Test Guide - Quest Test Directory

Paraneoplastic Neurological Syndromes: Laboratory Support of Diagnosis

This Clinical Focus discusses the role of autoantibody testing in the diagnosis of paraneoplastic neurological syndromes and associated cancer and tumor types.

See also

Related tests (58)

Related guides (1)

Test guide list

Clinical Focus

Paraneoplastic Neurological Syndromes

Laboratory Support of Diagnosis

Contents

Clinical background

Individuals suitable for testing

Table 1. Clinical Presentation and Associated Tumors of Paraneoplastic Neurological Syndromes

Test availability and selection

Table 2. Test Availability for PNS-Related Antibodies

Table 3. Antibodies Included on Tissue IFA Panels

Figure 1. Interpretation of Paraneoplastic Antibody Evaluation With Reflex to Titer and Line Blot, Basic (Test Code 93876) Serum Panel

Figure 2.Interpretation of Paraneoplastic Antibody Evaluation With Reflex to Titer and Line Blot, Basic, CSF (Test Code 94536) Panel

Figure 3. Interpretation of Autoimmune Neurology Expanded Antibody Panels With Reflex to Titer and Line Blot, Serum (Test Codes 94955, 94956, 94957) and CSF (Test Codes 94958, 94959, 94960)

Figure 4. Interpretation of Autoimmune Neurology Antibody Comprehensive Panel With Reflexes, Serum (Test Code 93888)

Table 4. Paraneoplastic Neurological Syndromes and Tumor/Cancer Types Associated With Autoantibodies

Test interpretation

Table 5. Sensitivity and Specificity of MG-Related Antibodies for Thymoma in Individuals With MG

Appendix: Laboratory Tests for Diagnosis of PNSs and Identification of Related Tumors

References

Clinical background [return to contents]

Paraneoplastic neurological syndromes (PNSs) occur when cancer triggers an immune response that attacks the nervous system. Symptoms vary based on the part of the nervous system that is attacked and can include cognitive, psychiatric, autonomic, and sensorimotor effects.^1,2

The prevalence of most PNSs is very low, but symptoms often precede discovery of cancer. Thus, diagnosis of a PNS and its cause may lead to earlier cancer treatment.² However, because PNS-associated antibodies may cause permanent damage, successful treatment of a tumor does not always result in neurological improvement.²

The exact mechanisms of autoantibody-caused dysfunction in PNSs are often unclear. For extracellular antigens (eg, channels and receptors), pathogenesis may involve interference with synaptic transmission. For intracellular antigens, pathogenesis may involve T-cell–mediated cellular immunity.

A suggested approach for the diagnosis of PNS involves a clinical and neurologic examination followed by a laboratory investigation to evaluate paraneoplastic causes.³ Careful consideration should be given to the specific antibodies that are associated with the observed syndrome and support the diagnosis. Appropriate antibody testing in the blood and/or cerebrospinal fluid (CSF) can then be carried out to identify these antibodies,³ which can guide the search for an underlying malignancy.

A single antibody, however, can be associated with multiple syndromes and cancer types, and a single syndrome or cancer type can be associated with multiple antibodies. Furthermore, these antibodies can occur in the absence of an underlying cancer; that is, conditions such as autoimmune encephalitis, rapidly progressing dementia, and epilepsy can be paraneoplastic or nonparaneoplastic. In certain clinical circumstances it may be helpful to simultaneously test for multiple autoantibodies in the serum and/or CSF⁴; for some patients, detection of antibodies is more robust with CSF than serum.^5-8

This Clinical Focus discusses the role of autoantibody testing in the diagnosis of PNSs and associated cancer and tumor types. It is intended as an overview. Complete diagnostic criteria, prognosis, follow-up studies, and treatment options (eg, immune modulation) of PNSs are beyond the scope of this Clinical Focus. These topics are covered in review articles and guidelines.^1,2,4 The information provided in this Clinical Focus is not intended as medical advice. Test selection and interpretation, diagnosis, and patient management decisions should be based on the physician’s education, clinical expertise, and assessment of the patient.

Individuals suitable for testing [return to contents]

Individuals who have signs and symptoms consistent with a PNS (Table 1)^1,2,4
Individuals who have a PNS with an unidentified underlying malignancy
Individuals with rapidly progressive neurological symptoms of unknown etiology

Table 1. Clinical Presentation and Associated Tumors of Paraneoplastic Neurological Syndromes [return to contents]

Neurological syndrome	Clinical presentation	Associated tumors (common cancer and tumor types are in bold)
Brainstem encephalitis/ opsoclonus-myoclonus^4,^a	Large-amplitude synchronic and chaotic eye movements (opsoclonus), spontaneous muscle jerks (myoclonus), and ataxia^1,2	Breast cancer, ovarian cancer, testicular tumor, SCLC, neuroblastoma (children)⁴
Cerebellar degeneration^4,^a	Ataxia, diplopia, dysarthria; early symptoms include dizziness, nausea, vomiting^1,2	SCLC, ovarian cancer, breast cancer, Hodgkin lymphoma, thymoma⁴
Encephalomyelitis/ limbic encephalitis^4,^a	Encephalomyelitis: subacute sensory neuropathy, limbic encephalitis, cerebellar ataxia; 30% of patients have autonomic neuropathy (eg, orthostatic hypotension, urinary retention, pupillary abnormalities, impotence, dry mouth)^1,2 Limbic encephalitis: short-term memory loss, seizures, mood changes, hallucinations; less common symptoms include hypothalamic symptoms (eg, hyperthermia, somnolence, endocrine dysfunction)^1,2	SCLC, testicular tumor, thymoma, neuroblastoma, prostate carcinoma, breast cancer, Hodgkin lymphoma⁴
Lambert-Eaton myasthenic syndrome⁴^,a	Proximal muscle weakness in lower extremities, fatigue, diaphragmatic weakness, bulbar symptoms; later symptoms include autonomic symptoms (eg, ptosis, impotence, dry mouth)^1,2	SCLC⁴
Myasthenia gravis^4,^a	Weakness and fatigue of voluntary muscles (eg, ocular-bulbar, limbs) and diaphragm^1,2	Thymoma⁴
Neuromyotonia (Isaac syndrome)⁴^,a	Twitching, muscle rippling, stiffness, cramps, slowed movement^1,2	Thymoma, SCLC⁴
Subacute autonomic neuropathy/ dysautonomia⁴^,a	Orthostatic hypotension, gastrointestinal dysfunction, dry eyes or mouth, bowel or bladder dysfunction, altered pupillary light reflexes, loss of sinus arrhythmia, chronic gastrointestinal pseudo-obstruction (constipation, nausea or vomiting, dysphagia, weight loss, abdominal distention)^1,2	SCLC, thymoma⁴
Subacute sensory neuropathy⁴^,a	Paresthesia or pain (in upper before lower extremities), ataxia, multifocal or asymmetric distribution of neuropathy, decreased sensory modalities, pseudoathetosis of hands, decreased or absent deep tendon reflexes^1,2	SCLC, breast cancer, ovarian cancer⁴
Stiff-person syndrome⁴^,a	Severe muscle stiffness, mainly in spine and legs; muscle spasms^1,2	Breast cancer, SCLC⁴

SCLC, small-cell lung cancer.
a	These syndromes can occur in the absence of cancer or tumors.

Test availability and selection [return to contents]

If a specific syndrome is suspected based on clinical presentation, individual antibody tests may help identify the presence of an underlying malignancy. However, there is consensus that limiting testing to a single methodology could contribute to low diagnostic yield.⁴

Quest Diagnostics offers several tests and panels (Appendix) that may help identify an underlying PNS or antibodies associated with specific autoimmune neurological disease. Selecting the appropriate test or panel depends on clinical indications (Table 1).

The panels offered by Quest come in 3 general categories; the main differences between categories are the numbers of antibodies tested and the reflex patterns of testing (see Tables 2 and 3 and the relevant figures):

Basic panels: serum (test code 93876, Figure 1)^9-15 and CSF (test code 94536, Figure 2)^9-12,16-19; contain the smallest number of antibodies; CSF panel does not test for ganglionic acetylcholine receptor (gAChR), N-type and P/Q- type voltage gated calcium channel (VGCC) antibodies
Expanded panels: serum (test code 94957, Figure 3)^9,10,20,21 and CSF (test code 94960, Figure 3); contain higher-sensitivity cell-binding tests for certain antibodies (aquaporin 4, CASPR2, Ma2/Ta, LGI1, myelin, and Zic4) rather than as reflex tests to positive IFA results in basic panels; neither serum nor CSF panels include antibodies targeting striated muscle or AChR-binding antibody
Comprehensive panel: serum only (test code 93888, Figure 4)^{9,10,14,15,19-21}; contains the largest number of antibodies, including all basic and expanded panel antibodies, antibodies that target recoverin and titin, and a line blot for all specimens

Many components are available individually, but some tests are only offered as components of line blots or mosaics (Table 2, Appendix).

