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Test ID: PNEFS Neuroimmunology Antibody Follow-up, Serum

Reporting Name

Neuroimmunology Ab Follow-up, S

Useful For

Monitoring patients who have previously tested positive for one or more antibodies within the past 5 years in a Mayo Neuroimmunology Laboratory serum evaluation

Clinical Information

Paraneoplastic autoimmune neurological disorders reflect a patient's humoral and cellular immune responses to cancer. The cancer may be new or recurrent, is usually limited in metastatic volume, and is often occult by standard imaging procedures. Autoantibodies specific for onconeural proteins found in the plasma membrane, cytoplasm, and nucleus of neurons or muscle are generated in this immune response and serve as serological markers of paraneoplastic autoimmunity. The most commonly recognized cancers in this context are small-cell lung carcinoma (SCLC), thymoma, ovarian (or related mullerian) carcinoma, breast carcinoma, and Hodgkin lymphoma. Pertinent childhood neoplasms recognized thus far include neuroblastoma, thymoma, Hodgkin lymphoma, and chondroblastoma. An individual patient's autoantibody profile can predict a specific neoplasm with 90% certainty, but not the neurological syndrome.

 

Four classes of autoantibodies are recognized in serum analysis:

-Neuronal nuclear (antineuronal nuclear antibody-type 1 [ANNA-1], ANNA-2, ANNA-3)

-Neuronal and muscle cytoplasmic (Purkinje cell cytoplasmic antibody, type 1 [PCA-1], PCA-2, PCA-Tr, collapsin response-mediator protein-5 [CRMP-5], amphiphysin, and striational)

-Glial nuclear (antiglial nuclear antibody)

-Plasma membrane cation channel antibodies (neuronal P/Q-type  and muscle acetylcholine receptor autoantibodies). These autoantibodies are potential effectors of neurological dysfunction.

 

Patients who are seropositive usually present with subacute neurological symptoms and signs. The patient may present with encephalopathy, cerebellar ataxia, myelopathy, radiculopathy, plexopathy, sensory, sensorimotor, or autonomic neuropathy, with or without coexisting evidence of a neuromuscular transmission disorder: Lambert-Eaton syndrome (LES), myasthenia gravis, or neuromuscular hyperexcitability. Initial signs may be subtle, but a subacute multifocal and progressive syndrome usually evolves. Sensorimotor neuropathy and cerebellar ataxia are common presentations, but the clinical picture in some patients is dominated by striking gastrointestinal dysmotility, limbic encephalopathy, basal ganglionitis, or cranial neuropathy (especially loss of vision, hearing, smell, or taste). Cancer risk factors include past or family history of cancer, history of smoking or social/environmental exposure to carcinogens. Early diagnosis and treatment of the neoplasm favor less neurological morbidity and offer the best hope for survival.

Interpretation

Antibodies directed at onconeural proteins shared by neurons, muscle, and certain cancers are valuable serological markers of a patient's immune response to cancer. They are not found in healthy subjects and are usually accompanied by subacute neurological symptoms and signs. Several autoantibodies have a syndromic association, but no known autoantibody predicts a specific neurological syndrome. Conversely, a positive autoantibody profile has 80% to 90% predictive value for a specific cancer. It is not uncommon for more than one paraneoplastic autoantibody to be detected, each predictive of the same cancer.

