matching oligoclonal bands in csf and serum matching oligoclonal bands in csf and serum

eCollection 2018 May. Carta S, Ferraro D, Ferrari S, Briani C, Mariotto S. Crit Rev Clin Lab Sci. The procedure usually takes about half an hour. It Do not be redundant. The Motor Evoked Potential (MEP) Test Explained, Overview of Chemodenervation (Non-Cosmetic Botox Injections), The Rise and Fall of the Controversial Doctor Behind Deep Brain Stimulation, Electric Current to the Noggin Improves Memory, Is the COVID-19 Vaccine Linked to Tinnitus? springerlink.com/content/lv0r2xt58rj600jb/, mayoclinic.org/tests-procedures/lumbar-puncture/basics/definition/prc-20012679, mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8017, books.google.com/books?id=FCbXDdOvB9IC&pg=PA319&lpg=PA319&dq=oligoclonal+Banding+meningitis&source=bl&ots=xXaV_Bq2ej&sig=Cf3UhU2a8sxtckVKViJkIujPHPE&hl=en&sa=X&ei=b1EEUL2GC-LC2QWx4dGqCw&ved=0CEwQ6AEwAQ#v=onepage&q=oligoclonal%20Banding%20meningitis&f=false, When Forgiveness Becomes Enough: Cindy Jenkins Talks OCD. CSF None found; four or more CSF-specific bands have been shown to be most consistent with MS. Accessibility I have had severe dizziness since August of 2009. A positive test might also indicate that you have: As always, give your doctor complete information on what medications you take. Submissions should not have more than 5 authors. Careers. Previously considered an incidental finding, some patients have matched IgG bands present in both the CSF and serum. Zeman A, McLean B, Keir G, Luxton R, Sharief M, Thompson E. J Neurol Neurosurg Psychiatry. Unconcentrated CSF and diluted serum are electrophoresed by isoelectric focusing. (Press Enter or Space to Go to Landing Page or Press Down to expand Menu), Federally Qualified Health Centers (FQHCs), Combatting Modern Slavery and Human Trafficking Statement. The presence of 2 or more unique CSF oligoclonal bands was reintroduced as one of the diagnostic criteria for MS in the 2017 revised McDonald criteria. The institution of Dr. Paz Soldan has received research support from National Multiple Sclerosis Society. Adv Clin Chem. They are used in the diagnosis of various and apply to letter. WebOligoclonal immunoglobulin G (IgG) bands (OCBs) are a useful diagnostic tool to detect a central humoral response. IgG oligoclonal bands (OCBs) are present in the cerebrospinal fluid (CSF) of more than 95% of patients with multiple sclerosis (MS), and are considered to be the immunological hallmark of disease. Zhonghua Yi Xue Za Zhi (Taipei). O'S-ci + *, only" (symbolised in the figure by a *); 3) patientswithatleast onecloneinserumandat least one clone unique to CSF, have both intrathecal andsystemic Clients without access to Test Prices can contact, Prospective clients should contact their Regional Manager. A finding of 4 or more cerebrospinal fluid (CSF)-specific bands (i.e., bands that are present in CSF but are absent in serum) is consistent with multiple sclerosis. Unable to load your collection due to an error, Unable to load your delegates due to an error. This test is not specific for multiple sclerosis. In particular, cerebrospinal fluid (CSF)-restricted OCBs represent This helps the doctor insert the needle more easily. All rights reserved. Previously considered an incidental finding, some patients have matched IgG bands present in both the CSF and serum. 5 Less has been reported on the other patterns and their relevance in the wider range of CNS disorders. Before the test, a doctor may order imaging tests, such as a CT scan or an MRI scan, to ensure that it is safe for the person to undergo the procedure. The test is also known as CSF oligoclonal banding or CSF immunofixation. The institution of Dr. Paz Soldan has received research support from Biogen. Could you elaborate on the OGB's connection to demyelination? The https:// ensures that you are connecting to the All Rights Reserved. While OCGB negative patients are unlikely to develop clinically definite (CD) MS, OCGB positivity may lead to an erroneous diagnosis in The institution of Dr. Clardy has received personal compensation in the range of $0-$499 for serving as a Consultant for Genentech. Somatosensory evoked potential (SEP) tests measure the electrical impulses traveling to and through your central nervous system in response to a, The motor evoked