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HelpTest ID: MAS1 Autoimmune Myelopathy Evaluation, Serum
Necessary Information
Provide the following information:
-Relevant clinical information
-Ordering provider name, phone number, mailing address, and e-mail address
Specimen Required
Patient Preparation:
1. For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication.
2. This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed, or canceled if radioactivity remains.
Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Specimen Volume: 4 mL
Forms
If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.
Useful For
Evaluating patients with suspected autoimmune myelopathy, myelitis, paraneoplastic myelopathy using serum specimens
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| MSI1 | Autoimmune Myelopathy Interp, S | No | Yes |
| AMPHS | Amphiphysin Ab, S | No | Yes |
| AGN1S | Anti-Glial Nuclear Ab, Type 1 | No | Yes |
| ANN1S | Anti-Neuronal Nuclear Ab, Type 1 | No | Yes |
| ANN2S | Anti-Neuronal Nuclear Ab, Type 2 | No | Yes |
| ANN3S | Anti-Neuronal Nuclear Ab, Type 3 | No | Yes |
| CRMWS | CRMP-5-IgG Western Blot, S | Yes | Yes |
| CRMS | CRMP-5-IgG, S | No | Yes |
| DPPIS | DPPX Ab IFA, S | No | Yes |
| GD65S | GAD65 Ab Assay, S | Yes | Yes |
| GFAIS | GFAP IFA, S | No | Yes |
| GL1IS | mGluR1 Ab IFA, S | No | Yes |
| MOGFS | MOG FACS, S | Yes | Yes |
| NIFIS | NIF IFA, S | No | Yes |
| NMOFS | NMO/AQP4 FACS, S | Yes | Yes |
| CCN | N-Type Calcium Channel Ab | No | Yes |
| CCPQ | P/Q-Type Calcium Channel Ab | No | Yes |
| PCABP | Purkinje Cell Cytoplasmic Ab Type 1 | No | Yes |
| PCAB2 | Purkinje Cell Cytoplasmic Ab Type 2 | No | Yes |
| PCATR | Purkinje Cell Cytoplasmic Ab Type Tr | No | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| AGNBS | AGNA-1 Immunoblot, S | No | No |
| AINCS | Alpha Internexin CBA, S | No | No |
| AMPCS | AMPA-R Ab CBA, S | No | No |
| AMPIS | AMPA-R Ab IF Titer Assay, S | No | No |
| AMIBS | Amphiphysin Immunoblot, S | No | No |
| AN1BS | ANNA-1 Immunoblot, S | No | No |
| AN2BS | ANNA-2 Immunoblot, S | No | No |
| DPPCS | DPPX Ab CBA, S | No | No |
| DPPTS | DPPX Ab IFA Titer, 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 |
| GL1CS | mGluR1 Ab CBA, S | No | No |
| GL1TS | mGluR1 Ab IFA Titer, S | No | No |
| MOGTS | MOG FACS Titer, S | No | No |
| NFHCS | NIF Heavy Chain CBA, S | No | No |
| NIFTS | NIF IFA Titer, 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 |
| NMOTS | NMO/AQP4 FACS Titer, S | No | No |
| PC1BS | PCA-1 Immunoblot, S | No | No |
| PCTBS | PCA-Tr Immunoblot, S | No | No |
Testing Algorithm
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 suggests NMDA-receptor antibody, then NMDA- receptor R antibody cell-binding assay (CBA) and NMDA- receptor R titer are performed at an additional charge.
If IFA pattern suggests AMPA- receptor antibody, then AMPA- receptor antibody CBA and AMPA- receptor titer are performed at an additional charge.
If IFA pattern suggests GABA-B- receptor antibody, then GABA-B- receptor antibody CBA and GABA-B- receptor titer are performed at an additional charge.
If IFA pattern suggests DPPX antibody, then DPPX antibody CBA and DPPX IFA titer are performed at an additional charge.
If IFA pattern suggests mGluR1 antibody, then mGluR1antibody CBA and mGluR1 IFA titer are performed at an additional charge.