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
GANG AChR Ganglionic Neuronal Ab, S No No
ACMFS AChR Modulating Flow Cytometry, S No No
AGNBS AGNA-1 Immunoblot, S No No
AINCS Alpha Internexin CBA, S No No
AMPCS AMPA-R Ab CBA, S No No
AMIBS Amphiphysin Immunoblot, S No No
AN1BS ANNA-1 Immunoblot, S No No
AN2BS ANNA-2 Immunoblot, S No No
AGN1S Anti-Glial Nuclear Ab, Type 1 No No
ANN1S Anti-Neuronal Nuclear Ab, Type 1 No No
ANN2S Anti-Neuronal Nuclear Ab, Type 2 No No
ANN3S Anti-Neuronal Nuclear Ab, Type 3 No No
CS2CS CASPR2-IgG CBA, S No No
CRMS CRMP-5-IgG, S No No
DPPCS DPPX Ab CBA, S No No
DPPTS DPPX Ab IFA Titer, S No No
DPPIS DPPX Ab IFA, S No No
GABCS GABA-B-R Ab CBA, S No No
GABIS GABA-B-R Ab IF Titer Assay, S No No
GFACS GFAP CBA, S No No
GFATS GFAP IFA Titer, S No No
GFAIS GFAP IFA, S No No
GRFCS GRAF1 CBA, S No No
GRFTS GRAF1 IFA Titer, S No No
GRFIS GRAF1 IFA, S No No
IGATS IgG Asialo GM1 Titer, S No No
IGG_A IgG Asialo. GM1 No No
IGDTS IgG Disialo GD1b Titer, S No No
IGG_D IgG Disialo. GD1b No No
IGMTS IgG Monos GM1 Titer, S No No
IG5CS IgLON5 CBA, S No No
IG5TS IgLON5 IFA Titer, S No No
IG5IS IgLON5 IFA, S No No
IMATS IgM Asialo GM1 Titer, S No No
IGM_A IgM Asialo. GM1 No No
IMDTS IgM Disialo GD1b Titer, S No No
IGM_D IgM Disialo. GD1b No No
IMMTS IgM Monos GM1 Titer, S No No
IGM_M IgM Monos. GM1 No No
ITPCS ITPR1 CBA, S No No
ITPTS ITPR1 IFA Titer, S No No
ITPIS ITPR1 IFA, S No No
LG1CS LGI1-IgG CBA, S No No
GL1CS mGluR1 Ab CBA, S No No
GL1TS mGluR1 Ab IFA Titer, S No No
GL1IS mGluR1 Ab IFA, S No No
VGKC Neuronal (V-G) K+ Channel Ab, S No No
NFHCS NIF Heavy Chain CBA, S No No
NIFTS NIF IFA Titer, S No No
NIFIS NIF IFA, S No No
NFLCS NIF Light Chain CBA, S No No
NMDCS NMDA-R Ab CBA, S No No
NMDIS NMDA-R Ab IF Titer Assay, S No No
CCPQ P/Q-Type Calcium Channel Ab No No
PC1BS PCA-1 Immunoblot, S No No
PCTBS PCA-Tr Immunoblot, S No No
PCABP Purkinje Cell Cytoplasmic Ab Type 1 No No
PCAB2 Purkinje Cell Cytoplasmic Ab Type 2 No No
PCATR Purkinje Cell Cytoplasmic Ab Type Tr No No
SRPIS SRP IFA Screen, S No No
SRPTS SRP IFA Titer, S No No
SRPBS SRP Immunoblot, S No No

Report Available

Varies

Day(s) Performed

GANG, VGKC, CCN, CCPQ:

Monday through Friday; 6 a.m., 8 a.m., 6 p.m.

Saturday, Sunday; 7 a.m.

 

ACMFS:

Monday, Wednesday, Saturday; 3 p.m.

 

AGNBS, AMIBS, AN1BS, AN2BS, PC1BS, PCTBS, SRPBS:

Monday through Friday; 6 p.m.

 

AINCS, NFHCS, NFLCS:

Tuesday, Thursday; 6 p.m.

 

AMPCS, CS2CS, DPPCS, GABCS, LG1CS, NMDCS:

Monday through Friday; 10 p.m.

Sunday; 3 p.m.

 

AMPIS, AMPHS, AGN1S, ANN1S, ANN2S, ANN3S, CRMS, DPPTS, DPPIS, GABIS, GFATS, GFAIS, GRFTS, GRFIS, IG5TS, IG5IS, ITPTS, ITPIS, GL1TS, GL1IS, NIFTS, NIFIS, NMDIS, PCABP, PCAB2, PCATR, SRPIS, SRPTS:

Monday through Friday; 5 a.m., 7 a.m., 5 p.m.

Saturday, Sunday; 6 a.m.

 

GFACS:

Monday, Wednesday, Friday; 6 p.m.

 

GRFCS, IG5CS, ITPCS, GL1CS:

Monday, Thursday; 6 p.m.

 

IGATS, IGG_A, IGDTS, IGG_D, IGMTS, IMA

Clinical Reference

Lancaster E, Martinez-Hernandez E, Dalmau J: Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology. 2011 Jul 12;77(2):179-189

Method Name

AMPIS, AMPHS, AGN1S, ANN1S, ANN2S, ANN3S, CRMS, DPPTS, DPPIS, GABIS, GFATS, GFAIS, GRFTS, GRFIS, IG5TS, IG5IS, ITPTS, ITPIS, GL1TS, GL1IS, NIFTS, NIFIS, NMDIS, PCABP, PCAB2, PCATR, SRPIS, SRPTS: Indirect Immunofluorescence Assay (IFA)

AINCS, AMPCS, CS2CS, DPPCS, GABCS, GFACS, GRFCS, IG5CS, ITPCS, LG1CS, GL1CS, NFHCS, NFLCS, NMDCS: Cell Binding Assay (CBA)

CCPQ, GANG, VGKC: Radioimmunoassay (RIA)

ACMFS: Flow Cytometry (FACS)

IGATS, IGG_A, IGDTS, IGG_D, IGMTS, IMATS, IGM_A, IMDTS, IGM_D, IMMTS, IGM_M: Enzyme-linked Immunosorbent Assay (EIA)

