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HelpTest ID: MAS1 Myelopathy, Autoimmune/Paraneoplastic Evaluation, Serum
Ordering Guidance
Multiple neuroimmunology profile tests are available. For testing that is performed with each profile, see Autoimmune Neurology Antibody Matrix.
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 or intravenous immunoglobulin treatment.
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.
Collection Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: Plastic vial
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 |
| PCABP | Purkinje Cell Cytoplasmic Ab Type 1 | No | Yes |
| PCAB2 | Purkinje Cell Cytoplasmic Ab Type 2 | 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 |
Testing Algorithm
If indirect immunofluorescence assay (IFA) patterns suggest antiglial nuclear antibody (AGNA)-1, 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 antineuronal nuclear antibodies (ANNA)-1, then ANNA-1 immunoblot is performed at an additional charge.
If IFA patterns suggest ANNA-2, then ANNA-2 immunoblot is performed at an additional charge.
If IFA patterns suggest Purkinje cytoplasmic antibody (PCA)-1, then PCA-1 immunoblot is performed at an additional charge.
If IFA pattern suggests N-methyl-D-aspartate receptor (NMDA-R) antibody, then NMDA-R antibody cell-binding assay (CBA) and NMDA-R antibody IFA titer are performed at an additional charge.
If IFA pattern suggests alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPA-R) antibody, then AMPA-R antibody CBA and AMPA-R antibody IFA titer are performed at an additional charge.
If IFA pattern suggests gamma-aminobutyric acid B receptor (GABA-B-R) antibody, then GABA-B-R antibody CBA and GABA-B-R antibody IFA titer are performed at an additional charge.
If IFA pattern suggests dipeptidyl-peptidase-like protein-6 (DPPX) antibody, then DPPX antibody CBA and DPPX antibody IFA titer are performed at an additional charge.
If IFA pattern suggests metabotropic glutamate receptor 1 (mGluR1) antibody, then mGluR1antibody CBA and mGluR1 antibody IFA titer are performed at an additional charge.
If IFA pattern suggests glial fibrillary acidic protein (GFAP) antibody, then GFAP antibody CBA and GFAP antibody IFA titer are performed at an additional charge.
If neuromyelitis optica/aquaporin-4-IgG (NMO/AQP4-IgG) fluorescence-activated cell sorting (FACS) screen assay requires further investigation, then NMO/AQP4-IgG FACS titration assay is performed at an additional charge.
If myelin oligodendrocyte glycoprotein (MOG) FACS screen assay requires further investigation, then MOG FACS titration assay is performed at an additional charge.
If IFA pattern suggests neuronal intermediate filament (NIF) antibody, then alpha internexin CBA, NIF heavy chain CBA, NIF light chain CBA, and NIF antibody IFA titer are performed at an additional charge.
See Autoimmune/Paraneoplastic Myelopathy Evaluation Algorithm-Serum
Method Name
AGN1S, AMPHS, AMPIS, ANN1S, ANN2S, ANN3S, CRMS, DPPIS, DPPTS, GABIS, GFAIS, GFATS, GL1IS, GL1TS, NIFIS, NIFTS, NMDIS, PCAB2, PCABP: Indirect Immunofluorescence Assay (IFA)
GD65S: Radioimmunoassay (RIA)
CRMWS: Western Blot (WB)
AGNBS, AMIBS, AN1BS, AN2BS, PC1BS: Immunoblot (IB)
MOGFS, MOGTS, NMOFS, NMOTS: Flow Cytometry (FCM)
AINCS, AMPCS, DPPCS, GABCS, GFACS, GL1CS, NFHCS, NFLCS, NMDCS: Cell-Binding Assay (CBA)
Reporting Name
Myelopathy, Autoimm/Paraneo, 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 |
Medical interpretation |
N/A |
|
AMPHS |
Amphiphysin Ab, S |
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 |
WB |
Negative |
|
CRMS |
CRMP-5-IgG, S |
IFA |
<1:240 |
|
DPPIS |
DPPX Ab IFA, S |
IFA |
Negative |
|
GD65S |
GAD65 Ab Assay, S |
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 |
FCM |
Negative |
|
NIFIS |
NIF IFA, S |
IFA |
Negative |
|
NMOFS |
NMO/AQP4 FACS, S |
FCM |
Negative |
|
PCABP |
PCA-1, S |
IFA |
<1:240 |
|
PCAB2 |
PCA-2, S |
IFA |
<1:240 |
Reflex Information
|
Test ID |
Reporting name |
Methodology* |
Reference value |
|
AGNBS |
AGNA-1 Immunoblot, S |
IB |
Negative |
|
AINCS |
Alpha Internexin CBA, S |
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 |
FCM |
<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 |
FCM |
<1:5 |
|
PC1BS |
PCA-1 Immunoblot, S |
IB |
Negative |
*Methodology abbreviations:
Immunofluorescence assay (IFA)
Cell-binding assay (CBA)
Flow cytometry (FCM)
Radioimmunoassay (RIA)
Immunoblot (IB)
Western blot (WB)
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, et al: Clinical, radiologic, and prognostic features of myelitis associated with myelin oligodendrocyte glycoprotein autoantibody. JAMA Neurol. 2019 Mar 1;76(3):301-309
2. Zalewski NL, Flanagan EP: Autoimmune and Paraneoplastic Myelopathies. Semin Neurol. 2018 Jun;38(3):278-289
3. Flanagan EP, Hinson SR, Lennon VA, et al: Glial fibrillary acidic protein immunoglobulin G as biomarker of autoimmune astrocytopathy: Analysis of 102 patients. Ann Neurol. 2017 Feb;81:298-309
4. Keegan BM, Pittock SJ, Lennon VA: Autoimmune myelopathy associated with collapsin response-mediator protein-5 immunoglobulin G. Ann Neurol. 2008 Apr;63:531-534
5. Weinshenker BG, Wingerchuk DM, Vukusic S, et al: Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis. Ann Neurol. 2006 Mar;59(3):566-569
Day(s) Performed
Profile tests: Monday through Sunday; Reflex tests: Varies
Report Available
10 to 13 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 US Food and Drug Administration.CPT Code Information
86255 x 12
86053
84182
86363
86341
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)
86363-MOGTS (if appropriate)
86255-NFHCS (if appropriate)
86256-NIFTS (if appropriate)
86255-NFLCS (if appropriate)
86255-NMDCS (if appropriate)
86256-NMDIS (if appropriate)
86053-NMOTS (if appropriate)
84182-PC1BS (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| MAS1 | Myelopathy, Autoimm/Paraneo, S | 94339-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 80776 | ANNA-2, S | 94343-1 |
| 83137 | ANNA-3, S | 94344-9 |
| 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 |
| 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 | 96486-6 |
| 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