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

Test ID: MDC2    
Movement Disorder, Autoimmune Evaluation, Spinal Fluid

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 using spinal fluid 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 are 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 suggest 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 GRAF1 antibody, then GRAF1 CBA and GRAF1 titer are 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 ITPR1 antibody, then ITPR1 CBA and ITPR1 titer are 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-Spinal Fluid 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 65 kDa 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

AMPHC

Amphiphysin Ab, CSF

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

CS2CC

CASPR2-IgG CBA, CSF

Cell-binding assay (CBA)

Negative

CRMWC

CRMP-5-IgG Western Blot, CSF

Western blot (WB)

Negative

CRMC

CRMP-5-IgG, CSF

IFA

<1:2

DPPIC

DPPX Ab IFA, CSF

IFA

Negative

GD65C

GAD65 Ab Assay, CSF

Radioimmunoassay (RIA)

< or =0.02 nmol/L

Reference values apply to all ages.

GRFIC

GRAF1 IFA, CSF

IFA

Negative

IG5IC

IgLON5 IFA, CSF

IFA

Negative

ITPIC

ITPR1 IFA, CSF

IFA

Negative

LG1CC

LGI1-IgG CBA, CSF

CBA

Negative

GL1IC

mGluR1 Ab IFA, CSF

IFA

Negative

NIFIC

NIF IFA, CSF

IFA

Negative

NMDCC

NMDA-R Ab CBA, CSF

CBA

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

CBA

Negative

AMPIC

AMPA-R Ab IF Titer Assay, CSF

IFA

<1:2

AMPCC

AMPA-R Ab CBA, CSF

CBA

Negative

AMIBC

Amphiphysin Immunoblot, CSF

IB

Negative

AN1BC

ANNA-1 Immunoblot, CSF

IB

Negative

AN2BC

ANNA-2 Immunoblot, CSF

IB

Negative

DPPTC

DPPX Ab IFA Titer, CSF

IFA

<1:2

DPPCC

DPPX Ab CBA, CSF

CBA

Negative

GABIC

GABA-B-R Ab IF Titer Assay, CSF

IFA

<1:2

GABCC

GABA-B-R Ab CBA, CSF

CBA

Negative

GRFCC

GRAF1 CBA, CSF

CBA

Negative

GRFTC

GRAF1 IFA Titer, CSF

IFA

<1:2

IG5CC

IgLON5 CBA, CSF

CBA

Negative

IG5TC

IgLON5 IFA Titer, CSF

IFA

<1:2

ITPCC

ITPR1 CBA, CSF

CBA

Negative

ITPTC

ITPR1 IFA Titer, CSF

IFA

<1:2

GL1TC

mGluR1 Ab IFA Titer, CSF

IFA

<1:2

GL1CC

mGluR1 Ab CBA, CSF

CBA

Negative

NFHCC

NIF Heavy Chain CBA, CSF

CBA

Negative

NIFTC

NIF IFA Titer, CSF

IFA

<1:2

NFLCC

NIF Light Chain CBA, CSF

CBA

Negative

NMDIC

NMDA-R Ab IF Titer Assay, CSF

IFA

<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, 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 cerebrospinal fluid (CSF) collection may cause a false-negative result.

 

Intravenous immunoglobulin (IVIg) treatment prior to the CSF 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