potential (MEP) test measures electrical signaling through the motor pathways of your nervous system. My doctor was not concerned because of the fact that the bands were "mirrored" in CSF and blood. His paired cerebrospinal fluid (CSF) and serum samples were sent to the clinical biochemistry laboratory for oligoclonal band analysis by CSF isoelectric focusing and IgG immunofixation (Fig. Fortini AS, Sanders EL, Weinshenker BG, Katzmann JA: Cerebrospinal fluid oligoclonal bands in the diagnosis of multiple sclerosis. Last medically reviewed on March 18, 2022. After a few moments, it will begin working. MS is a disease that affects the CNS, which consists of the brain and spinal cord. My symptoms are The .gov means its official. It feels just like when the dentist's Novocaine is wearing off. Oligoclonal bands and antibody responses in multiple sclerosis. Ive done 2 years of physical therapy wher OMG, you are so describing me. Epub 2022 Apr 22. Significance of Myelin Oligodendrocyte Glycoprotein Antibodies in CSF: A Retrospective Multicenter Study. Nicole E Stanley, MD Anatomic and Clinical Pathology, PGY-3 Dizziness, light headed for 4 weeks. Clear diagnoses had been made in 112 of these patients: in 56 identical CSF and serum bands were present, revealing a systemic immune response, while in 46 additional unique CSF bands indicated that intrathecal IgG synthesis was also occurring. Clipboard, Search History, and several other advanced features are temporarily unavailable. Theyll ask you to hold still, and theyll insert a hollow needle into your lower spine. J Neurol Neurosurg Psychiatry. 2022;109:129-163. doi: 10.1016/bs.acc.2022.03.004. Dr. Rose has received intellectual property interests from a discovery or technology relating to health care. These bands in the CSF pattern are produced by a limited number of Oligoclonal bands (OCBs) are a type of protein that occurs in the cerebrospinal fluid (CSF). Increased intrathecal Ig synthesis may occur in other inflammatory CSF diseases and, therefore this assay is not specific for MS. CSF Oligoclonal Bands Interpretation: <2 bands. In addition, the serum bands in systemic inflammation tend to be small and evenly distributed (3). Authors' Disclosures or Potential Conflicts of Interest:No authors declared any potential conflicts of interest. Cerebrospinal Fluid (CSF) Oligoclonal Band Screen - Healthline 2022 Sep;59(6):391-404. doi: 10.1080/10408363.2022.2039591. All rights reserved. This test is usually ordered if your doctor thinks you may have MS. OMG, you are so describing me. Have you found anything out yet? I've been dealing with this now for 2 years with no answers and countless tests. What are IgG bands? CSF actively serves your body with important functions that include: If your physician suspects inflammation in your central nervous system, they will order a CSF oligoclonal banding. Estimation of intrathecal IgG synthesis: simulation of the risk of underestimation. Read any comments already posted on the article prior to submission. The detection of increased intrathecal immunoglobulin synthesis is the basis for current diagnostic laboratory tests for MS. You can learn more about how we ensure our content is accurate and current by reading our. The test alone is not enough to diagnose MS. A doctor must also find: The CSF oligoclonal banding screening involves undergoing a procedure called a lumbar puncture. Approach to the patient with neurologic disease. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Any ideas what's going on? WebOligoclonal bands (OCBs) are bands of immunoglobulins that are seen when a patient's blood serum, or cerebrospinal fluid (CSF) is analyzed. 2019 April 09; 2019:92, The oligoclonal band (OCB) assay requires paired cerebrospinal fluid (CSF) and serum samples. ways to boost your brainpower. The determination of intrathecal IgM, including IgM/lipid-specific IgM OCBs, on the other hand, seems to be of prognostic relevance and is associated with a more aggressive disease course. Detection of oligoclonal bands in patients with neurologic diseases: comparison between agarose gel-, immunofixation- and isoelectric-focusing electrophoresis. WebThe presence of oligoclonal bands (OCBs) of immunoglobulin G (IgG) in CSF provides evidence for the occurrence of a humoral immune response, but it is not always Oligoclonal bands (OCB); multiple sclerosis; neurodegenerative disorders; peripheral neuropathy. 