TEST CATALOG ORDERING & RESULTS SPECIMEN HANDLING CUSTOMER SERVICE EDUCATION & INSIGHTS
Test Catalog

Test ID: MAC1    
Autoimmune Myelopathy Evaluation, Spinal Fluid

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

Evaluating patients with suspected autoimmune myelopathy, myelitis, paraneoplastic myelopathy using spinal fluid specimens

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

If indirect immunofluorescence assay (IFA) patterns suggest AGNA-1 antibody, then AGNA-1 immunoblot is performed at an additional charge.

 

If IFA patterns suggest amphiphysin antibody, then amphiphysin immunoblot is performed at an additional charge.

 

If IFA patterns suggest ANNA-1 antibody, then ANNA-1 immunoblot is performed at an additional charge.

 

If IFA patterns suggest ANNA-2 antibody, then ANNA-2 immunoblot is performed at an additional charge.

 

If IFA patterns suggest PCA-1 antibody, then PCA-1 immunoblot is performed at an additional charge.

 

If IFA patterns suggest PCA-Tr antibody, then PCA-Tr immunoblot is performed at an additional charge.

 

If IFA pattern suggest NMDA-receptor antibody, then NMDA- receptor antibody cell-binding assay (CBA) and NMDA- receptor titer are performed at an additional charge.

 

If IFA pattern suggest AMPA- receptor antibody, then AMPA- receptor antibody CBA and AMPA- receptor titer are performed at an additional charge.

 

If IFA pattern suggest GABA-B- receptor antibody, then GABA-B- receptor antibody CBA and GABA-B- receptor titer are performed at an additional charge.

 

If IFA pattern suggest DPPX antibody, then DPPX antibody CBA and DPPX IFA titer are performed at an additional charge.

 

If IFA pattern suggest mGluR1 antibody, then mGluR1antibody CBA and mGluR1 IFA titer are performed at an additional charge.

 

If IFA pattern suggest GFAP antibody, then GFAP antibody CBA and GFAP IFA titer are performed at an additional charge.

 

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

 

If IFA pattern suggests NIF antibody, then alpha internexin CBA, NIF heavy chain CBA, NIF light chain CBA, and NIF titer are performed at an additional charge.

 

See Autoimmune Myelopathy Evaluation Algorithm-Spinal Fluid in Special Instructions.

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

Patients with autoimmune myelopathy present with subacute onset and rapid progression of spinal cord symptoms with one or more of the following: weakness, gait difficulties, loss of sensation, neuropathic pain, and bowel and bladder dysfunction. Clinical history and examination, spinal cord magnetic resonance imaging and cerebrospinal fluid (CSF) testing may provide clues to an autoimmune diagnosis. Autoimmune myelopathy evaluation of both serum and CSF can assist in the diagnosis (paraneoplastic or idiopathic autoimmune), and aid distinction from other causes of myelopathy (multiple sclerosis, sarcoidosis, vascular disease). Early testing may assist in early diagnosis of occult cancer, prompt initiation of immune therapies, or both.

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.

Test ID

Reporting name

Methodology

Reference value

MCI1

Autoimmune Myelopathy Interp, CSF

 

 

AMPHC

Amphiphysin Ab, CSF

Indirect immunofluorescence assay (IFA)

<1:2

AGN1C

Anti-Glial Nuclear Ab, Type 1

IFA

<1:2

ANN1C

Anti-Neuronal Nuclear Ab, Type 1

IFA

<1:2

ANN2C

Anti-Neuronal Nuclear Ab, Type 2

IFA

<1:2

ANN3C

Anti-Neuronal Nuclear Ab, Type 3

IFA

<1:2

CRMWC

CRMP-5-IgG Western Blot, CSF

Western blot

Negative

CRMC

CRMP-5-IgG, CSF

IFA

<1:2

DPPIC

DPPX Ab IFA, CSF

IFA

Negative

GD65C

GAD65 Ab Assay, CSF

Radioimmunoassay

< or =0.02 nmol/L

Reference values apply to all ages.