Table 2. Test Availability for PNS-Related Antibodies [return to contents]

Antibody	Single antibody tests	Basic test, serum (93876)	Basic test, CSF (94536)	Expanded test, serum (94957)	Expanded test, CSF (94960)	Comprehensive test, serum (93888)
Tissue IFA panel^a (see Table 3 for antibodies)		●^b	●^c	●^d	●^d	●^e
RIA
AChR, binding	●	●				●
AChR, blocking	●					Reflex
AChR, modulating	●	Reflex				Reflex
gAChR	●	●		●		●
VGCC, N-type	●	●		●		●
VGCC, P/Q-type	●	●		●		●
VGKC	●	●	Reflex	●	●	●
CBA
Aquaporin 4 (NMO)	●	Reflex	Reflex^c	●^d	●^d	Reflex^e
DPPX	●			●^d	●^d	●^e
AMPAR (1 & 2)		Reflex	Reflex^c	●^d	●^d	●^e
GABA_BR		Reflex	Reflex^c	●^d	●^d	●^e
NMDAR1	●	Reflex	Reflex^c	●^d	●^d	●^e
LGI1	●		Reflex^c	●^d	●^d	●^e
CASPR2	●		Reflex^c	●^d	●^d	●^e
Line blot
AGNA (SOX1)			Reflex	Reflex	Reflex	●
Amphiphysin	●	Reflex	Reflex	Reflex	Reflex	●
ANNA1 (Hu)	●	Reflex	Reflex	Reflex	Reflex	●
ANNA2 (Ri)	●	Reflex	Reflex	Reflex	Reflex	●
CRMP5 (CV2)	●	Reflex	Reflex	Reflex	Reflex	●
GAD65	●	Reflex	Reflex	Reflex	Reflex	●
Ma2/Ta	●			Reflex	Reflex	●
PCA1 (Yo)	●	Reflex	Reflex	Reflex	Reflex	●
PCA-Tr (DNER)	●		Reflex	Reflex^d	Reflex^d	●^e
Recoverin	●					●
Titin	●					●
Zic4	●			Reflex	Reflex	●
IFA
PCA-Tr (DNER)	●			Reflex^d	Reflex^d	Reflex^e
MAG IgM	●			Reflex	Reflex	Reflex
MAG-SGPG	●			Reflex		Reflex
MAG	●			Reflex		Reflex
Striated muscle	●	●^a				●^e

AChR, acetylcholine receptor; AGNA, anti-glial nuclear antibody; AMPAR, alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor; ANNA, anti-neuronal nuclear antibody; CASPR2, contactin-associated protein-like 2; CBA, cell-binding assay; CRMP5, collapsin response mediator protein 5; CAR, cancer-associated retinopathy; CSF, cerebrospinal fluid; DNER, delta/notch-like epidermal growth factor-related receptor; DPPX, dipeptidyl-peptidase-like protein-6; GABABAR, gamma-aminobutyric acid receptor B; gAChR, ganglionic acetylcholine receptor; GAD65, glutamic acid decarboxylase 65 kD protein; IFA, immunofluorescence assay; LGl1, leucine-rich glioma inactivated-1; MAG, myelin-associated glycoprotein; MG, myasthenia gravis; MGUS, monoclonal gammopathy of uncertain significance; NMDAR1, N-methyl-D-aspartate receptor; NMO, neuromyelitis optica; NMOSD, neuromyelitis spectrum disorder; PCA, Purkinje cell cytoplasmic antibody; PCA-Tr, Purkinje cell cytoplasmic antibody type Tr; RIA, radioimmunoassay; RyR, ryanodine receptor; SCLC, small-cell lung cancer; VGCC, voltage-gated calcium channel; VGKC, voltage-gated potassium channel.
a	Quest uses IFAs that employ nonhuman primate tissue rather than tissues from other animals.
b	In addition to reflex tests listed in this column, this IFA panel reflexes to ANNA3 and PCA2 titers if the respective antibodies are suggested by IFA. The individual IFA test for striated muscle antibody also reflexes to titer.
c	In addition to reflex tests listed in this column, this IFA panel reflexes to ANNA3 and PCA2 titers if the respective antibodies are suggested by IFA. The CBA tests also reflex to titers of respective antibodies.
d	In addition to reflex tests listed in this column, this IFA panel reflexes to ANNA3, PCA2, or myelin titer if the respective antibodies are suggested by IFA. The CBA tests also reflex to titers of respective antibodies. If PCA-Tr antibody is suggested by IFA, and both PCA-1 and PCA-Tr (DNER) are negative by line blot, the panel reflexes to PCA-Tr CBA IFA; if positive, the test reflexes to PCA-Tr titer.
e	In addition to reflex tests listed in this column, this IFA panel reflexes to ANNA3, PCA2, or myelin titer if the respective antibodies are suggested; the individual IFA test for striated muscle antibody also reflexes to titer. The CBA tests reflex to titers of respective antibodies. If PCA-Tr antibody is suggested by IFA, and both PCA-1 and PCA-Tr (DNER) are negative by line blot, the panel reflexes to PCA-Tr CBA IFA; if positive, the test reflexes to PCA-Tr titer.

Table 3. Antibodies Included on Tissue IFA Panels [return to contents]

Antibody	Basic, serum (93876)^a	Basic, CSF (94536)^a	Expanded, serum (94957)^a	Expanded, CSF (94960)^a	Comprehensive, serum (93888)^a
AGNA (SOX1)	●	●	●	●	●
Amphiphysin	●	●	●	●	●
ANNA1	●	●	●	●	●
ANNA2	●	●	●	●	●
ANNA3	●	●	●	●	●
CRMP5 (CV2)	●	●	●	●	●
PCA1	●	●	●	●	●
PCA2	●	●	●	●	●
PCA-Tr (DNER)	●	●	●	●	●
Aquaporin 4 (NMO)		●	●	●	●
GAD65		●	●	●	●
Ma2/Ta			●	●	●
Myelin			●	●	●

AGNA, anti-glial nuclear antibody; ANNA, anti-nuclear nuclear antibody; CSF, cerebrospinal fluid; CRMP5, collapsin response mediator protein 5; DNER, delta/notch-like epidermal growth factor-related receptor; GAD65, glutamic acid decarboxylase 65 kD protein; PCA, Purkinje cell cytoplasmic antibody; PCA-Tr, Purkinje cell cytoplasmic antibody type Tr.
a	Many, but not all, antibody tests are available individually (Table 2, Appendix); some tests are only offered as components of line blots or mosaics.

Figure 1. Interpretation of Paraneoplastic Antibody Evaluation With Reflex to Titer and Line Blot, Basic (Test Code 93876) Serum Panel
[return to contents]

Figure 2. Interpretation of Paraneoplastic Antibody Evaluation With Reflex to Titer and Line Blot, Basic, CSF (Test Code 94536) Pael
[return to contents]

Figure 3. Interpretation of Autoimmune Neurology Expanded Antibody Panels With Reflex to Titer and Line Blot, Serum (Test Codes 94955, 94956, 94957) and CSF (Test Codes 94958, 94959, 94960)
[return to contents]

Figure 4. Interpretation of Autoimmune Neurology Antibody Comprehensive Panel With Reflexes, Serum (Test Code 93888)
[return to contents]

Many, but not all, antibody tests are available individually (Table 2, Appendix); some tests are only offered as components of line blots or mosaics. If a clinician would like to order individual tests related to a particular syndrome or cancer type, Table 4 and information in the Test Interpretation section can help identify which antibodies would be most appropriate. Table 4 includes PNS-related antibodies and associated syndromes and cancer types. The Test Interpretation section contains information about the antibodies.

Table 4. Paraneoplastic Neurological Syndromes and Tumor/Cancer Types Associated With Autoantibodies
[return to contents]

Test interpretation [return to contents]

The presence of an antibody is associated with certain PNSs and malignancies (Tables 4 and 5).^4,9-19,21-55 Diagnostic criteria combine assignment of high-risk (>70%), intermediate-risk (30%-70%), and lower-risk (<30%) antibodies (risk defined by prevalence of cancer association) with phenotype and presence or absence of cancer.⁴ A points-based “PNS score” for diagnostic certainty (definite, probably, possible, or non-PNS) is based on these criteria.⁴

However, antibodies and syndromes can occur in the absence of cancer or a tumor; in such situations, they can help diagnose nonparaneoplastic forms of conditions. To confirm the presence of an underlying malignancy, positive antibody test results must be followed with imaging (eg, computed tomography [CT], fluorodeoxyglucose-positron emission tomography [FDG-PET], magnetic resonance imaging [MRI], ultrasound, mammography) or other laboratory tests (eg, biopsy, other antigen testing).²

The absence of an antibody rarely confirms the absence of an associated syndrome or cancer type. Table 5 provides specific information for each PNS-related antibody.

Table 5. Association of PNS Antibodies With Cancers and Neurological Syndromes [return to contents]