7th ed. 'MacMoody'. Next, theyll apply a local anesthetic. When the oligoclonal band assay detects 2 or more unique IgG bands in the cerebrospinal fluid (CSF), the result is positive. Submit only on articles published within 6 months of issue date. 1975 Aug;52(2):111-20 According to Mayo Medical Laboratories, this screen is positive in 70 to 80 percent of MS patients. The separated immunoglobulins (Ig) are visualized by an IgG immunoblot, and OCBs that are present in the CSF and not in the serum are reported. Lane 1, serum sample; lane 1, corresponding CSF sample. National Library of Medicine CSF oligoclonal banding is a test ordered by physicians when serious health concerns related to your central nervous system arise. They will remove the needle and apply a dressing. The presence of oligoclonal band is If a person receives a diagnosis of MS, they can find resources and support from the following organizations: OCBs appear in the CSF of the vast majority of people living with MS. I also have numbness in my left thumb and left toes (occasionally on the right too) and twitches in my legs. The site is secure. An EEG is a test that measures your brain waves and helps detect abnormal brain activity. Only orderable as part of a profile. The institution of Dr. Clardy has received personal compensation in the range of $0-$499 for serving as a Consultant for GuidePoint. A. Dr. Greenlee has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Wheeler, Trigg, O'Donnell, LLP. Oligoclonal Bands Epub 2022 Mar 11. Am J Clin Pathol. Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics. The diagnostic process will also involve the doctor: If elevated OCB levels are present but a person does not fit the criteria for MS, a doctor will likely continue to search for the underlying cause. Address correspondence to the author at: Division of Clinical Biochemistry, Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada E3B 5N5. 2022 May;52(3):511-525. The detection of increased intrathecal immunoglobulin (Ig) synthesis is the basis for current diagnostic laboratory tests for MS. You must ensure that your Disclosures have been updated within the previous six months. More research is needed to, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. My neurologist says I should start experimenting with some medicines to see if any would help the dizziness. Dr. Greenlee has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Sommers Schwartz. The reason for this is that the presence of OCBs can also indicate other conditions that cause inflammation in the CNS. Background: One means by which a diagnosis of autoimmune central nervous system disease is supported is via identification of unique oligoclonal bands in the cerebrospinal fluid. -, N Engl J Med. The presence of multiple bands indicates that something is wrong. Web page addresses and e-mail addresses turn into links automatically. Oligoclonal immunoglobulin G (IgG) bands (OCBs) are a useful diagnostic tool to detect a central humoral response. Doctors can use this screen to help them diagnose MS. Learn, Late onset multiple sclerosis is the term for multiple sclerosis (MS) that develops later in life, usually after the age of 50. Epub 2022 Apr 22. Learn more about the, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. Oligoclonal bands can be present even when the CSF IgG level is normal. The institution of Dr. Rose has received research support from National Multiple Sclerosis Society. 2004 Aug 31;15(3):86-94. eCollection 2004 Aug. Bonnan M, Gianoli-Guillerme M, Courtade H, Demasles S, Krim E, Marasescu R, Drau H, Debeugny S, Barroso B. Ann Clin Transl Neurol. New to this community of sorts and want to pose a question I know has been asked similarly on some other threads. Increased intrathecal Ig synthesis may occur in other inflammatory CSF diseases, and therefore, this assay is not specific for MS. official website and that any information you provide is encrypted A local anaesthetic is used for the short procedure. In this context, recent research has focused on the automated assessment of CSF kappa free light Ig chains as a more sensitive, non-operator-dependent marker of intrathecal Ig synthesis. Bethesda, MD 20894, Web