AGNBS, AMIBS, AN1BS, AN2BS, PC1BS, PCTBS, SRPBS: Immunoblot (IB)

Specimen Type

Serum


Ordering Guidance


This test is only appropriate for follow-up in patients who have previously tested positive in a serum test. If patients have not previously been positive in a serum test, order 1 of the following:

-PAVAL / Paraneoplastic, Autoantibody Evaluation, Serum

-GID2 / Autoimmune Gastrointestinal Dysmotility Evaluation, Serum

-DYS2 / Autoimmune Dysautonomia Evaluation, Serum

-DMS2 / Dementia, Autoimmune Evaluation, Serum

-ENS2 / Encephalopathy, Autoimmune Evaluation, Serum

-EPS2 / Epilepsy, Autoimmune Evaluation, Serum

-MDS2 / Movement Disorder, Autoimmune Evaluation, Serum

-MGLE / Myasthenia Gravis/Lambert-Eaton Myasthenic Syndrome Evaluation, Serum

-MGMR / Myasthenia Gravis Evaluation with Muscle-Specific Kinase (MuSK) Reflex, Serum



Specimen Required


Collection Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Submission Container/Tube: 13- x 75-mm plastic screw-top vial.

Specimen Volume: 4 mL

Collection Instructions: Centrifuge within 2 hours. Aliquot and ship in 13- x 75-mm plastic screw-top vial.


Specimen Minimum Volume

2 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  72 hours

Reference Values

Test ID

Reporting Name

Methodology

Reference Value

GANG

AChR Ganglionic Neuronal Ab, S

Radioimmunoassay (RIA)

≤0.02 nmol/L

ACMFS

AChR Modulating Flow Cytometry, S

Flow Cytometry (FACS)

Negative

AGNBS

AGNA-1 Immunoblot, S

Immunoblot (IB)

Negative

AINCS

Alpha Internexin CBA, S

Cell Binding Assay (CBA)

Negative

AMPCS

AMPA-R Ab CBA, S

CBA

Negative

AMPIS

AMPA-R Ab IF Titer Assay, S

Indirect Immunofluorescence Assay (IFA)