Antibody	Associated syndrome/condition	Associated cancer	Positive result interpretation
AChR	MG	Thymoma	Found in almost all patients with MG and thymoma but with low specificity (one study found 23% vs MG with thymic atrophy or normal thyroid histology and 0% vs hyperplasia)¹⁵; most patients with MG have binding and modulating AChR but about 4% test positive for only modulating AChR⁴⁴; blocking AChR is present in about 1% of patients without binding antibody⁵⁶
AGNA (SOX1)	LEMS, sensory neuropathy, limbic encephalitis, cerebellar degeneration²⁸	SCLC (most common), lung²⁸	Found in 43%-64% of patients with LEMS and SCLC (vs 0% without SCLC)^28,57; >90% frequency of cancer(s) in AGNA-positive PNS⁴
AMPAR	Limbic encephalitis¹¹	SCLC, lung, thymoma, breast, ovarian¹¹	Found in 0.2% of all patients with suspected PNS¹¹ (9% of patients with limbic encephalitis⁵⁸); patients with encephalitis⁵⁹ have been shown to have titers ≥1:10; >50% frequency of cancer(s) in AMPAR-positive PNS⁴
Amphiphysin	Brainstem encephalitis/ opsoclonus-myoclonus, sensory neuropathy, encephalomyelitis/ limbic encephalitis, stiff-person syndrome¹⁰	SCLC and breast (most common), lung⁴⁰	Found in 0.026% of all patients with suspected PNS¹⁰; often found with other PNS-related antibodies (eg, CRMP5, ANNA1, VGCC)^13,40; 80% frequency of cancer(s) in amphiphysin-positive PNS⁴
ANNA1 (Hu)	Sensory neuropathy, cerebellar ataxia, limbic encephalitis, brainstem encephalitis, autonomic neuropathy^39,45,46	SCLC (most common), lung, bladder, breast, GI tract, prostate, pancreas, ovary^13,39,45,46	Found in 0.4% of patients with suspected PNS¹³ (54%-86% of patients with confirmed PNS and neuropathy^39,45,46); cancer develops in 80%-98% of patients^13,39,45,46
ANNA2 (Ri)	Opsoclonus-myoclonus, cerebellar ataxia, stiff-person syndrome²⁴	Lung and breast (most common), SCLC²⁴	Found in 0.02% of patients with suspected PNS¹⁰; >70% frequency of cancer(s) in ANNA2-positive PNS⁴
ANNA3	Sensory neuropathy, limbic encephalopathy (often multifocal)⁹	SCLC (most common), adenocarcinoma (lung, esophagus)⁹	Found in 0.02% of patients with suspected PNS⁹ (one large study found among ANNA3-positive patients with oncological data, 5 had SCLC, 2 adenocarcinoma, 1 lung mass, 1 thoracic and abdominal masses)⁹
Aquaporin 4 (NMO)	NMOSD¹⁹	Breast, lung, thymic, cervical, B-cell lymphoma, and others¹⁹	Found in 0.02% of patients with suspected PNS¹⁹ (one study found 93% with NMOSD and 29% with neoplasms)¹⁹; <5% frequency of cancer(s) in AQP4-positive PNS⁴
CRMP5 (CV2)	Sensory neuropathy, cerebellar ataxia, autonomic neuropathy, limbic encephalitis, chorea²³	SCLC, thymoma^13,23,45	Found in 0.02% of patients with suspected PNS²³ (prevalent in paraneoplastic chorea, which is commonly associated with SCLC); overall frequency of cancer(s) in CRMP5-positive PNS⁴ is >80%; over 50% of patients also test positive for other PNS-related antibodies, including ANNA1, N-type VGCC, and P/Q type VGCC¹³
GABA_BR	Limbic encephalitis¹²	SCLC (most common), lung⁴⁸	Found in 71% of patients with limbic encephalitis and SCLC¹²; median titers have been reported in the range of 1:40-1:2,000 in serum, 1:20-1:640 in the CSF⁶⁰; >80% frequency of cancer(s) in GABA_BR -positive PNS⁴
gAChR	Autonomic neuropathy, sensorimotor polyneuropathy, neuropsychiatric manifestations²²	Adenocarcinoma (breast, prostate, lung, GI), B-cell lymphoma, melanoma, and others²²	Found in 1% of patients with suspected PNS²²; one study found 30% of patients had cancer and 25% of these had multiple malignant neoplasms²²
GAD65	Stiff-person syndrome, cerebellar ataxia, limbic encephalitis³⁰	SCLC, lung, thymoma, breast, pancreatic, thymic, hematological cancers⁴¹	Few reports of GAD65 in PNS, mainly SCLC⁴¹; >100 times higher in stiff-person syndrome than in type 1 diabetes⁴⁹; <15% frequency of cancer(s) in GAD65-positive PNS⁴
Ma2/Ta	Limbic encephalitis, brainstem encephalitis, cerebellar degeneration²⁵	Testicular germ-cell tumors (especially men <50 years of age), lung, breast⁵⁰	Among Ma2/Ta-positive patients, 90% present with limbic, brainstem, and/or diencephalic syndromes²⁵; >75% frequency of cancer(s) in Ma2/Ta-positive PNS⁴
MAG	Sensory or sensorimotor neuropathy^21,51	MGUS, WM^21,51	Among MAG-positive patients, 93% present with sensory or sensorimotor neuropathy²¹; 81%-85% have MGUS^21,51
NMDAR1	Encephalitis with prominent psychiatric symptoms, seizures, dyskinesias, autonomic instability³⁷	Ovarian teratoma (most common), testicular³⁷	In one study, all NMDAR2-positive patients with encephalitis presented with psychiatric symptoms³⁷; CSF and serum titers are higher in patients with poor outcomes or teratoma compared to patients with good outcomes or without teratomas⁶¹; 38% frequency of cancer(s) in NMDAR-positive PNS⁴
PCA1 (Yo)	Cerebellar degeneration^31,42	Ovarian (most common), breast^31,42	PCA1-positive patients with paraneoplastic cerebellar degeneration are almost always women and 79%-95% develop cancer^31,42
PCA2	Encephalomyelitis, limbic encephalitis, cerebellar ataxia¹⁰	Lung (SCLC, NSCLC), breast¹⁰	Found in 0.24% of patients with suspected PNS (80% of these patients with SCLC have high titers⁶²); cancer is found in 79% of PCA2-positive patients¹⁰; frequently found with other antibodies (CRMP5, P/Q-type VGCC, GAD65, ANNA1)¹⁰
PCA-Tr (DNER)	Cerebellar degeneration²⁰	Hodgkin lymphoma (most common)²⁰	Found in 0.006% of patients with suspected PNS¹⁰; highly specific for Hodgkin lymphoma as the cause of paraneoplastic cerebellar degeneration⁵²; 90% frequency of cancer(s) in PCA-Tr-positive PNS⁴
Recoverin	CAR³⁸	SCLC (most common), endometrial, breast, colon, skin³⁸	Found in 6% of patients with suspected paraneoplastic or autoimmune retinopathy (all were confirmed to have paraneoplastic retinopathy)³⁸
Striated muscle (RyR, Titin)	MG¹⁴	Thymoma (most common)¹⁴	Found in 69% of MG patients with thymoma but more specific (97% vs MG with thymic atrophy, hyperplasia, or normal thyroid histology) compared to AChR antibody^14,15; titin is considered a biomarker for thymoma in MG¹⁵
VGCC (P/Q-type and N-type)	LEMS, cerebellar degeneration^29,53-55	SCLC (most common)^29,53-55	Found in almost all patients (96%-100%^29,53) with LEMS and cancer (primary marker for LEMS; 85%-95% of patients test positive)^29,53,55; 70%-78% frequency of SCLC in VGCC-positive patients with LEMS^29,55
VGKC (LGl1 and CASPR2; DPPX)	LGl1 and CASPR2: limbic encephalitis, seizures, cognitive decline neuromyotonia, Morvan syndrome, neuropathic pain, sleep disturbance, personality change^16-18 DPPX: multifocal neurological disorders, most prominently encephalopathy, myelopathy, weight loss, autonomic dysfunction³⁴	LGl1 and CASPR2: thymoma¹⁶ DPPX: B-cell neoplasms³⁴	Found in 0.06% of patients with suspected PNS⁶³; LGI1 is more associated with CNS symptoms than peripheral nervous system symptoms; CASPR2 with peripheral and CNS symptoms¹⁶; Morvan syndrome is usually associated with high CASPR2 titers, which are accompanied by lower LG1 titers¹⁷
Zic4	Cerebellar degeneration³³	SCLC (most common)³³	Found in 13% of patients with PNS; 90% frequency of SCLC in Zic4-positive patients³³; frequently found with ANNA1 or CRMP5³³

AChR, acetylcholine receptor; AGNA, anti-glial nuclear antibody; AMPAR; alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor; ANNA, anti-nuclear nuclear antibody; CASPR2, contactin-associated protein-like 2; CRMP5, collapsin response mediator protein 5; CAR, cancer-associated retinopathy; DPPX, dipeptidyl-peptidase-like protein-6; GABABAR, gamma-aminobutyric acid receptor B; gAChR, ganglionic acetylcholine receptor; GAD65, glutamic acid decarboxylase 65 kD protein; LGl1, leucine-rich glioma inactivated-1; LEMS, Lambert-Eaton myasthenic syndrome; MAG, myelin-associated glycoprotein; MG, myasthenia gravis; MGUS, monoclonal gammopathy of uncertain significance; NMDAR1, N-methyl-D-aspartate receptor; NMOSD, neuromyelitis spectrum disorder; NSCLC, non small-cell lung cancer; PCA, Purkinje cell cytoplasmic antibody type 1; PCA-Tr, Purkinje cell cytoplasmic antibody type Tr; RyR, ryanodine receptor; SCLC, small-cell lung cancer; VGCC, voltage-gated calcium channel; VGKC, voltage-gated potassium channel; WM, Waldenström macroglobulinemia.

