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

Test ID: MDS2    
Movement Disorder, Autoimmune Evaluation, Serum

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

Evaluating patients with suspected paraneoplastic or other autoimmune movement disorders including patients with ataxia, chorea, dyskinesias, myoclonus, parkinsonism, and stiff-person spectrum in serum specimens

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

If immunofluorescence assay (IFA) pattern suggests amphiphysin antibody, then amphiphysin immunoblot is performed at an additional charge.

 

If IFA pattern suggests AGNA-1 antibody, then AGNA-1 immunoblot is performed at an additional charge.

 

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

 

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

 

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

 

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

 

If IFA pattern suggests IgLON5 antibody, then IgLON5 CBA and IgLON5 titer are performed at an additional charge.

 

If IFA pattern suggests GRAF1 antibody, then GRAF1 CBA and GRAF1 titer are performed at an additional charge.

 

If IFA pattern suggests ITPR1 antibody, then ITPR1 CBA and ITPR1 titer are performed at an additional charge.

 

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

 

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

 

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

 

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

 

If IFA pattern suggests NMDA-receptor antibody and NMDA-receptor CBA is positive, then NMDA-receptor titer 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 Movement Disorder Autoimmune Evaluation Algorithm-Serum in Special Instructions.

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

Autoimmune movement disorders encapsulate a large and diverse group of neurologic disorders occurring either in isolation or accompanying more diffuse autoimmune encephalitic illnesses.

 

The full range of movement phenomena has been described and, as they often occur in adults, many of the presentations can mimic neurodegenerative disorders, such as autoimmune chorea mimicking Huntington disease. Disorders may be ataxic, hypokinetic (parkinsonism), or hyperkinetic (myoclonus, chorea other dyskinetic disorders).

 

The autoantibody targets are diverse and include neuronal surface proteins such as leucine-rich, glioma-inactivated 1 (LGI1), as well as antibodies reactive with intracellular antigens (such as Purkinje cell cytoplasmic antibody-1: PCA-1) that are markers of a central nervous system process mediated by CD8+ cytotoxic T cells.

 

In some instances (such as PCA-1 autoimmunity), antibodies detected in serum and cerebrospinal fluid can be indicative of a paraneoplastic cause, and may direct the cancer search. In other instances (such as 65kDa isoform of glutamic acid decarboxylase: GAD65 autoimmunity), a paraneoplastic cause is very unlikely, and early treatment with immunotherapy may promote improvement or recovery.

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

GANG

AChR Ganglionic Neuronal Ab, S

Radioimmunoassay (RIA)

< or =0.02 nmol/L

AMPHS

Amphiphysin Ab, S

Immunofluorescence assay (IFA)

<1:240

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

Cell-binding assay (CBA)

Negative

CRMS

CRMP-5-IgG, S

IFA

<1:240

CRMWS

CRMP-5-IgG Western Blot, S

Western blot (WB)

Negative

DPPIS

DPPX Ab IFA, S

IFA

Negative

GD65S

GAD65 Ab Assay, S

RIA

< or =0.02 nmol/L

Reference values apply to all ages.  

GRFIS

GRAF1 IFA, S

IFA

Negative

IG5IS

IgLON5 IFA, S

IFA

Negative

ITPIS

ITPR1 IFA, S

IFA

Negative

LG1CS

LGI1-IgG CBA, S

CBA

Negative

GL1IS

mGluR1 Ab IFA, S

IFA

Negative

NIFIS

NIF IFA, S

IFA

Negative

NMDCS

NMDA-R Ab CBA, S

CBA

Negative

CCN

N-Type Calcium Channel Ab

RIA

< or = 0.03 nmol/L  

CCPQ

P/Q-Type Calcium Channel Ab

RIA

< or =0.02 nmol/L

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

Reflex Information:

Test ID

Reporting Name

Methodology

Reference Value

AGNBS

AGNA-1 Immunoblot, S

Immunoblot (IB)

Negative

AINCS

Alpha Internexin CBA, S

CBA

Negative

AMPIS

AMPA-R Ab IF Titer Assay, S

IFA

<1:120

AMPCS

AMPA-R Ab CBA, S

CBA

Negative

AMIBS

Amphiphysin Immunoblot, S

IB

Negative

AN1BS

ANNA-1 Immunoblot, S

IB

Negative

AN2BS

ANNA-2 Immunoblot, S

IB

Negative

DPPCS

DPPX Ab CBA, S

CBA

Negative

DPPTS

DPPX Ab IFA Titer, S

IFA

<1:240

GABCS

GABA-B-R Ab CBA, S

CBA

Negative

GABIS

GABA-B-R Ab IF Titer Assay, S

IFA

<1:120

GRFCS

GRAF1 CBA, S

CBA

Negative

GRFTS

GRAF1 IFA Titer, S

IFA

<1:240

IG5CS

IgLON5 CBA, S

CBA

Negative

IG5TS

IgLON5 IFA Titer, S

IFA

<1:240

ITPCS

ITPR1 CBA, S

CBA

Negative

ITPTS

ITPR1 IFA Titer, S

IFA

<1:240

GL1CS

mGluR1 Ab CBA, S

CBA

Negative

GL1TS

mGluR1 Ab IFA Titer, S

IFA

<1:240

NFHCS

NIF Heavy Chain CBA, S

CBA

Negative

NIFTS

NIF IFA Titer, S

IFA

<1:240

NFLCS

NIF Light Chain CBA, S

CBA

Negative

NMDIS

NMDA-R Ab IF Titer Assay, S

IFA

<1:120

PC1BS

PCA-1 Immunoblot, S

IB

Negative

PCTBS

PCA-Tr Immunoblot, S

IB

Negative

 

Neuron-restricted patterns of IgG staining that do not fulfill criteria for ANNA-1, ANNA-2, 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 antibody result is consistent with a diagnosis of an autoimmune movement disorder.

 

A search for cancer may be indicated, depending on the antibody profile.

 

A trial of immune therapy may bring about improvement in neurological symptoms.

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

A negative antibody test result does not exclude an autoimmune movement disorder.

 

Corticosteroid treatment prior to the serum collection may cause a false-negative result.

 

Intravenous immunoglobulin (IVIg) treatment prior to the serum collection may cause a false-positive result.

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

Honorat JA, McKeon A: Autoimmune Movement Disorders: a Clinical and Laboratory Approach. Curr Neurol Neurosci Rep 2017 Jan;17(1):4 doi: 10.1007/s11910-017-0709-2

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