Test ID: MDS2 Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Serum
Ordering Guidance
Multiple neuroimmunology profile tests are available. 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 (IVIg) 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 paraneoplastic or other autoimmune movement disorders including patients with ataxia, brainstem encephalitis, chorea, dyskinesias, myoclonus, and parkinsonism in serum specimens
Profile Information
Test ID | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
MDSI | Movement Disorder 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 |
CS2CS | CASPR2-IgG CBA, S | No | Yes |
CRMS | CRMP-5-IgG, S | No | Yes |
CRMWS | CRMP-5-IgG Western Blot, S | Yes | Yes |
DPPIS | DPPX Ab IFA, S | No | Yes |
GD65S | GAD65 Ab Assay, S | Yes | Yes |
GRFIS | GRAF1 IFA, S | No | Yes |
IG5IS | IgLON5 IFA, S | No | Yes |
ITPIS | ITPR1 IFA, S | No | Yes |
K11CS | KLHL11 Ab CBA, S | Yes | Yes |
LG1CS | LGI1-IgG CBA, S | No | Yes |
GL1IS | mGluR1 Ab IFA, S | No | Yes |
NIFIS | NIF IFA, S | No | Yes |
NMDCS | NMDA-R Ab CBA, S | No | Yes |
CCPQ | P/Q-Type Calcium Channel Ab | No | Yes |
PCABP | Purkinje Cell Cytoplasmic Ab Type 1 | Yes | Yes |
PCAB2 | Purkinje Cell Cytoplasmic Ab Type 2 | Yes | 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 |
GRFCS | GRAF1 CBA, S | No | No |
GRFTS | GRAF1 IFA Titer, S | No | No |
IG5CS | IgLON5 CBA, S | No | No |
IG5TS | IgLON5 IFA Titer, S | No | No |
ITPCS | ITPR1 CBA, S | No | No |
ITPTS | ITPR1 IFA Titer, S | No | No |
GL1CS | mGluR1 Ab CBA, S | No | No |
GL1TS | mGluR1 Ab IFA 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 |
NMDIS | NMDA-R Ab IF Titer Assay, S | No | No |
PC1BS | PCA-1 Immunoblot, S | No | No |
PCTBS | PCA-Tr Immunoblot, S | No | No |
K11TS | KLHL11 Ab IFA Titer, S | No | No |
Testing Algorithm
If immunofluorescence assay (IFA) pattern suggests amphiphysin antibody, then amphiphysin immunoblot is performed at an additional charge.
If IFA pattern suggests antiglial nuclear antibody-1 (AGNA)-1, then AGNA-1 immunoblot is performed at an additional charge.
If IFA pattern suggests antineuronal nuclear antibodies (ANNA)-1, 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 Purkinje cytoplasmic antibody (PCA-1), 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 cell-binding assay (CBA) and IgLON5 antibody IFA titer are performed at an additional charge.
If IFA pattern suggests GTPase regulator associated with focal adhesion kinase-1 (GRAF1) antibody, then GRAF1 CBA and GRAF1 antibody IFA titer are performed at an additional charge.
If IFA pattern suggests inositol 1,4,5-trisphosphate receptor (ITPR1) antibody, then ITPR1 CBA and ITPR1 antibody IFA titer are performed at an additional charge.
If IFA pattern suggests alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA)-receptor antibody, then AMPA-receptor cell-binding assay (CBA) and AMPA-receptor antibody IFA titer are performed at an additional charge.
If IFA pattern suggests dipeptidyl-peptidase-like protein-6 antibody (DPPX) antibody, then DPPX CBA and DPPX antibody IFA titer are performed at an additional charge.
If IFA pattern suggests gamma-aminobutyric acid B (GABA-B)-receptor antibody, then GABA-B-receptor CBA and GABA-B-receptor antibody IFA titer are performed at an additional charge.
If IFA pattern suggests metabotropic glutamate receptor 1 (mGluR1) antibody, then mGluR1 CBA and mGluR1 antibody IFA titer are performed at an additional charge.
If IFA pattern suggests N-methyl-D-aspartate (NMDA)-receptor antibody and NMDA-receptor CBA is positive, then NMDA-receptor antibody IFA titer 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.
If Kelch-like protein 11 (KLHL11) CBA is reactive, then KLHL11 antibody IFA titer is performed at an additional charge.
