Test Catalog

Test ID: DYS1    
Autoimmune Dysautonomia Evaluation, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Investigating idiopathic dysautonomic symptoms


Directing a focused search for cancer in patients with idiopathic dysautonomia


Investigating autonomic symptoms that appear in the course or wake of cancer therapy and are not explainable by recurrent cancer or metastasis (detection of autoantibodies in this profile helps differentiate autoimmune dysautonomia from the effects of chemotherapy)

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If indirect immunofluorescence assay (IFA) (ANN1S) patterns are indeterminate, then paraneoplastic autoantibody Western blot is performed at an additional charge.


If IFA patterns suggest CRMP-5-IgG, then CRMS and/or CRMP-5-IgG Western blot is performed at an additional charge.


If IFA patterns suggest amphiphysin antibody, then AMPHS and/or amphiphysin Western blot is performed at an additional charge.


If IFA pattern suggests antineuronal nuclear antibody type 2 or type 3, Purkinje cell cytoplasmic antibody type 1, type 2, or type trace, and/or anti-glial nuclear antibody type 1, then ANN2S, ANN3S, PCABP, PCAB2, PCATR, and/or AGN1S is performed at an additional charge.


If IFA pattern suggests NMO/AQP4-IgG, then NMO/AQP4-IgG FACS is performed at an additional charge.


If NMO/AQP4-IgG FACS screen requires further evaluation, then NMO/AQP4-IgG FACS titration is performed at an additional charge.


If IFA pattern suggests NMDA-R, then NMDA-R CBA and/or NMDA-R titer is performed at an additional charge.


If IFA pattern suggests AMPA-R, then AMPA-R CBA and/or AMPA-R titer is performed at an additional charge.


If IFA pattern suggests GABA-B-R, then GABA-B-R CBA and/or GABA-B-R titer is performed at an additional charge.


If acetylcholine (Ach) receptor binding antibody is >0.02, then ACh receptor modulating antibodies and CRMP-5-IgG Western blot are performed at an additional charge.


If VGKC >0.00, LGI1-IgG CBA, S and CASPR2-IgG CBA, S are performed at an additional charge.


See Autoimmune Dysautonomia Evaluation Testing Algorithm in Special Instructions

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Autoimmune dysautonomia encompasses disorders of peripheral autonomic synapses, ganglionic neurons, autonomic nerve fibers, and central autonomic pathways mediated by neural-specific IgG or effector T cells. These disorders may be idiopathic or paraneoplastic, subacute or insidious in onset, and may present as a limited disorder or generalized pandysautonomia. Pandysautonomia is usually subacute in onset and severe, and includes impaired pupillary light reflex, anhidrosis, orthostatic hypotension, cardiac arrhythmias, gastrointestinal dysmotility, sicca manifestations, and bladder dysfunction. Limited dysautonomia is confined to 1 or just a few domains, is often mild and may include sicca manifestations, postural orthostatism and cardiac arrhythmias, bladder dysfunction, or gastrointestinal dysmotilities. Diagnosis of limited dysautonomia requires documentation of objective abnormalities by autonomic reflex testing, thermoregulatory sweat test, or gastrointestinal motility studies.


The most commonly encountered autoantibody marker of autoimmune dysautonomia is the neuronal ganglionic alpha-3-(acetylcholine receptor: AChR) autoantibody. This autoantibody to date is the only proven effector of autoimmune dysautonomia. A direct relationship has been demonstrated between antibody titer and severity of dysautonomia in both alpha-3-AChR-immunized animals and patients with autoimmune dysautonomia. Patients with high alpha-3-AChR autoantibody values (>1.0 nmol/L) generally have profound pandysautonomia. Dysautonomic patients with lower alpha-3-AChR autoantibody values (0.03-0.99 nmol/L) have limited dysautonomia.


Importantly, cancer is detected in 30% of patients with alpha-3-AChR autoantibody. Cancers recognized most commonly include small-cell lung carcinomas, thymoma, adenocarcinomas of breast, lung, prostate, and gastrointestinal tract, and lymphoma. Cancer risk factors include a past or family history of cancer, history of smoking, or social or environmental exposure to carcinogens. Early diagnosis and treatment of the neoplasm favors neurologic improvement and lessens morbidity.


Autoantibodies to other onconeural proteins shared by neurons, glia or muscle (eg, antineuronal nuclear antibody-type 1: ANNA-1, CRMP-5-IgG, N-type voltage-gated calcium channel, muscle AChR, and sarcomeric [striational antigens]) serve as additional markers of paraneoplastic or idiopathic dysautonomia. A specific neoplasm is often predictable by the individual patient's autoantibody profile.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.


