a sensitivity of 75% and a specificity of 95% in the diagnosis of multiple sclerosis.

CONCLUSIONS

Although neither test would identify 100% of patients with multiple sclerosis, the combination of CSF oligoclonal banding and an elevated CSF IgG index correctly identified most patients with multiple sclerosis and excluded all patients without the disease in this patient population.