Appendix [return to contents]

Laboratory Tests for Diagnosis of PNSs and Identification of Related Tumors
(for clinical use [ie, associated syndromes and tumors], refer to Table 4)

Test code	Test name
Single antibody tests
AChR
206	Acetylcholine Receptor Binding Antibody
34459	Acetylcholine Receptor Blocking Antibody
26474^a	Acetylcholine Receptor Modulating Antibody
Amphiphysin
4674^b	Recombx^® Amphiphysin Autoantibody Test
ANNA1 (Hu)
37053^a,c	Hu Antibody Screen With Reflex to Titer and Western Blot Includes ANNA1 (Hu) antibody (IFA) with reflex to WB with reflex to titer.
37710^a,c	Hu Antibody Screen With Reflex to Titer and Western Blot, CSF Includes ANNA1 (Hu) antibody (IFA) with reflex to WB with reflex to titer.
ANNA2 (Ri)
10140^a,c	Ri Antibody Screen With Reflex to Titer and WB Includes ANNA2 (Ri) antibody (IFA) with reflex to WB with reflex to titer.
90121^a,c	Ri Antibody Screen With Reflex to Titer and Western Blot, CSF Includes ANNA2 (Ri) antibody (IFA) with reflex to WB with reflex to titer.
Aquaporin 4 (NMO)
38323^a	Aquaporin-4 (AQP4) (NMO-IgG) Antibody With Reflex to Titer, CSF Includes AQP4 antibody with reflex to titer.
38321^a	Aquaporin-4 (AQP4) (NMO-IgG) Antibody With Reflex to Titer, Serum Includes AQP4 antibody with reflex to titer.
90382	Aquaporin-4 (AQP4) Antibody (NMO-IgG), ELISA
93893^a	Aquaporin-4 Antibody (IgG), CBA
CASPR2
92413^b	CASPR2 Antibody Test
CRMP5 (CV2)
4681^b	Recombx^® CV2 Autoantibody Test
DPPX
93891^a	DPPX Receptor Antibody, CBA IFA
gACHR
93881^a	Acetylcholine Receptor Ganglionic (Alpha 3) Antibody
GAD65
92414^b	GAD65 Neurological Syndrome Antibody Test
LGI1
92416^b	LGI1 Antibody Test
Myelin and MAG
4639^d	Myelin Antibody (IgG), IFA
37438^a	Myelin Associated Glycoprotein (MAG) Antibody (IgM), EIA
37078^a	Myelin Associated Glycoprotein (MAG)-SGPG Antibody (IgM)
NMDAR1
92394	NMDA Receptor (NR1-subunit) Autoantibody Test
PCA1 (Yo)
90119^a,c	Yo Antibody Screen With Reflex to Titer and Western Blot Includes PCA1 (Yo) antibody with reflex to WB with reflex to titer.
90117^a,c	Yo Antibody Screen With Reflex to Titer and Western Blot, CSF Includes PCA1 (Yo) antibody with reflex to WB with reflex to titer.
PCA-Tr
93894^a	Purkinje Cell Cytoplasmic Antibody Type Tr (DNER), CBA IFA
Recoverin
4684^b	Recombx^® CAR (Anti-Recoverin) Autoantibody Test
RyR
94743^b	RyR Autoantibody Test
Striated muscle
266^a	Striated Muscle Antibody With Reflex to Titer
Titin
92792^b	Titin Autoantibody Test
VGCC (N -type)
93882^a	Voltage-Gated Calcium Channel (VGCC) Type N Antibody
VGCC (P/Q-type)
34057	Voltage-Gated Calcium Channel (VGCC) Type P/Q Antibody
VGKC
93883^a	Voltage-Gated Potassium Channel (VGKC) Antibody
Zic4
4689^b	Recombx^® Zic4 Autoantibody Test
Multiple antibody tests (panels)^e
90133^a,c	Autoimmune Cerebellar Ataxia Panel Includes IgA level with reflex to tissue transglutaminase IgG; PCA1 (Yo) antibody (IFA) with reflex to WB with reflex to titer; tissue transglutaminase IgA antibody with reflex to endomysial IgA with reflex to endomysial IgA titer; and VGCC type P/Q antibody.
94605^b,c	Autoimmune Epilepsy Evaluation Includes CASPR2, GAD65, LGI1, NMDAR, and VGKC antibodies.
93888^a,c	Autoimmune Neurology Antibody Comprehensive Panel With Reflexes, Serum Includes a tissue IFA screen for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), ANNA3, AQP4, CRMP5 (CV2), GAD65, Ma2/Ta, myelin, PCA1 (Yo), PCA2, and PCA-Tr (DNER) antibodies; a CBA screen for AMPAR1, AMPAR2, CASPR2, GABA-B receptor, LGI1, and NMDAR antibodies; and a line blot for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CRMP5 (CV2), GAD65, Ma2/Ta, PCA1 (Yo), PCA-Tr (DNER), recoverin, titin, and Zic4 antibodies. Results suggesting AMPAR1, AMPAR2, ANNA3, CASPR2, GABA-B receptor, LGI1, NDMAR, or PCA2 antibodies reflex to respective titers; results suggesting AQP4 antibody reflex to AQP4 antibody (CBA) with reflex to titer; results suggesting myelin antibody reflex to titer and MAG antibody (WB) with reflex to MAG-SGPG antibody and MAG antibody (EIA); tissue IFA results suggesting PCA-Tr (DNER) antibody with negative PCA-Tr (DNER) and Yo line blot results reflex to PCA-Tr (DNER) CBA with reflex to titer. Also includes DPPX receptor antibody with reflex to titer; striated muscle antibody with reflex to titer; AChR binding antibody with reflexes to AChR modulating antibody (if AChR binding is negative or equivocal) and/or AChR blocking antibody (if AChR binding is positive or equivocal); and AChR ganglionic (alpha 3), VGCC type N, VGCC type P/Q, and VGKC antibodies.
94958^a,c	Encephalitis Antibody Evaluation With Reflex to Titer and Line Blot, CSF Includes a tissue IFA screen for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), ANNA3, AQP4, CRMP5 (CV2), GAD65, Ma2/Ta, myelin, PCA1 (Yo), PCA2, and PCA-Tr (DNER) antibodies with reflex to a line blot for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CRMP5 (CV2), GAD65, Ma2/Ta, PCA1 (Yo), PCA-Tr (DNER), and Zic4 antibodies; and a CBA screen for AMPAR1, AMPAR2, CASPR2, GABA-B receptor, LGI1, and NMDAR antibodies. Results suggesting AMPAR1, AMPAR2, ANNA3, CASPR2, GABA-B receptor, LGI1, NMDAR, or PCA2 antibodies reflex to respective titers; results suggesting myelin antibody reflex to titer; tissue IFA results suggesting PCA-Tr (DNER) antibody with negative PCA-Tr (DNER) and Yo line blot results reflex to PCA-Tr (DNER) CBA with reflex to titer. Also includes AQP4 antibody (CBA) with reflex to titer, DPPX receptor antibody with reflex to titer; and VGKC antibody.
94955^a,c	Encephalitis Antibody Evaluation With Reflex to Titer and Line Blot, Serum Includes a tissue IFA screen for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), ANNA3, AQP4, CRMP5 (CV2), GAD65, Ma2/Ta, myelin, PCA1 (Yo), PCA2, and PCA-Tr (DNER) antibodies with reflex to a line blot for AGNA1/SOX1, amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CRMP5 (CV2), GAD65, Ma2/Ta, PCA1 (Yo), PCA-Tr (DNER), and Zic4 antibodies; and a CBA screen for AMPAR1, AMPAR2, CASPR2, GABA-B receptor, LGI1, and NMDAR antibodies. Results suggesting AMPAR1, AMPAR2, ANNA3, CASPR2, GABA-B receptor, LGI1, NMDAR, or PCA2 antibodies reflex to respective titers; results suggesting myelin antibody reflex to titer and MAG antibody (WB) with reflex to MAG-SGPG antibody and MAG antibody (EIA); tissue IFA results suggesting PCA-Tr (DNER) antibody with negative PCA-Tr (DNER) and Yo line blot results reflex to PCA-Tr (DNER) CBA with reflex to titer. Also includes AQP4 antibody (CBA) with reflex to titer, DPPX receptor antibody with reflex to titer; and AChR ganglionic (alpha 3), VGCC type N, VGCC type P/Q, and VGKC antibodies.
94959^a,c	Epilepsy Antibody Evaluation With Reflex to Titer and Line Blot, CSF Includes a tissue IFA screen for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), ANNA3, AQP4, CRMP5 (CV2), GAD65, Ma2/Ta, myelin, PCA1 (Yo), PCA2, and PCA-Tr (DNER) antibodies with reflex to a line blot for AGNA1/SOX1, amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CRMP5 (CV2), GAD65, Ma2/Ta, PCA1 (Yo), PCA-Tr (DNER), and Zic4 antibodies; and a CBA screen for AMPAR1, AMPAR2, CASPR2, GABA-B receptor, LGI1, and NMDAR antibodies. Results suggesting AMPAR1, AMPAR2, ANNA3, CASPR2, GABA-B receptor, LGI1, NMDAR, or PCA2 antibodies reflex to respective titers; results suggesting myelin antibody reflex to titer; tissue IFA results suggesting PCA-Tr (DNER) antibody with negative PCA-Tr (DNER) and Yo line blot results reflex to PCA-Tr (DNER) CBA with reflex to titer. Also includes AQP4 antibody (CBA) with reflex to titer, DPPX receptor antibody with reflex to titer; and VGKC antibody.
94956^a,c	Epilepsy Antibody Evaluation With Reflex to Titer and Line Blot, Serum Includes a tissue IFA screen for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), ANNA3, AQP4, CRMP5 (CV2), GAD65, Ma2/Ta, myelin, PCA1 (Yo), PCA2, and PCA-Tr (DNER) antibodies with reflex to a line blot for AGNA1/SOX1, amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CRMP5 (CV2), GAD65, Ma2/Ta, PCA1 (Yo), PCA-Tr (DNER), and Zic4 antibodies; and a CBA screen for AMPAR1, AMPAR2, CASPR2, GABA-B receptor, LGI1, and NMDAR antibodies. Results suggesting AMPAR1, AMPAR2, ANNA3, CASPR2, GABA-B receptor, LGI1, NMDAR, or PCA2 antibodies reflex to respective titers; results suggesting myelin antibody reflex to titer and MAG antibody (WB) with reflex to MAG-SGPG antibody and MAG antibody (EIA); tissue IFA results suggesting PCA-Tr (DNER) antibody with negative PCA-Tr (DNER) and Yo line blot results reflex to PCA-Tr (DNER) CBA with reflex to titer. Also includes AQP4 antibody (CBA) with reflex to titer, DPPX receptor antibody with reflex to titer; and AChR ganglionic (alpha 3), VGCC type N, VGCC type P/Q, and VGKC antibodies.