N-Type Calcium Channel Antibody

< or =0.03 nmol/L

P/Q-Type Calcium Channel Antibody

< or =0.02 nmol/L

AChR Ganglionic Neuronal Antibody

< or =0.02 nmol/L

Neuronal VGKC Autoantibody

< or =0.02 nmol/L

Glutamic Acid Decarboxylase (GAD65) Antibody                            

< or =0.02 nmol/L



Antineuronal Nuclear Antibody-Type 1 (ANNA-1)


Antineuronal Nuclear Antibody-Type 2 (ANNA-2)


Antineuronal Nuclear Antibody-Type 3 (ANNA-3)


Anti-Glial/Neuronal Nuclear Antibody-Type 1 (AGNA-1)




Purkinje Cell Cytoplasmic Antibody, Type 1 (PCA-1)


Purkinje Cell Cytoplasmic Antibody, Type 2 (PCA-2)


Purkinje Cell Cytoplasmic Antibody, Type Tr (PCA-Tr)


Amphiphysin Antibody




Note: Titers lower than 1:240 are detectable by recombinant CRMP-5 Western blot analysis. CRMP-5 Western blot analysis will be done on request on stored serum (held 4 weeks). This supplemental testing is recommended in cases of chorea, vision loss, cranial neuropathy, and myelopathy. Call the Neuroimmunology Laboratory at 800-533-1710 or 507-266-5700 to request CRMP-5 Western blot.


Striational (Striated Muscle) Antibodies




ACh Receptor (Muscle) Binding Antibody

< or =0.02 nmol/L

AChR Receptor (Muscle) Modulating Antibody

0-20% loss of AChR


Neuromyelitis Optica (NMO)/Aquaporin-4-IgG FACS Assay



Paraneoplastic Western Blot


CRMP-5-IgG Western Blot       


Amphiphysin Western Blot



N-Methyl-D-aspartate receptor (NMDA-R)

CBA: Negative

IFA: <1:120

2-amino-3-(5-methyl-3-oxo-1,2- oxazol-4-yl) propanoic acid receptor (AMPA-R)

CBA: Negative

IFA: <1:120                    

Gamma-Amino Butyric acid-type B receptor (GABA-B-R)

CBA: Negative

IFA <1:120

Leucine-Rich Glioma Inactivated Protein-1 IgG (LGI1)


Contactin-Associated Protein-Like-2 IgG (CASPR2)


Interpretation Provides information to assist in interpretation of the test results

Antibodies directed at onconeural proteins shared by neurons, muscle, and glia are valuable serological markers of a patient's immune response to cancer. These autoantibodies are not found in healthy subjects, and are usually accompanied by subacute neurological symptoms and signs. It is not uncommon for more than 1 autoantibody to be detected in patients with autoimmune dysautonomia. These include:

-Plasma membrane cation channel antibodies (neuronal ganglionic [alpha-3] and muscle [alpha-1] acetylcholine receptor; neuronal calcium channel N-type or P/Q-type, and neuronal voltage-gated potassium channel antibodies). All of these autoantibodies are potential effectors of autonomic dysfunction.

-Antineuronal nuclear autoantibody-type 1

-Neuronal and muscle cytoplasmic antibodies (CRMP-5 IgG, glutamic acid decarboxylase and striational)


A rising autoantibody titer in previously seropositive patients suggests cancer recurrence.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Negative results do not exclude autoimmune dysautonomia or cancer.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Vernino S, Low PA, Fealey RD, et al: Autoantibodies to ganglionic acetylcholine receptors in autoimmune autonomic neuropathies. N Engl J Med 2000;343:847-855

2. O'Suilleabhain P, Low PA, Lennon VA: Autonomic dysfunction in the Lambert-Eaton myasthenic syndrome: serologic and clinical correlates. Neurology 1998;50:88-93

3. Dhamija R, Tan KM, Pittock SJ, et al: Serological profiles aiding the diagnosis of autoimmune gastrointestinal dysmotility. Clin Gastroenterol Hepatol 2008;6:988-992

4. McKeon A, Lennon VA, Lachance DH, et al: The ganglionic acetylcholine receptor autoantibody: oncological, neurological and serological accompaniments. Arch Neurol 66(6):735-741

Special Instructions Library of PDFs including pertinent information and forms related to the test