If IFA pattern suggests 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 MOG FACS screen assay requires further investigation, then MOG 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-Serum in Special Instructions.
Method Name
AGN1S, AMPHS, AMPIS, ANN1S, ANN2S, ANN3S, CRMS, DPPIS, DPPTS, GABIS, GFAIS, GFATS, GL1IS, GL1TS, NIFIS, NIFTS, NMDIS, PCAB2, PCABP, PCATR: Indirect Immunofluorescence Assay (IFA)
CCN, CCPQ, GD65S: Radioimmunoassay (RIA)
CRMWS: Western Blot (WB)
AGNBS, AMIBS, AN1BS, AN2BS, PC1BS, PCTBS: Immunoblot (IB)
MOGFS, MOGTS, NMOFS, NMOTS: Flow Cytometry (FACS)
AINCS, AMPCS, DPPCS, GABCS, GFACS, GL1CS, NFHCS, NFLCS, NMDCS: Cell-Binding Assay (CBA)
Reporting Name
Autoimmune Myelopathy Eval, SSpecimen Type
SerumSpecimen Minimum Volume
2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days | ||
| Ambient | 72 hours |
Clinical Information
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
|
Test ID |
Reporting name |
Methodology |
Reference value |
|
MSI1 |
Autoimmune Myelopathy Interp, S |
|
|
|
AMPHS |
Amphiphysin Ab, S |
Indirect immunofluorescence assay (IFA) |
<1:240 |
|
AGN1S |
Anti-Glial Nuclear Ab, Type 1 |
IFA |
<1:240 |
|
ANN1S |
ANNA-1, S |
IFA |
<1:240 |
|
ANN2S |
ANNA-2, S |
IFA |
<1:240 |
|
ANN3S |
ANNA-3, S |
IFA |
<1:240 |
|
CRMWS |
CRMP-5-IgG Western Blot, S |
Western blot |
Negative |
|
CRMS |
CRMP-5-IgG, S |
IFA |
<1:240 |
|
DPPIS |
DPPX Ab IFA, S |
IFA |
Negative |
|
GD65S |
GAD65 Ab Assay, S |
Radioimmunoassay (RIA) |
≤0.02 nmol/L Reference values apply to all ages. |
|
GFAIS |
GFAP IFA, S |
IFA |
Negative |
|
GL1IS |
mGluR1 Ab IFA, S |
IFA |
Negative |
|
MOGFS |
MOG FACS, S |
Flow cytometry |
Negative |
|
NIFIS |
NIF IFA, S |
IFA |
Negative |
|
NMOFS |
NMO/AQP4 FACS, S |
Flow cytometry |
Negative |
|
CCN |
N-Type Calcium Channel Ab |
RIA |
≤ 0.03 nmol/L |
|
CCPQ |
P/Q-Type Calcium Channel Ab |
RIA |
≤0.02 nmol/L |
|
PCABP |
PCA-1, S |
IFA |
<1:240 |
|
PCAB2 |
PCA-2, S |
IFA |
<1:240 |
|
PCATR |
PCA-Tr, S |
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 |
Cell-binding assay (CBA) |
Negative |
|
AMPCS |
AMPA-R Ab CBA, S |
CBA |
Negative |
|
AMPIS |
AMPA-R Ab IF Titer Assay, S |
IFA |
<1:120 |
|
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 |
|
GFACS |
GFAP CBA, S |
CBA |
Negative |
|
GFATS |
GFAP IFA Titer, S |
IFA |
<1:240 |
|
GL1CS |
mGluR1 Ab CBA, S |
CBA |
Negative |
|
GL1TS |
mGluR1 Ab IFA Titer, S |
IFA |
<1:240 |
|
MOGTS |
MOG FACS Titer, S |
Flow cytometry |
<1:20 |
|
NFHCS |
NIF Heavy Chain CBA, S |
CBA |
Negative |
|
NIFTS |
NIF IFA Titer, 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 |
<1:120 |
|
NMOTS |
NMO/AQP4 FACS Titer, S |
Flow cytometry |
<1:5 |
|
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
A positive result is consistent with a diagnosis of autoimmune myelopathy in the appropriate clinical context.