90138^a,c	Hu, Yo, and Ri Antibodies With Reflex to Titers and Western Blot Includes ANNA1 (Hu), ANNA2 (Ri), and PCA1 (Yo) antibodies (IFA) with reflexes for each analyte to WB with reflex to titer.
90122^a,c	Hu, Yo, and Ri Antibodies With Reflex to Titers and Western Blot, CSF Includes ANNA1 (Hu), ANNA2 (Ri), and PCA1 (Yo) antibodies (IFA) with reflexes for each analyte to WB with reflex to titer.
11306^a,c	Lambert-Eaton Syndrome Antibody Panel Includes AChR binding and modulating antibodies; striated muscle antibody screen with reflex to titer; and VGCC type P/Q antibody.
7550(X)^a,c	Myasthenia Gravis Panel 1 Includes AChR binding antibody and striated muscle antibody with reflex to titer.
10104^a	Myasthenia Gravis Panel 2 Includes AChR binding, blocking, and modulating antibodies.
93859^a,c	Myasthenia Gravis Panel 2 With Reflex to MuSK Antibody Includes AChR binding, blocking, and modulating antibodies with reflex to MuSK antibody.
10211(X)^a,c	Myasthenia Gravis Panel 3 Includes AChR binding, blocking, and modulating antibodies; and striated muscle antibody with reflex to titer.
91623^b	NeoCerebellar Degeneration Paraneoplastic Evaluation With Recombx^® Includes amphiphysin, ANNA1 (Hu), ANNA2 (Ri) CRMP5 (CV2), GAD65, MaTa, PCA1 (Yo), and Zic4 antibodies.
91636^b	NeoComplete Paraneoplastic Evaluation With Recombx^® Includes AChR ganglionic, amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CASPR2, CRMP5 (CV2), GAD65, LGI1, MaTa, NMDAR (NR1), PCA1 (Yo), recoverin, VGCC, and Zic4 antibodies.
91622^b	NeoEncephalitis Paraneoplastic Evaluation With Recombx^® Includes amphiphysin, ANNA1 (Hu), CASPR2, CRMP5 (CV2), GAD65, LGI1, MaTa, NMDAR (NR1), and VGKC antibodies.
4725^f	NeoSensory Neuropathy Paraneoplastic Profile With Recombx^® Includes Recombx^® amphiphysin,CV2 and Hu antibodies.
93890^a	Neurology Antibody, CBA IFA Includes AMPAR1, AMPAR2, CASPR2, GABA-B-R, LGI1, and NMDAR1 antibodies.
93892^a	Neurology Antibody, Line Blot Includes AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CRMP5 (CV2), GAD65, Ma2/Ta, PCA1 (Yo), PCA-Tr (DNER), recoverin, titin, and Zic4 antibodies.
93876^a,c	Paraneoplastic Antibody Evaluation With Reflex to Titer and Line Blot, Basic Includes AChR binding antibody with reflex to AChR modulating antibody; striated muscle antibody with reflex to titer; and AChR (ganglionic), VGCC type N, VGCC type P/Q, and VGKC antibodies. Also includes a tissue IFA screen for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), ANNA3, CRMP5 (CV2), PCA1 (Yo), PCA2, and PCA-Tr (DNER) antibodies; positive or equivocal AChR binding antibody results and/or tissue IFA results that are positive, indeterminate, and/or suggesting GAD65 or CRMP5 (CV2) antibodies reflex to a line blot for amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CRMP5 (CV2), GAD65, and PCA1 (Yo); tissue IFA results positive for ANNA3 or PCA2 antibodies reflex to respective titers; tissue IFA results suggesting AQP4 antibody reflex to AQP4 antibody (CBA); tissue IFA results suggesting AMPAR1/2, GABA-B receptor, or NMDAR antibodies reflex to a CBA for AMPAR1, AMPAR2, GABA-B receptor, and NDMAR antibodies.
94536^a,c	Paraneoplastic Antibody Evaluation With Reflex to Titer and LB, Basic, CSF Includes a tissue IFA screen for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), ANNA3, AQP4, CRMP5 (CV2), GAD65, PCA1 (Yo), PCA2, and PCA-Tr (DNER) antibodies; tissue IFA results positive or indeterminate for amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CRMP5 (CV2), GAD65, PCA1 (Yo), or PCA-Tr (DNER) antibodies reflex to a line blot for amphiphysin, ANNA1 (Hu), ANNA2 (Ri), AQP4, CRMP5 (CV2), GAD65, PCA1 (Yo), PCA2, and PCA-Tr (DNER); tissue IFA results positive for ANNA3 or PCA2 antibodies reflex to respective titers; tissue IFA results positive for AQP4 antibody reflex to AQP4 antibody (CBA) with reflex to titer; tissue IFA results suggesting LGI1, CASPR2, or voltage-gated ion channel antibodies reflex to VGKC antibody; tissue IFA results suggesting AMPAR1, AMPAR2, CASPR2, GABA-B receptor, LGI1, NMDAR, or voltage-gated ion channel antibodies reflex to a CBA for AMPAR1, AMPAR2, CASPR2, GABA-B receptor, LGI1, and NMDAR. CBA results positive for AMPAR1, AMPAR2, CASPR2, GABA-B receptor, LGI1, or NMDAR reflex to respective titers.
94603^b	Paraneoplastic Autoantibody Evaluation With Recombx^®, CSF Includes amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CASPR2, CRMP5 (CV2), LGI1, MaTa, NMDAR, PCA1 (Yo), recoverin, and Zic4 antibodies.
94957^a,c	Paraneoplastic Antibody Expanded Evaluation With Reflex to Titer and LB, Serum Includes a tissue IFA screen for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), ANNA3, AQP4, CRMP5 (CV2), GAD65, Ma2/Ta, myelin, PCA1 (Yo), PCA2, and PCA-Tr (DNER) antibodies; a CBA screen for AMPAR1, AMPAR2, CASPR2, GABA-B receptor, LGI1, and NMDAR antibodies; and a line blot for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CRMP5 (CV2), GAD65, Ma2/Ta, PCA1 (Yo), PCA-Tr (DNER) , and Zic4 antibodies. Results suggesting AMPAR1, AMPAR2, ANNA3, CASPR2, GABA-B receptor, LGI1, NDMAR, or PCA2 antibodies reflex to respective titers; results suggesting AQP4 antibody reflex to AQP4 antibody (CBA) with reflex to titer; results suggesting myelin antibody reflex to titer and MAG antibody (WB) with reflex to MAG-SGPG antibody and MAG antibody (EIA); tissue IFA results suggesting PCA-Tr (DNER) antibody with negative PCA-Tr (DNER) and Yo line blot results reflex to PCA-Tr (DNER) CBA with reflex to titer. Also includes DPPX receptor antibody with reflex to titer; and AChR ganglionic (alpha 3), VGCC type N, VGCC type P/Q, and VGKC antibodies.
94960^a,c	Paraneoplastic Antibody Expanded Evaluation With Reflex to Titer and Line Blot, CSF Includes a tissue IFA screen for AGNA (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), ANNA3, AQP4, CRMP5 (CV2), GAD65, Ma2/Ta, myelin, PCA1 (Yo), PCA2, and PCA-Tr (DNER) antibodies with reflex to a line blot for AGNA1 (SOX1), amphiphysin, ANNA1 (Hu), ANNA2 (Ri), CRMP5 (CV2), GAD65, Ma2/Ta, PCA1 (Yo), PCA-Tr (DNER), and Zic4 antibodies; and a CBA screen for AMPAR1, AMPAR2, CASPR2, GABA-B receptor, LGI1, and NMDAR antibodies. Results suggesting AMPAR1, AMPAR2, ANNA3, CASPR2, GABA-B receptor, LGI1, NMDAR, or PCA2 antibodies reflex to respective titers; results suggesting myelin antibody reflex to titer; tissue IFA results suggesting PCA-Tr (DNER) antibody with negative PCA-Tr (DNER) and Yo line blot results reflex to PCA-Tr (DNER) CBA with reflex to titer. Also includes AQP4 antibody (CBA) with reflex to titer, DPPX receptor antibody with reflex to titer; and VGKC antibody.
4683^b	Recombx^® MaTa Autoantibody Test Includes Ma and Ta antibodies.
94604^b	SensoriMotor Neuropathy Profile With Recombx^® Complete Includes ANNA1 (Hu), Co-asialo-GM-1, GALOP, GD1a, Co-GD1b, Co-GM-1, SGPG, MAG, and sulfatide antibodies.
90136^a,c	Sensory-Motor Neuropathy Complete Antibody Panel Includes ANA Screen (IFA) with reflex to titer and pattern; ANCA screen with reflex to C-ANCA, P-ANCA, and/or atypical P-ANCA titer; ANNA1 (Hu) antibody screen with reflex to WB with reflex to titer; cryoglobulin screen with reflex to % cryoglobulin (cryocrit) and cryoglobulin immunofixation and immunodiffusion; ganglioside asialo-GM-1 IgG and IgM antibodies; ganglioside GD1a IgG and IgM, ganglioside GD1b IgG and IgM, ganglioside GM-1 IgG and IgM, and ganglioside GQ1b IgG antibodies; IgA level with reflex to tissue transglutaminase IgG; IgG level; IgM level; immunofixation; MAG IgM antibody (WB) with reflexes to MAG-SGPG IgM and MAG IgM (EIA) antibodies; MPO antibody, PR3 antibody, RF, SS-A, and SS-B antibodies; and tissue transglutaminase IgA antibody with reflexes to endomysial antibody and titer.
15977^a,c	Sensory Neuropathy Complete Antibody Panel Includes ANA Screen (IFA) with reflex to titer and pattern; ANCA screen with reflex to C-ANCA, P-ANCA, and/or atypical P-ANCA titer; ANNA1 (Hu) antibody with reflex to WB with reflex to titer; cryoglobulin screen with reflex to % cryoglobulin (cryocrit) and cryoglobulin immunofixation and immunodiffusion; ganglioside GD1b IgG and IgM and ganglioside GQ1b IgG antibodies; IgA level with reflex to tissue transglutaminase IgG; IgG level; IgM level; immunofixation; MAG IgM antibody (WB) with reflexes to MAG-SGPG IgM and MAG IgM (EIA) antibodies; MPO antibody; PR3 antibody; RF; SS-A and SS-B antibodies; and tissue transglutaminase IgA antibody with reflexes to endomysial antibody with reflex to titer.