Policies Oligoclonal bands present in CSF, but not in serum, indicate central nervous system production. Lumbar puncture is widely used and considered safe. (2007). Additional information regarding LOINC codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf. Lin MW, Suan D, Lenton K, Henniker T, Burke T, Vucic S, Fulcher DA. Oligoclonal Bands - Gloucestershire Hospitals NHS Foundation Trust What is the interpretation for this sample? See additional information. A doctor will insert a needle through the skin and into the spine. Yu Chen, Multiple Cerebrospinal Fluid Bands with Accompanying Serum Bands, Clinical Chemistry, Volume 60, Issue 12, 1 December 2014, Pages 15821583, https://doi.org/10.1373/clinchem.2014.224378. Bethesda, MD 20894, Web Policies WebCSF is used in the diagnosis of multiple sclerosis (MS) by identifying increased intrathecal IgG synthesis qualitatively (oligoclonal bands). Please go to our Submission Site to add or update your Disclosure information. Andersson M, Alvarez-Cermeo J, Bernardi G, Cogato I, Fredman P, Frederiksen J et al. 2023 Healthline Media UK Ltd, Brighton, UK. People who receive a diagnosis of MS typically have positive test results, indicating that OCB is present in the CSF. Learn more. Similarly, if a test comes back negative but a person is experiencing symptoms, additional tests may be necessary to confirm what is causing the symptoms. Cerebrospinal fluid in the diagnosis of multiple sclerosis: a consensus report, 2014 The American Association for Clinical Chemistry, This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (, Analytical and Non-Analytical Variation May Lead to Inappropriate Antimicrobial Dosing in Neonates: An In Silico Study, A Case of Yellow Airway Secretions and Oral Fluid, Severe Hypophosphatemia: The Hidden Truth, Commentary on Severe Hypophosphatemia: The Hidden Truth, Genomic Newborn Screening: Baby Steps into the Future, Clinical Chemistry Guide to Scientific Writing, Clinical Chemistry Guide to Manuscript Review, https://doi.org/10.1373/clinchem.2014.224378, https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 American Association of Clinical Chemistry. If the test comes back positive for OCB levels, but a doctor cannot diagnose MS, they will likely order further testing to determine the underlying cause of the elevated OCB levels. These tests are not specific for multiple sclerosis. Thompson AJ, Banwell BL, Barkhof F, et al: Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Carta S, Cobo Calvo , Armangu T, Saiz A, Lechner C, Rostsy K, Breu M, Baumann M, Hftberger R, Ayzenberg I, Schwake C, Sepulveda M, Martnez-Hernndez E, Oliv-Cirera G, Arrambide G, Tintor M, Bernard-Valnet R, Du Pasquier R, Brilot F, Ramanathan S, Schanda K, Gajofatto A, Ferrari S, Sechi E, Flanagan EP, Pittock SJ, Redenbaugh V, Reindl M, Marignier R, Mariotto S. Neurology. Multiple sclerosis and systemic sclerosis are two autoimmune conditions that affect different parts of the body. Your spinal cord and your brain make up your nervous system.. Lumbar puncture (spinal tap), Oligoclonal banding, serum, and spinal fluid. A test that reveals elevated levels of OCBs could indicate MS. The site is secure. Management of For more information see: -OLIG / Oligoclonal Banding, Serum and Spinal Fluid, -MSP3 / Multiple Sclerosis (MS) Profile, Serum and Spinal Fluid, Isoelectric Focusing (IEF) with IgG Immunoblot Detection. When the oligoclonal band assay detects 2 or more unique IgG bands in the cerebrospinal fluid (CSF), the result is positive. 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Oligoclonal Banding, Serum and Spinal Fluid - Neurology Catalog FOIA Only patients with matched or matched plus unique oligoclonal band results were analyzed. Gurtner KM, Shosha E, Bryant SC, et al: CSF free light chain identification of demyelinating disease: comparison with oligoclonal banding and other CSF indexes. I am 44 and female. Typically, Botox is used to reduce the appearance of facial wrinkles. CSF is used in the diagnosis of multiple sclerosis (MS) by identifying increased intrathecal IgG synthesis qualitatively (oligoclonal bands). 