For more information see Movement Disorder Autoimmune Evaluation Algorithm-Serum.
Method Name
AGN1S, AMPHS, AMPIS, ANN1S, ANN2S, ANN3S, CRMS, DPPIS, DPPTS, GABIS, GL1IS, GL1TS, GRFIS, GRFTS, IG5IS, IG5TS, ITPIS, ITPTS, K11TS, NIFIS, NIFTS, NMDIS, PCAB2, PCABP, PCATR: Indirect Immunofluorescence Assay (IFA)
AINCS, AMPCS, CS2CS, DPPCS, GABCS, GL1CS, GRFCS, IG5CS, ITPCS, K11CS, LG1CS, NFHCS, NFLCS, NMDCS: Cell Binding Assay (CBA)
CRMWS: Western Blot (WB)
AGNBS, AMIBS, AN1BS, AN2BS, PC1BS, PCTBS: Immunoblot (IB)
CCPQ, GD65S: Radioimmunoassay (RIA)
Reporting Name
Movement, Autoimm/Paraneo, SSpecimen Type
SerumSpecimen Minimum Volume
3 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Serum | Refrigerated (preferred) | 28 days | |
Frozen | 28 days | ||
Ambient | 72 hours |
Clinical Information
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). Associated disorders may fall under the rubric of brainstem encephalitis.
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
Test ID |
Reporting Name |
Methodology* |
Reference Value |
MDSI |
Movement Disorder Interp, S |
Medical interpretation |
N/A |
AMPHS |
Amphiphysin Ab, S |
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 |
CBA |
Negative |
CRMS |
CRMP-5-IgG, S |
IFA |
<1:240 |
CRMWS |
CRMP-5-IgG Western Blot, S |
WB |
Negative |
DPPIS |
DPPX Ab IFA, S |
IFA |
Negative |
GD65S |
GAD65 Ab Assay, S |
RIA |
≤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 |
K11CS |
KLHL11 Ab CBA, S |
CBA |
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 |
CCPQ |
P/Q-Type Calcium Channel Ab |
RIA |
≤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 |
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 |
K11TS |
KLHL11 Ab 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 |
*Methodology abbreviations:
Immunofluorescence assay (IFA)
Cell-binding assay (CBA)
Western blot (WB)
Radioimmunoassay (RIA)
Immunoblot (IB)
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 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.
Clinical Reference
2. Dubey D, Wilson MR, Clarkson B, et al: Expanded clinical Phenotype, oncological associations, and immunopathologic insights of paraneoplastic Kelch-like protein-11 encephalitis. JAMA Neurol. 2020 Nov 1;77(11):1420-1429. doi: 10.1001/jamaneurol.2020.2231
Day(s) Performed
Profile tests: Monday through Sunday; Reflex tests: Varies
Report Available
10 to 13 daysCPT Code Information
86596
86255 x 19
84182
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-GRFCS (if appropriate)
86256-GRFTS (if appropriate)
86255-IG5CS (if appropriate)
86256-IG5TS (if appropriate)
86255-ITPCS (if appropriate)
86256-ITPTS (if appropriate)
86256-K11TS (if appropriate)
86255-GL1CS (if appropriate)
86256-GL1TS (if appropriate)
86255-NFHCS (if appropriate)
86256-NIFTS (if appropriate)
86255-NFLCS (if appropriate)
86256-NMDIS (if appropriate)
84182-PC1BS (if appropriate)
84182-PCTBS (if appropriate)
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
MDS2 | Movement, Autoimm/Paraneo, S | 94701-0 |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
61516 | NMDA-R Ab CBA, S | 93503-1 |
64279 | LGI1-IgG CBA, S | 94287-0 |
64281 | CASPR2-IgG CBA, S | 94285-4 |
64930 | DPPX Ab IFA, S | 82976-2 |
64928 | mGluR1 Ab IFA, S | 94347-2 |
601998 | Movement Disorder Interp, S | 69048-7 |
606946 | IgLON5 IFA, S | 96476-7 |
606952 | ITPR1 IFA, S | 96464-3 |
606964 | NIF IFA, S | 96486-6 |
606958 | GRAF1 IFA, S | 96471-8 |
610581 | KLHL11 Ab CBA, S | 99072-1 |
80776 | ANNA-2, S | 94343-1 |
83137 | ANNA-3, S | 94344-9 |
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 |
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
Test 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.mml-Movement-Disorders