CBA, cell-binding assay; CSF, cerebrospinal fluid; IFA, immunofluorescence assay; LB, line blot; WB, Western blot.
a	This test was developed and its analytical performance characteristics have been determined by Quest. It has not been cleared or approved by the US Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
b	This test was developed and its analytical performance characteristics have been determined by Athena Diagnostics. It has not been cleared or approved by the US Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
c	Reflex tests are performed at an additional charge and are associated with additional CPT^® codes.
d	This test was performed using a kit that has not been cleared or approved by the FDA. The analytical performance characteristics of this test have been determined by Quest. This test should not be used for diagnosis without confirmation by other medically established means.
e	Some panel components may be ordered separately (see preceding list of single antibody tests).
f	Refer to Athena Diagnostics for test information. This test is performed by Athena Diagnostics.

References [return to contents]

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Vernino S, Tuite P, Adler CH, et al. Paraneoplastic chorea associated with CRMP-5 neuronal antibody and lung carcinoma. Ann Neurol. 2002;51(5):625-630. doi:10.1002/ana.10178
Lancaster E, Lai M, Peng X, et al. Antibodies to the GABAB receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol. 2010;9(1):67-76. doi:10.1016/S1474-4422(09)70324-2
Kim J, Namchuk M, Bugawan T, et al. Higher autoantibody levels and recognition of a linear NH2-terminal epitope in the autoantigen GAD65, distinguish stiff-man syndrome from insulin-dependent diabetes mellitus. J Exp Med. 1994;180(2):595-606. doi:10.1084/jem.180.2.595
Mathew RM, Vandenberghe R, Garcia-Merino A, et al. Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis. Neurology. 2007;68(12):900-905. doi:10.1212/01.wnl.0000252379.81933.80
Magy L, Kaboré R, Mathis S, et al. Heterogeneity of polyneuropathy associated with anti-MAG antibodies. J Immunol Res. 2015;2015:450391. doi:10.1155/2015/450391
Graus F, Dalmau J, Valldeoriola F, et al. Immunological characterization of a neuronal antibody (anti-Tr) associated with paraneoplastic cerebellar degeneration and Hodgkin's disease. J Neuroimmunol. 1997;74(1-2):55-61. doi:10.1016/S0165-5728(96)00205-6
Motomura M, Lang B, Johnston I, et al. Incidence of serum anti-P/O-type and anti-N-type calcium channel autoantibodies in the Lambert-Eaton myasthenic syndrome. J Neurol Sci. 1997;147(1):35-42. doi:10.1016/S0022-510X(96)05303-8
Takamori M, Takahashi M, Yasukawa Y, et al. Antibodies to recombinant synaptotagmin and calcium channel subtypes in Lambert-Eaton myasthenic syndrome. J Neurol Sci. 1995;133(1-2):95-101. doi:10.1016/0022-510X(95)00162-U
Nakao YK, Motomura M, Fukudome T, et al. Seronegative Lambert-Eaton myasthenic syndrome: study of 110 Japanese patients. Neurology. 2002;59(11):1773-1775. doi:10.1212/01.WNL.0000037485.56217.5F
Howard FM, Jr., Lennon VA, Finley J, et al. Clinical correlations of antibodies that bind, block, or modulate human acetylcholine receptors in myasthenia gravis. Ann N Y Acad Sci. 1987;505:526-538. doi:10.1111/j.1749-6632.1987.tb51321.x
Sabater L, Titulaer M, Saiz A, et al. SOX1 antibodies are markers of paraneoplastic Lambert-Eaton myasthenic syndrome. Neurology. 2008;70(12):924-928. doi:10.1212/01.wnl.0000281663.81079.24
Lai M, Hughes EG, Peng X, et al. AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Ann Neurol. 2009;65(4):424-434. doi:10.1002/ana.21589
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Content reviewed 4/2026

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Related tests (58)

11306 - Lambert-Eaton Syndrome Antibody Panel

Lambert-Eaton myasthenic syndrome is a paraneoplastic phenomena associated with small cell lung cancer. There is a decrease of voltage-gated calcium channels on presynaptic nerve terminals due to an auto-antibody reactive with the channels. There is an associated proximal muscle weakness and often coexisting thyroid autoimmune disease and vitiligo.

91623 - NeoCerebellar Degeneration Paraneoplastic Profile with Recombx®

Anti-CV2, anti-Hu, anti-Ma, anti-Ta, anti-Ri, anti-Yo, anti-Zic4 antibodies, and anti-GAD65 are found in patients with acute or subacute symptoms of cerebellar degeneration including gait ataxia, nystagmus and/or dysarthria, and opsoclonus/myoclonus. This semi-quantitative assay may be useful in monitoring therapeutic responses in select cases.

206 - Acetylcholine Receptor Binding Antibody

Myasthenia Gravis (MG) is an autoimmune neuromuscular disorder characterized by muscle weakness, most commonly due to autoantibody-mediated loss of functional acetylcholine receptors (AChR) in the neuromuscular junction. AChR binding autoantibodies are diagnostic of MG, and are found in 85-90% of MG patients. This assay aids in the differential diagnosis of conditions with MG-like muscle weakness and in monitoring therapeutic response. If binding antibodies are negative, assays for modulating and blocking antibodies should be considered.

26474 - Acetylcholine Receptor Modulating Antibody

Myasthenia Gravis (MG) is an autoimmune neuromuscular disorder characterized by muscle weakness, most commonly due to autoantibody-mediated loss of functional acetylcholine receptors (AChR) in the neuromuscular junction. AChR binding autoantibodies are diagnostic of MG, and are found in 85-90% of MG patients. AChR modulating antibodies cross-link AChR molecules on cell surface, promoting internalization, and decreasing AChR surface density. The AChR binding and modulating antibody assays have similar sensitivities, but performing them together increases sensitivity of antibody detection by approximately 5%.

94743 - RyR Autoantibody Test

Detects anti-RyR (ryanodine receptor) in the sera of patients with Myasthenia Gravis (MG). Other striational antibodies, such as titin, are rarely found in acetylcholine receptor (AChR) antibody-negative MG. Anti-titin is detected in 20% to 40% of all MG patients and anti-RyR in 13% to 38%. Anti-titin (49% to 95%) and anti-RyR (70% to 80%) are frequently found in thymoma associated-MG cases.

93890 - Neurology Antibody, CBA IFA

Autoantibodies to brain neurotransmitter cell surface receptors may be seen in paraneoplastic syndromes or in idiopathic autoimmune encephalitis. Antibodies to N-methyl-D-aspartate receptor (NMDAR1) may be seen in a progressive syndrome leading to behavioral changes, psychosis, seizures and coma; teratoma or other neoplasms are seen in some cases. Antibodies to voltage gated potassium channel (VGKC) are found in paraneoplastic and idiopathic autoimmune encephalopathy; in many cases, antibodies actually target VGKC-associated proteins LGI-1 or CASPR2. Antibodies to AMPAR1 and AMPAR2 are usually associated with limbic encephalitis but can present with other symptoms or psychosis, and is paraneoplastic in >50% of cases.

93882 - Voltage-Gated Calcium Channel (VGCC) Type N Antibody

N-type calcium channel antibodies are more highly associated with primary lung cancer than P/Q-type. One or all of the autoantibodies in the myasthenia gravis (MG)/LEMS evaluation can occur with neoplasia without evidence of neurological impairment. One or both calcium channel antibodies (P/Q and N) can occur with paraneoplastic and idiopathic cerebellar ataxia, encephalomyeloneuropathies, and autonomic neuropathy. Classical symptoms of LEMS include proximal muscle weakness, fatigability, dry mouth and impotence. When presentation is further complicated with oculobulbar weakness, these symptoms can easily be misinterpreted as MG. However, because VGCC antibodies are positive in only approximately 5% of MG patients, the measurement of these antibodies is very useful in distinguishing LEMS from MG.

93876 - Paraneoplastic Antibody Evaluation w/Reflex to Titer and Line Blot,Basic

Detection of antineuronal autoantibodies aids the diagnosis of paraneoplastic syndromes and autoimmune encephalopathies and related conditions. Identification of specific antineuronal autoantibodies may direct evaluation for underlying often occult malignancy. Characterization of autoantibody specificity may allow syndromic classification and assist in diagnosis and management. Antineuronal antibodies are detected and characterized based on indirect immunofluorescence staining pattern on multiple neuronal, non-neuronal tissues, and transformed substrate cells, and radioimmunoassays, and western blot analysis.

4683 - Recombx® MaTa Autoantibody Test

Anti-Ma and anti-Ta antibodies can be detected in patients with a wide range of paraneoplastic neurological syndromes including acute or subacute onset of symptoms of limbic encephalitis, brainstem encephalitis, cerebellar degeneration, or polyneuropathy. This semi-quantitative assay may be useful in monitoring therapeutic responses in select cases.

4681 - Recombx® CV2 Autoantibody Test

Anti-CV2 antibody can be detected in patients with paraneoplastic neurological syndromes that include the acute or subacute onset of a sensory neuropathy, limbic encephalitis, encephalomyelitis, chorea, or cerebellar degeneration. This semi-quantitative assay may be useful in monitoring therapeutic responses in select cases.