2022 Oct 23;12(11):2571. doi: 10.3390/diagnostics12112571. Before Cerebrospinal fluid (CSF) is the liquid that protects and cushions your brain and spinal cord. Prmmer JK, Stein VM, Marti E, Lutterotti A, Jelcic I, Schpbach-Regula G, Buch T, Maiolini A. PLoS One. The institution of Dr. Clardy has received research support from Alexion Pharma. Detection of Oligoclonal Ig Bands: Clinical Significance and Trends in Methodological Improvement. Clin Chem Lab Med. For assistance, contact. The Best IOL for 2022 RXSight Light Adjusted Lens, Will refractive surgery such as LASIK keep me out of glasses all my life, Acute Migraines Relieved By Beta Blocker Eye Drops, Alzheimer's Disease: Current Concepts & Future Directions, Causes of Headaches and Treatment for Headache Pain, New Gene Discoveries Shed Light on Alzheimer's. 1994;57:897-902, 2. government site. cerebrospinal fluid immunoglobulins in neurological Oligoclonal bands: An immunological and clinical approach. Multiple System Atrophy (MSA) is a neurodegenerative disease with heterogeneous manifestations and is therefore difficult to diagnose definitively. Learn how this disease affects the nervous system. Conclusions: The presence of matched CSF and serum bands identifies a distinct population of patients as compared to patients with matched plus unique oligoclonal bands, and thus can assist clinicians in diagnostic evaluation, especially that of an autoimmune disorder. 1994 Aug;57(8):897-902, 2. WebOligoclonal Banding, Serum Useful For Diagnosis of multiple sclerosis; especially useful in patients with equivocal clinical presentation and radiological findings Determining number of serum oligoclonal bands in order to calculate the number of cerebrospinal fluid-specific bands present Method Name Only orderable as part of a profile. WebEvidence of an intrathecal immunoglobulin synthesis, as demonstrated by Reiber’s diagram or the more sensitive oligoclonal bands (OCB), are typical for neuroinflammatory diseases, and normally not expected in non-inflammatory neurological diseases. In the first group neoplasia and peripheral neuropathies accounted for over 50% of the diagnoses, infections and systemic inflammatory disorders for 32%, and multiple sclerosis was diagnosed in only one case. Clin Chem Lab Med. Heres what you need to know about it. Epub 2022 Dec 16. Clin Chem Lab Med. Lines and paragraphs break automatically. The results of an EEG can be used to rule out or confirm. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 1. Tiu VE, Popescu BO, Enache II, Tiu C, Terecoasa E, Panea CA. eCollection 2023. eCollection 2020 Jan-Mar. Multiple sclerosis is a disease that can cause permanent damage to your bodys nerves and the communication mechanisms between your brain and body. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements. If similar bands arent present in your blood, you may have multiple sclerosis (MS). PLoS One. CSF Oligoclonal Bands higgs-boson@gmail.com. Other reasons your physician may request a CSF oligoclonal banding test are to identify if other serious illnesses are present, such as: A spinal tap can pose a couple of moderate to low risks. Oligoclonal bands: clinical utility and interpretation cues. A doctor may use a CSF oligoclonal banding test to help confirm MS, but they will also need to consider other diagnostic criteria. -. 13 The presence of two or more OCB in the CSF without an identical match in the serum is considered pathological. Some people have a headache after a lumbar puncture. More guidelines and information on Disputes & Debates, Involvement of Type I Interferon Signaling in Muscle Stem Cell Proliferation During Dermatomyositis, Neurology | Print ISSN:0028-3878 SI Abnormal Reports. CreutzfeldtJakob disease immunoassay panel with CSF 14-3-3, tau, and S100B proteins was negative. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Diagnosis of multiple sclerosis; especially useful in patients with, Clients without access to Test Prices can contact, Prospective clients should contact their Regional Manager. This pattern, multiple CSF bands with some accompanying serum bands, should be differentiated from the pattern of multiple similar CSF and serum bands present in systemic inflammation (1) and from monoclonal gammopathy, where 1 or 2 identical bands are found in CSF and serum (2). WebCSF Olig Bands Interpretation: <4 bands. 8600 Rockville Pike Theyll ask you to turn on your side and expose your back. The institution of Dr. Paz Soldan has received research support from Western Institute for Biomedical Research. I've been dealing with this now for 2 years with no answers and countless tests. 