GFAIC

GFAP IFA, CSF

IFA

Negative

GL1IC

mGluR1 Ab IFA, CSF

IFA

Negative

NIFIC

NIF IFA, CSF

IFA

Negative

NMOFC

NMO/AQP4 FACS, CSF

Flow cytometry

Negative

PCTRC

Purkinje Cell Cytoplasmic Ab Type Tr

IFA

<1:2

PCA1C

Purkinje Cell Cytoplasmic Ab Type 1

IFA

<1:2

PCA2C

Purkinje Cell Cytoplasmic Ab Type 2

IFA

<1:2

Reflex Information:

Test ID

Reporting name

Methodology

Reference value

AGNBC

AGNA-1 Immunoblot, CSF

Immunoblot (IB)

Negative

AINCC

Alpha Internexin CBA, CSF

Cell-binding assay (CBA)

Negative

AMPCC

AMPA-R Ab CBA, CSF

CBA

Negative

AMPIC

AMPA-R Ab IF Titer Assay, CSF

IFA

<1:2

AMIBC

Amphiphysin Immunoblot, CSF

IB

Negative

AN1BC

ANNA-1 Immunoblot, CSF

IB

Negative

AN2BC

ANNA-2 Immunoblot, CSF

IB

Negative

DPPCC

DPPX Ab CBA, CSF

CBA

Negative

DPPTC

DPPX Ab IFA Titer, CSF

IFA

<1:2

GABCC

GABA-B-R Ab CBA, CSF

CBA

Negative

GABIC

GABA-B-R Ab IF Titer Assay, CSF

IFA

<1:2

GFACC

GFAP CBA, CSF

CBA

Negative

GFATC

GFAP IFA Titer, CSF

IFA

<1:2

GL1CC

mGluR1 Ab CBA, CSF

CBA

Negative

GL1TC

mGluR1 Ab IFA Titer, CSF

IFA

<1:2

NFHCC

NIF Heavy Chain CBA, CSF

CBA

Negative

NIFTC

NIF IFA Titer, CSF

IFA

<1:2

NFLCC

NIF Light Chain CBA, CSF

CBA

Negative

NMDCC

NMDA-R Ab CBA, CSF

CBA

Negative

NMDIC

NMDA-R Ab IF Titer Assay, CSF

IFA

<1:2

NMOTC

NMO/AQP4 FACS Titer, CSF

Flow cytometry

<1:2

PC1BC

PCA-1 Immunoblot, CSF

IB

Negative

PCTBC

PCA-Tr Immunoblot, CSF

IB

Negative

 

Neuron-restricted patterns of IgG staining that do not fulfill criteria for ANNA-1, ANNA-2, ANNA-3, CRMP-5-IgG, PCA-1, PCA-2, or PCA-Tr may be reported as "unclassified anti-neuronal IgG." Complex patterns that include nonneuronal elements may be reported as "uninterpretable."

Interpretation Provides information to assist in interpretation of the test results

A positive result is consistent with a diagnosis of autoimmune myelopathy in the appropriate clinical context.

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 a diagnosis of autoimmune myelopathy.

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

1. Dubey D, Pittock SJ, Krecke KN: Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody. JAMA Neurol 2018 Dec 21. doi: 10.1001/jamaneurol.2018.4053. Epub ahead of print

2. Zalewski NL, Flanagan EP: Autoimmune and Paraneoplastic Myelopathies. Semin Neurol 2018 Jun;38(3):278-289

3. Flanagan EP, Hinson SR, Lennon VA: Glial fibrillary acidic protein immunoglobulin G as biomarker of autoimmune astrocytopathy: Analysis of 102 patients. Ann Neurol 2017;81:298-309

4. Keegan BM, Pittock SJ, Lennon VA: Autoimmune myelopathy associated with collapsin response-mediator protein-5 immunoglobulin G. Ann Neurol 2008;63:531-534

5. Weinshenker BG, Wingerchuk DM, Vukusic S: Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis. Ann Neurol 2006;59:566-569

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