4674 - Recombx® Amphiphysin Autoantibody Test

Anti-Amphiphysin antibody is found in patients with sensory neuropathy, Stiff-Person syndrome, paraneoplastic encephalomyelitis (PEM), limbic encephalitis, or myelopathy. This semi-quantitative assay may useful in monitoring therapeutic responses in select cases.

91636 - NeoComplete Paraneoplastic Evaluation with Recombx®

Anti-Hu, anti-CV2, anti-Yo, anti-Ri, anti-CAR, anti-Ma, anti-Ta, anti-Zic4 antibodies, anti-voltage gated calcium channels (VGCC), anti-P/Q type and voltage gated potassium channels (VGKC), anti- Ganglionic AChR, anti-Amphiphysin, anti-NMDA receptor (NR1-subunit), anti-LGI1, anti-CASPR2, and anti-GAD65 are found in patients with the acute or subacute onset of limbic encephalitis, brainstem encephalitis, focal cortical encephalitis, myelitis, cerebellar degeneration, opsoclonus/myoclonus, retinopathy, sensory neuropathy, autonomic dysfunction, Stiff Person Syndrome and/or Lambert-Eaton Myasthenic Syndrome. This semi-quantitative assay may be useful in monitoring therapeutic responses in select cases.

94956 - Epilepsy Antibody Evaluation with Reflex to Titer and Line Blot, Serum

The Epilepsy Antibody Evaluation panel provides an evaluation of possible autoantibodies in patients with suspected autoimmune epilepsy, and optimizes the likelihood of detecting neuronal specific autoantibodies, whether present singly or occurring as multiple autoantibodies.

94960 - Paraneoplastic Antibody Expanded Evaluation with Reflex to Titer and LB, CSF

Detection of antineuronal autoantibodies aids the diagnosis of autoimmune paraneoplastic syndromes, encephalopathies, and other autoimmune neurological conditions. Identification of specific antineuronal autoantibodies may also help in the diagnostic workup for occult malignancies. Finally, knowledge of the specific identity of antineuronal autoantibodies aids greatly in making therapeutic decisions for patients. Antineuronal antibodies are detected and identified by Indirect Immunofluorescence, using multiple neuronal tissues, non-neuronal tissues, and transfected substrate cells, as well as Radioimmunoassays. Line Blot assays are used for confirmatory reflex testing.

90136 - Sensory-Motor Neuropathy Complete Antibody Panel

Sensory-motor neuropathies may occur by various mechanisms. These include development of autoantibodies to neuronal structures such as myelin associated glycoprotein (MAG) antibody, Hu antibody, and the ganglioside antibodies. Sensory-motor neuropathies may also occur via antibody cross-reactivity or local immune complex deposition as seen in autoimmune disease with primarily non-neuronal targets including Sjogren's syndrome (SSA/SSB), systemic lupus erythematosus and related conditions (ANA IFA), celiac disease (tTG antibody), vasculitis (ANCA), and immune complex deposition (cryoglobulins, rheumatoid factor). Motor-sensory neuropathy may be associated with monoclonal gammopathy (serum immunofixation and serum immunoglobulins).

91622 - NeoEncephalitis Paraneoplastic Evaluation with Recombx®

Anti-Hu, anti-CV2, anti-Ma, anti-Ta, anti-voltage gated potassium channels (VGKC), anti-Amphiphysin, anti-GAD65, anti-NMDA receptor (NR1-subunit), anti- LGI1, and anti-CASPR2 antibodies are found in patients with the acute or subacute onset of limbic encephalitis including confusion/dementia, depression/anxiety and/or seizures or hallucinations and usually MRI changes in medial temporal lobes. This semi-quantitative assay may be useful in monitoring therapeutic responses in select cases.

90138 - Hu, Yo, and Ri Antibodies with Reflex to Titers and Western Blot

Hu anti-neuronal nuclear antibody (anti-Hu) is found in 5-10% of patients with small cell carcinoma of the lung. Purkinje cell (Yo) antibody is found in patients with paraneoplastic cerebellar degeneration and is associated with breast, ovarian, and other gynecologic cancers. Some patients with ovarian cancer have low titers of Yo antibodies in the absence of cerebellar degeneration. Anti-Hu antibodies are associated with paraneoplastic encephalomyelitis and sensory neuropathy. Anti-Ri antibody can be detected in patients with paraneoplastic opsoclonus/myoclonus syndrome. Neoplasms most often associated with anti-Ri include breast cancer, small cell lung cancer, and gynecological cancers.

93891 - DPPX Receptor Antibody, CBA

Dipeptidyl peptidase-like protein 6 (DPPX) is a regulatory subunit of voltage gated potassium channels in neurons of the central nervous system. Antibodies to DPPX have been associated with agitation, confusion, amnesia, delirium, allodynia, myoclonus, rigidity, tremor, exaggerated startle, ataxia, dysphagia, dysarthria seizures, psychosis, depression, sleep disturbance, respiratory failure and unexplained diarrhea, gastroparesis constipation, bladder dysautonomia, and abnormalities in cardiac conduction and thermoregulation.

93888 - Autoimmune Neurology Antibody Comprehensive Panel with Reflexes, Serum

A comprehensive approach to detection of known antineuronal autoantibodies aids the diagnosis of paraneoplastic syndromes and autoimmune encephalopathies and related conditions. Identification of specific antineuronal autoantibodies may direct evaluation for idiopathic autoimmune disease or underlying often occult malignancy. Characterization of autoantibody specificity may allow syndromic classification and assist in diagnosis and management. Antineuronal antibodies are detected and characterized based on indirect immunofluorescence staining pattern on multiple neuronal, non-neuronal tissues, and transformed substrate cells, and radioimmunoassays, and line blot analysis.

93892 - Neurology Antibody, Line Blot

Western line blot aids in the identification of specific anti-neuronal autoantibodies which can help establish a paraneoplastic syndrome diagnosis and may aid identification of the likely underlying tumor. The most commonly associated malignancies include small cell lung, breast and ovarian cancers, and hematologic malignancies. Clinical presentation of a given antibody may differ amongst patients; different antibodies may cause similar or identical clinical presentations. Paraneoplastic antibodies may be found in the absence of identifiable tumor.

10104 - Myasthenia Gravis Panel 2

Myasthenia Gravis is a neurological disorder characterized by a decrease in acetylcholine receptors. Patients exhibit skeletal muscle weakness and fatigability. Approximately 80% of patients with Myasthenia Gravis, excluding ocular involvement only, have detectable acetylcholine receptor antibody.

10211 - Myasthenia Gravis Panel 3

10140 - Ri Antibody Screen with Reflex to Titer and Western Blot

Anti-Ri can be detected in patients with the paraneoplastic opsoclonus/myoclonus syndrome. Neoplasms most often associated with Anti-Ri include breast cancer, gynecological cancers, and small cell lung cancer.

90117 - Yo Antibody Screen with Reflex to Titer and Western Blot, CSF

Purkinje Cell (Yo) antibody is found in approximately half of the patients with paraneoplastic cerebellar degeneration and is associated with ovarian, uterine, and small cell lung carcinomas and Hodgkin’s lymphoma.

92413 - CASPR2 Antibody Test

Anti-CASPR2 antibodies are found in patients with the acute or subacute onset of symptoms of limbic encephalitis, peripheral nerve hyperexcitability, and neuromyotonia.

92416 - LGI1 Antibody Test

Anti-LGI1 antibody is found in patients with the acute or subacute onset of limbic encephalitis, or faciobrachial dystonic seizures.

34459 - Acetylcholine Receptor Blocking Antibody

Myasthenia Gravis (MG) is an autoimmune neuromuscular disorder characterized by muscle weakness, most commonly due to autoantibody-mediated loss of functional acetylcholine receptors (AChR) in the neuromuscular junction. AChR binding autoantibodies are diagnostic of MG, and are found in 85-90% of MG patients. AChR blocking autoantibodies prevent inter-action of binding antibodies with the AChR. Fewer than 1% of patients have blocking antibodies without binding antibodies. Blocking antibodies are present in about 50% of patients with MG, but rare in other conditions. Therefore, blocking antibodies have utility in ruling out a possible false positive binding assay and detecting the rare patient without AChR binding antibodies.

90122 - Hu, Yo, and Ri Antibodies with Reflex to Titers and Western Blot, CSF

94536 - Paraneoplastic Antibody Evaluation with Reflex to Titer and LB, Basic, CSF

Fluorescent staining patterns on multiple neuronal and non-neuronal tissues identify likely autoantibodies present. Reflex testing to western line blot, cell based indirect immunofluorescent assay or radioimmunoassay may define specific autoantibodies.

4684 - Recombx® CAR (Anti-Recoverin) Autoantibody Test

Anti-recoverin antibodies can be detected in patients with cancer-associated retinopathy (CAR). This semi-quantitative assay may be useful in monitoring therapeutic responses in select cases.

4689 - Recombx® Zic4 Autoantibody Test

Anti-Zic4 antibody is usually found in patients with paraneoplastic cerebellar degeneration and is associated with small cell lung carcinoma. This semi-quantitative assay may be useful in monitoring therapeutic responses in select cases.

93859 - Myasthenia Gravis Panel 2 with Reflex to MuSK Antibody

Myasthenia gravis (MG) is an autoimmune disorder affecting the neuromuscular junction. 80% of patients with generalized MG have serum antibodies to AChR - Blocking, Binding, or Modulating. Antibodies to MuSK make up a variable proportion of the remaining 20%.

37053 - Hu Antibody Screen with Reflex to Titer and Western Blot

Paraneoplastic Syndrome involves non-metastatic systemic effects that accompany malignant disease. Antineuronal Nuclear Antibody (Anti-Hu) is found in 5-10% of patients with small cell carcinoma of the lung. Anti-Hu is associated with subacute syndrome of encephalomyeloradiculopathy, sensory neuropathy, and autoimmune neuropathy, predominantly affecting the gastrointestinal tract.