Clinical Reference
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
Day(s) and Time(s) Performed
AGN1S, AMPHS, AMPIS, ANN1S, ANN2S, ANN3S, CRMS, DPPIS, DPPTS, GABIS, GFAIS, GFATS, GL1IS, GL1TS, NIFIS, NIFTS, NMDIS, PCAB2, PCABP, PCATR:
Monday through Friday; 5 a.m., 7 a.m., 5 p.m.
Saturday, Sunday; 6 a.m.
CCN, CCPQ:
Monday through Friday; 6 a.m., 8 a.m., 6 p.m.
Saturday, Sunday; 7 a.m.
CRMWS:
Monday through Thursday; 8 a.m.
AGNBS, AMIBS, AN1BS, AN2BS, PC1BS, PCTBS:
Monday through Friday; 6 p.m.
GD65S:
Monday through Friday; 5 a.m., 2 p.m.
Saturday, Sunday; 7 a.m.
MOGFS, MOGTS, NMOFS, NMOTS:
Monday, Tuesday, Thursday; 6 p.m.
AMPCS, DPPCS, GABCS, NMDCS:
Monday through Friday, Sunday; 10 p.m.
GL1CS:
Monday, Thursday; 6 p.m.
AINCS, NFHCS, NFLCS:
Tuesday, Thursday; 6 p.m.
GFACS:
Monday, Wednesday, Friday; 6 p.m.
Analytic Time
10 daysTest 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 U.S. Food and Drug Administration.CPT Code Information
83519 x 2
86255 x15
86341
84182
84182-AGNBS (if appropriate)
86255-AINCS (if appropriate)
86255-AMPCS (if appropriate)
86256-AMPIS (if appropriate)
84182-AMIBS (if appropriate)
84182-AN1BS (if appropriate)
84182-AN2BS (if appropriate)
86255-DPPCS (if appropriate)
86256-DPPTS (if appropriate)
86255-GABCS (if appropriate)
86256-GABIS (if appropriate)
86255-GFACS (if appropriate)
86256-GFATS (if appropriate)
86255-GL1CS (if appropriate)
86256-GL1TS (if appropriate)
86256-MOGFS (if appropriate)
86256-MOGTS (if appropriate)
86255-NFHCS (if appropriate)
86256-NIFTS (if appropriate)
86255-NFLCS (if appropriate)
86255-NMDCS (if appropriate)
86256-NMDIS (if appropriate)
86256-NMOFS (if appropriate)
86256-NMOTS (if appropriate)
84182-PC1BS (if appropriate)
84182-PCTBS (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| MAS1 | Autoimmune Myelopathy Eval, S | 94339-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 80776 | ANNA-2, S | 94343-1 |
| 83137 | ANNA-3, S | 94344-9 |
| 81184 | N-Type Calcium Channel Ab | 94348-0 |
| 81185 | P/Q-Type Calcium Channel Ab | 94349-8 |
| 83077 | CRMP-5-IgG, S | 94815-8 |
| 83107 | CRMP-5-IgG Western Blot, S | 47401-5 |
| 81596 | GAD65 Ab Assay, S | 94345-6 |
| 83138 | PCA-2, S | 94351-4 |
| 9477 | PCA-1, S | 94350-6 |
| 83076 | PCA-Tr, S | 94352-2 |
| 38324 | NMO/AQP4 FACS, S | 43638-6 |
| 65563 | MOG FACS, S | 90248-6 |
| 64930 | DPPX Ab IFA, S | 82976-2 |
| 64928 | mGluR1 Ab IFA, S | 94347-2 |
| 605127 | Autoimmune Myelopathy Interp, S | 69048-7 |
| 605155 | GFAP IFA, S | 94346-4 |
| 606964 | NIF IFA, S | In Process |
| 89080 | AGNA-1, S | 94341-5 |
| 81722 | Amphiphysin Ab, S | 94340-7 |
| 80150 | ANNA-1, S | 94342-3 |
| 36349 | Reflex Added | 77202-0 |
Special Instructions
mml-neuroimmunology; mml-spinal-cord