<1:120

AMPHS

Amphiphysin Ab, S

IFA

<1:240

AMIBS

Amphiphysin Immunoblot, S

IB

Negative

AN1BS

ANNA-1 Immunoblot, S

IB

Negative

AN2BS

ANNA-2 Immunoblot, S

IB

Negative

AGN1S

Anti-Glial Nuclear Ab, Type 1

IFA

<1:240

ANN1S

Anti-Neuronal Nuclear Ab, Type 1

IFA

<1:240

ANN2S

Anti-Neuronal Nuclear Ab, Type 2

IFA

<1:240

ANN3S

Anti-Neuronal Nuclear Ab, Type 3

IFA

<1:240

CS2CS

CASPR2-IgG CBA, S

CBA

Negative

CRMS

CRMP-5-IgG, S

IFA

<1:240

DPPCS

DPPX Ab CBA, S

CBA

Negative

DPPTS

DPPX Ab IFA Titer, S

IFA

<1:240

DPPIS

DPPX Ab IFA, S

IFA

<1:240

GABCS

GABA-B-R Ab CBA, S

CBA

Negative

GABIS

GABA-B-R Ab IF Titer Assay, S

IFA

<1:240

GFACS

GFAP CBA, S

CBA

Negative

GFATS

GFAP IFA Titer, S

IFA

<1:240

GFAIS

GFAP IFA, S

IFA

<1:240

GRFCS

GRAF1 CBA, S

CBA

Negative

GRFTS

GRAF1 IFA Titer, S

IFA

<1:240

GRFIS

GRAF1 IFA, S

IFA

<1:240

IGATS

IgG Asialo GM1 Titer, S

EIA

<1:16000

IGG_A

IgG Asialo. GM1

EIA

Negative

IGDTS

IgG Disialo GD1b Titer, S

EIA

<1:2000

IGG_D

IgG Disialo. GD1b

EIA

Negative

IGMTS

IgG Monos GM1 Titer, S

EIA

<1:2000

IG5CS

IgLON5 CBA, S

CBA

Negative

IG5TS

IgLON5 IFA Titer, S

IFA

<1:240

IG5IS

IgLON5 IFA, S

IFA

<1:240

IMATS

IgM Asialo GM1 Titer, S

EIA

<1:8000

IGM_A

IgM Asialo. GM1

EIA

Negative

IMDTS

IgM Disialo GD1b Titer, S

EIA

<1:2000

IGM_D

IgM Disialo. GD1b

EIA

Negative

IMMTS

IgM Monos GM1 Titer, S

EIA

<1:4000

IGM_M

IgM Monos. GM1

EIA

Negative

ITPCS

ITPR1 CBA, S

CBA

Negative

ITPTS

ITPR1 IFA Titer, S

IFA

<1:240

ITPIS

ITPR1 IFA, S

IFA

<1:240

LG1CS

LGI1-IgG CBA, S

CBA

Negative

GL1CS

mGluR1 Ab CBA, S

CBA

Negative

GL1TS

mGluR1 Ab IFA Titer, S

IFA

<1:240

GL1IS

mGluR1 Ab IFA, S

IFA

<1:240

VGKC

Neuronal (V-G) K+ Channel Ab, S

RIA

≤0.02 nmol/L

NFHCS

NIF Heavy Chain CBA, S

CBA

Negative

NIFTS

NIF IFA Titer, S

IFA

<1:240

NIFIS

NIF IFA, S

IFA

<1:240

NFLCS

NIF Light Chain CBA, S

CBA

Negative

NMDCS

NMDA-R Ab CBA, S

CBA

Negative

NMDIS

NMDA-R Ab IF Titer Assay, S

IFA

<1:240

CCN

N-Type Calcium Channel Ab

RIA

≤0.03 nmol/L

CCPQ

P/Q-Type Calcium Channel Ab

RIA

≤0.02 nmol/L

PC1BS

PCA-1 Immunoblot, S

IB

Negative

PCTBS

PCA-Tr Immunoblot, S

IB

Negative

PCABP

Purkinje Cell Cytoplasmic Ab Type 1

IFA

<1:240

PCAB2

Purkinje Cell Cytoplasmic Ab Type 2

IFA

<1:240

PCATR

Purkinje Cell Cytoplasmic Ab Type Tr

IFA

<1:240

SRPIS

SRP IFA Screen, S

IFA

<1:240

SRPTS

SRP IFA Titer, S

IFA

<1:240

SRPBS

SRP Immunoblot, S

IB

 Negative

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

83519-GANG (if appropriate)

86255-ACMFS (if appropriate)

84182-AGNBS (if appropriate)

86255-AINCS (if appropriate)

86255-AMPCS (if appropriate)

86256-AMPIS (if appropriate)

86255-AMPHS (if appropriate)

84182-AMIBS (if appropriate)

84182-AN1BS (if appropriate)

84182-AN2BS (if appropriate)

86255-AGN1S (if appropriate)

86255-ANN1S (if appropriate)

86255-ANN2S (if appropriate)

86255-ANN3S (if appropriate)

86255-CS2CS (if appropriate)

86255-CRMS (if appropriate)

86255-DPPCS (if appropriate)

86256-DPPTS (if appropriate)

86255-DPPIS (if appropriate)

86255-GABCS (if appropriate)

86256-GABIS (if appropriate)

86255-GFACS (if appropriate)

86256-GFATS (if appropriate)

86255-GFAIS (if appropriate)

86255-GRFCS (if appropriate)

86256-GRFTS (if appropriate)

86255-GRFIS (if appropriate)

83520-IGATS (if appropriate)

83516-IGG_A (if appropriate)

83520-IGDTS (if appropriate)

83516-IGG_D (if appropriate)

83520-IGMTS (if appropriate)

86255-IG5CS (if appropriate)

86256-IG5TS (if appropriate)

86255-IG5IS (if appropriate)

83520-IMATS (if appropriate)

83516-IGM_A (if appropriate)

83520-IMDTS (if appropriate)

83516-IGM_D (if appropriate)

83520-IMMTS (if appropriate)

83516-IGM_M (if appropriate)

86255-ITPCS (if appropriate)

86256-ITPTS (if appropriate)

86255-ITPIS (if appropriate)

86255-LG1CS (if appropriate)

86255-GL1CS (if appropriate)

86256-GL1TS (if appropriate)

86255-GL1IS (if appropriate)

83519-VGKC (if appropriate)

86255-NFHCS (if appropriate)

86256-NIFTS (if appropriate)

86255-NIFIS (if appropriate)

86255-NFLCS (if appropriate)

86255-NMDCS (if appropriate)

86256-NMDIS (if appropriate)

83519-CCN (if appropriate)

83519-CCPQ (if appropriate)

84182-PC1BS (if appropriate)

84182-PCTBS (if appropriate)

86255-PCABP (if appropriate)

86255-PCAB2 (if appropriate)

86255-PCATR (if appropriate)

86255-SRPIS (if appropriate)

86256-SRPTS (if appropriate)

84182-SRPBS (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
PNEFS Neuroimmunology Ab Follow-up, S 80615-8

 

Result ID Test Result Name Result LOINC Value
84300 Neuroimmunology Ab Follow-up, S 80615-8

Forms

If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.

Mayo Clinic Laboratories | Endocrinology Catalog Additional Information:

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