93881 - Acetylcholine Receptor Ganglionic (Alpha 3) Antibody

The G-nAChR autoantibody assay can be used to identify Autoimmune Autonomic Ganglionopathy (AAG) or paraneoplastic AAG in patients with autonomic neuropathy. Identification of paraneoplastic AAG in a patient is important, as there is an association between increased levels of G-nAChR antibodies and small-cell lung cancer (SCLC) or thymoma. Detection of paraneoplastic AAG, followed by resection and/or treatment of the patients’ tumor, can lead to a successful patient recovery. The G-nAChR autoantibody assay can be used as a serological diagnostic tool to differentiate patients suffering from immmunotreatment-responsive AAG from idiopathic autonomic neuropathy. Both conditions can present as acquired Autonomic Nervous System (ANS) dysfunction characterized by diffuse autonomic nervous system failure. The demonstration of AAG can lead to a focused immunological treatment and successful patient recovery. The G-nAChR antibody assay can also identify patients with limited forms of dysmotility, diabetic autonomic neuropathy, or postural tachycardia syndrome.

94604 - SensoriMotor Neuropathy Profile with Recombx®-Complete

Anti-MAG, anti-SGPG, anti-GM1, anti-GD1a, anti-GD1b, anti-asialo GM1, anti-sulfatide, anti-Hu, and IgM GALOP antibodies are found in patients with a peripheral neuropathy and mixed sensory and motor symptoms. This semi-quantitative assay may be useful in monitoring therapeutic responses in select cases.

94603 - Paraneoplastic Autoantibody Evaluation with Recombx®, CSF

Anti-Hu, anti-CV2, anti-Yo, anti-Ri, anti-CAR, anti-Ma, anti-Ta, anti-Zic4, anti-Amphiphysin, anti-NMDA receptor (NR1-subunit), anti-LGI1 and anti-CASPR2 are found in patients with the acute or subacute onset of limbic encephalitis, brainstem encephalitis, focal cortical encephalitis, myelitis, cerebellar degeneration, opsoclonus/ myoclonus, retinopathy, sensory neuropathy, autonomic dysfunction, Stiff Person Syndrome and/or Lambert-Eaton Myasthenic Syndrome. This semi-quantitative assay may be useful in monitoring therapeutic responses in select cases.

94605 - Autoimmune Epilepsy Evaluation

Anti-GAD65 antibodies, anti-voltage gated potassium channels (VGKC), anti-CASPR2, anti-LGI1, and anti-NMDA receptor (NR1 subunit) antibodies are found in patients with epilepsy with an acute/subacute presentation without evidence of CNS infection, toxic, metabolic, or other known cause of epilepsy, and possibly with evidence of CNS inflammation.

38323 - Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, CSF

NMO (neuromyelitis optica, Devic disease) is an immune- mediated chronic inflammatory disease that predominantly affects the optic nerve and spinal cord and presents with optic neuritis (ON) and myelitis. Limited forms of this disease, such as isolated ON, brainstem encephalitis and longitudinal extensive transverses myelitis (LETM), have been referred to as NMO spectrum disorders (NMOSD). NMO was originally thought to be a variant of multiple sclerosis, but is now recognized as a distinct disease. The presence of serum antibodies against aquaporin-4 (AQP4) is associated with NMO and NMOSD.

38321 - Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum

92792 - Titin Autoantibody Test

Anti-titin antibody is a striational antibody that is associated with myasthenia gravis with an older age of onset (approximately >60 years). Anti-titin antibodies are detected in patients with thymoma associated-MG.

93893 - Aquaporin-4 Antibody (IgG), CBA

Antibody to Aquaporin 4 causes neuromyelitis optica (NMO), a demyelinating disease of the central nervous system often confused diagnostically with multiple sclerosis (MS) and/or transverse myelitis. NMO causes optic neuritis and transverse myelitis. Early discrimination between MS and NMO is important, as optimum treatment for both diseases may differ considerably.

93883 - Voltage-Gated Potassium Channel (VGKC) Antibody

Limbic encephalitis (LE) is a paraneoplastic neurological syndrome often associated with small cell lung carcinoma and more rarely with testicular, breast, and other tumors. Clinical hallmarks of paraneoplastic limbic encephalitis are changing mental status, short-term memory impairment, seizures, confusion, and behavioral changes. Hu antibody-negative LE patients usually do not develop symptoms beyond the limbic system and appear to improve more often after treatment of the cancer than those who have Hu antibodies, suggesting that the pathogenesis of the LE in both groups could be different. Recent studies have detected antibodies to voltage-gated potassium channels (VGKC) in patients with LE, with and without associated tumors. Neurological symptoms were found to improve with a reduction of VGKC antibody levels.

93894 - Purkinje Cell Cytoplasmic Antibody Type Tr (DNER), CBA IFA

Delta/notch-like epidermal growth factor-related receptor (DNER) is a central nervous system-specific ligand for the Notch receptors expressed by cerebellar Purkinje neurons, essential for the normal development of Purkinje cells and Bergmann glia. DNER is the target of PCA-Tr antibodies associated with paraneoplastic cerebellar degeneration (PCD) in patients with Hodgkin's lymphoma.

90133 - Autoimmune Cerebellar Ataxia Panel

Cerebellar ataxia may occur as a result of autoantibodies to cerebellar targets. These may include antibodies to the Purkinje cell antigen Yo, the voltage gated calcium channel (VGCC) or tissue transglutaminase (tTG). Glutin ataxia is associated with widespread tissue transglutaminase (tTG) IgA deposition around vessels in the cerebellum, pons, and medulla.

90121 - Ri Antibody Screen with Reflex to Titer and Western Blot, CSF

90382 - Aquaporin-4 (AQP4) Antibody (NMO-IgG), ELISA

Confirm suspected cases of NMO and assist in making a differential diagnosis and identifying the cause of MS-like symptoms in the patient. An accurate diagnosis will further help predict disease course and provide direction in treatment options.

37710 - Hu Antibody Screen with Reflex to Titer and Western Blot, CSF

94958 - Encephalitis Antibody Evaluation with Reflex to Titer and Line Blot, CSF

Encephalitis due to anti-neuronal autoantibodies may present in a variety of ways and may be associated with a variety of tumors. Screening for anti-neuronal autoantibodies is performed using tissue immunofluorescence with confirmation by line blot assay. This CSF panel also includes additional testing for autoantibodies frequently associated with encephalitis such as NMDA receptor using cell-based assays. Testing using both serum and CSF increases sensitivity for detection.

94959 - Epilepsy Antibody Evaluation with Reflex to Titer and Line Blot, CSF

Seizure disorder may be the initial presentation of encephalitis due to anti-neural autoantibodies, especially during the acute phase and in younger patients. In addition to screening for a variety of anti-neural autoantibodies using tissue immunofluorescence, this CSF panel includes testing for autoantibodies frequently associated with seizures such as GABA-B receptor, LGI1 and NMDA receptor using cell-based assays. Testing using both CSF and serum increases sensitivity for detection

90119 - Yo Antibody Screen with Reflex to Titer and Western Blot

34057 - Voltage-Gated Calcium Channel (VGCC) Type P/Q Antibody

To diagnose Lambert-Eaton myasthenic syndrome, a paraneoplastic syndrome associated with small-cell lung carcinoma.

37078 - Myelin Associated Glycoprotein (MAG)-SGPG Antibody (IgM)

MAG, Antibody IgM is useful in detecting antibodies associated with autoimmune peripheral neuropathy.

7550 - Myasthenia Gravis Panel 1

Useful in the diagnosis of Myasthenia Gravis

94955 - Encephalitis Antibody Evaluation with Reflex to Titer and Line Blot, Serum

The Encephalitis Antibody Panel provides an evaluation of possible autoantibodies in patients with suspected autoimmune encephalitis, and optimizes the likelihood of detecting neuronal specific autoantibodies, whether present singly or occurring as multiple autoantibodies.

94957 - Paraneoplastic Antibody Expanded Evaluation w/Reflex to Titer and LB, Serum

Detection of antineuronal autoantibodies aids the diagnosis of autoimmune paraneoplastic syndromes, encephalopathies, and other autoimmune neurological conditions. Identification of specific antineuronal autoantibodies may also help in the diagnostic workup for occult malignancies. Finally, knowledge of the specific identity of antineuronal autoantibodies aids greatly in making therapeutic decisions for patients. Antineuronal antibodies are detected and identified by indirect immunofluorescence, using multiple neuronal tissues, non-neuronal tissues, and transfected substrate cells, as well as radioimmunoassays. Line blot assays are used for confirmatory reflex testing.

4639 - Myelin Antibody (IgG), IFA

Antibodies against myelin are found in multiple sclerosis and other neurological diseases. However, the diagnostic value of this serum antibody is controversial, as high titers in healthy subjects can also be detected. Antibodies against myelin-associated glycoproteins are present at times with Guillain-Barre syndrome.

92414 - GAD65 Neurological Syndrome Antibody Test

Anti-GAD65 antibody is found in patients with Stiff-Person syndrome, subacute cerebellar ataxia, or encephalitis.

92394 - NMDA Receptor (NR1-subunit) Autoantibody Test

Anti-NMDA receptor (NR1-subunit) antibody is found in patients with encephalitis, acute psychiatric disturbances, seizures, memory deficits, and hypoventilation.

Related guides (1)

Myasthenia Gravis and Autoantibodies

This Clinical Focus provides information relating to the appropriate use and interpretation of antibody tests for myasthenia gravis diagnosis and management.

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Reference ranges are provided as general guidance only. To interpret test results use the reference range in the laboratory report.

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