2003 Nov:120(5):672-675, 3. CSF is the clear fluid that is present around the spinal cord and the brain. Isoelectric focusing with IgG immunoblotting compared with high-resolution agarose gel electrophoresis and cerebrospinal fluid IgG index. Those with matched oligoclonal bands only were more likely to be older (p<0.001) and to have systemic autoimmune disease (p 0.004). This article discusses the link between OCBs and MS and what the testing involves. CSF oligoclonal banding: MedlinePlus Medical Encyclopedia In addition, serum oligoclonal bands are present in some patients with Hodgkin's disease and in up to 5% of normal individuals. Bookshelf The presence of no oligoclonal bands or one band is normal. However, technical issues including blot, staining, and IEF reproducibility as well as operator-dependent pattern interpretations decrease reproducibility, causing misinterpretations of results, with significant diagnostic implications. and transmitted securely. The results can help diagnose conditions of the central nervous. We avoid using tertiary references. 'Orthopedic Surgeon'. The anesthetic will reduce or eliminate the pain of needle insertion. MNT is the registered trade mark of Healthline Media. The presence of oligoclonal bands in CSF from patients with multiple sclerosis does not correlate with the activity of the demyelinating process. The presence of oligoclonal bands in CSF, but not serum, is indicative of local Oligoclonal Bands sharing sensitive information, make sure youre on a federal What Is a Somatosensory Evoked Potential (SEP) Test? Elsevier; 2015:chap 18). (n.d.) Retrieved from. More than 90% of patients with multiple sclerosis show oligoclonal banding at some time during the course of their disease. Most of the clinical interest in CSF electrophoresis is focused on the region. We avoid using tertiary references. PMC Ann Clin Biochem. These findings, however, are not specific for MS as CSF-specific IgG synthesis may also be found in patients with other neurologic diseases including infectious, inflammatory, cerebrovascular, and paraneoplastic disorders. You may need to arrange to take the day of your test off. Ann Clin Biochem 1990;27:436-443; Hortin GL: Amino Acids, Peptides, and Proteins. The diagnosis of multiple sclerosis (MS) is dependent on clinical, radiological, and laboratory findings. They will insert the thin needle between the two bones in the lower back and extract the sample. The institution of Dr. Clardy has received research support from Western Institute for Veteran Research. 2023 Laboratory Corporation of America Holdings. Some of the risks for spinal taps include: To minimize the risk of negative reactions, be sure to follow your doctors advice on fluids and foods, and inform them of any allergies to medications., In order to perform the CSF Oligoclonal Banding test, a sample of your cerebrospinal fluid is retrieved. The institution of an immediate family member of Dr. Liu has received research support from NIH. Patients with matched plus unique oligoclonal bands were more likely to have an abnormal MRI spine (p<0.001) and CSF pleocytosis (p<0.001). Dr. Clardy has received personal compensation for serving as an employee of Veterans Health Administration (VHA). They can also use it to diagnose other inflammatory conditions and neurological diseases. 1998 Jul;61(7):375-81. It causes periods of worsening symptoms and periods of remission. Multiple sclerosis (MS) is a progressive condition that affects the central nervous system and the brain. The institution of Dr. Clardy has received personal compensation in the range of $0-$499 for serving as a Consultant for VielaBio. Diagnostics (Basel). Testing schedules may vary. Cerebrospinal fluid (CSF) and serum, collected at the same time, 0.5 mL cerebrospinal fluid (CSF) and 0.5 mL serum, Red-top tube or gel-barrier tube and plastic (CSF) tube, Plasma instead of serum specimen (since fibrinogen band may obscure the electrophoretic zone); serum and CSF not collected within eight hours of each other, Diagnose diseases of the central nervous system including meningitis, tumor, syphilis, and multiple sclerosis, Isoelectric focusing (IEF) and immunoblotting on agarose gel.