Ordering Recommendation

Comprehensive panel for the evaluation of paraneoplastic and neuromuscular junction disorders, and/or encephalitis, in the presence or absence of malignancy.

Mnemonic

NEURO R4

Methodology

Semiquantitative Cell-Based Indirect Fluorescent Antibody/Qualitative Immunoblot/Quantitative Radioimmunoassay/Semiquantitative Enzyme-Linked Immunosorbent Assay

Performed

Tue

Reported

3-10 days

New York DOH Approval Status

This test is New York DOH approved.

Specimen Required

Patient Preparation
Collect

Serum Separator Tube (SST)

Specimen Preparation

Separate from cells ASAP or within 2 hours of collection. Transfer four 1 mL serum aliquots to ARUP standard transport tubes. (Min: 2.8 mL)

Storage/Transport Temperature

Frozen

Unacceptable Conditions

Amniotic fluid, ocular fluid, peritoneal fluid, synovial fluid, CSF, or plasma. Contaminated, grossly hemolyzed, icteric, or lipemic specimens.

Remarks
Stability

After separation from cells: Ambient: 24 hours; Refrigerated: 1 week; Frozen: 1 month (Three freeze/thaw cycles are acceptable)

Reference Interval

Test Number
Components
Reference Interval
  Neuronal Antibody (Amphiphysin) Negative
  P/Q-Type Calcium Channel Antibody 24.5 pmol/L or less
  Glutamic Acid Decarboxylase Antibody 0.0-5.0 IU/mL
  N-methyl-D-Aspartate Receptor Ab, Serum Less than 1:10
  Voltage-Gated Potassium Channel Ab, Ser 31 pmol/L or less
  Purkinje Cell/Neuronal Nuclear IgG Scrn None Detected
  CASPR2 Ab IgG Screen by IFA, Serum Less than 1:10
  LGI1 Ab IgG Screen by IFA, Serum Less than 1:10
  Neuromyelitis Optica/AQP4-IgG, Serum Less than 1:10
  CV2.1 Antibody IgG Screen by IFA Less than 1:10
  AMPA Receptor Ab IgG Screen, Serum Less than 1:10
  GABA-B Receptor Ab IgG Screen, Serum Less than 1:10
  MOG Antibody IgG Screen, Serum Less than 1:10
  SOX1 Antibody, IgG by Immunoblot, Serum Negative
  Ganglionic Acetylcholine Receptor Ab 8.4 pmol/L or less
  DPPX Ab IgG CBA IFA Screen, Serum Less than 1:10
  ITPR1 Ab IgG CBA-IFA Screen, Serum Less than 1:10
  IgLON5 Ab IgG CBA-IFA Screen, Serum Less than 1:10
  GABA-AR Ab IgG CBA-IFA Screen, Serum Less than 1:10
  mGluR1 Ab IgG CBA-IFA Screen, Serum Less than 1:10

Interpretive Data

Refer to Report


Component
Interpretation
Voltage-Gated Potassium Channel (VGKC) Antibody, Serum 31 pmol/L or less: Negative
32-87 pmol/L: Indeterminate
88 pmol/L or greater: Positive
P/Q-Type Voltage-Gated Calcium Channel (VGCC) Antibody 0.0 to 24.5 pmol/L: Negative
24.6 to 45.6 pmol/L: Indeterminate
45.7 pmol/L or greater: Positive
Ganglionic Acetylcholine Receptor Antibody 0.0 - 8.4 pmol/L: Negative
8.5 - 11.6 pmol/L: Indeterminate
11.7 pmol/L or greater: Positive

Compliance Category

Laboratory Developed Test (LDT)

Note

If N-methyl-D-Aspartate Receptor Antibody is positive, then titer will be performed. Additional charges apply.
If CV2.1 Antibody IgG Screen by IFA is positive, then titer will be performed, and Acetylcholine Receptor Binding Antibody will be added. Additional charges apply.
If AQP4 antibody IgG is positive, then titer will be added. Additional charges apply.
If PCCA/ANNA antibody IgG is screened by IFA. If the IFA screen is indeterminate, then a Neuronal Nuclear Antibodies (Hu, Ri, Yo, and Tr/DNER) IgG by Immunoblot will be performed. If the IFA screen is positive at 1:10 or greater, then a PCCA/ANNA antibodies titer and Neuronal Nuclear Antibodies (Hu, Ri, Yo, Tr/DNER) IgG by Immunoblot will be performed. Additional charges apply.
If LGI1 antibody IgG is positive, then titer will be added. Additional charges apply.
If CASPR2 antibody IgG is positive, then titer will be added. Additional charges apply.
If AMPAR antibody IgG is positive, then titer will be added. Additional charges apply.
If GABA-BR antibody IgG is positive, then titer will be added. Additional charges apply.
If MOG antibody IgG is positive, then titer will be added. Additional charges apply.
If DPPX antibody IgG is positive, then titer will be added. Additional charges apply.
If ITPR1 antibody IgG is positive, then titer will be added. Additional charges apply.
If IgLON5 antibody IgG is positive, then titer will be added. Additional charges apply.
If GABA-AR antibody IgG is positive, then titer will be added. Additional charges apply.
If mGLUR1 antibody IgG is positive, then titer will be added. Additional charges apply.

Hotline History

N/A

CPT Codes

83519 x2; 84182 x2; 86255 x12; 86341; 86052; 86362; 86596; if reflexed, add 83519; 84182 x4; 86256 per titer

Components

Component Test Code* Component Chart Name LOINC
0051709 Neuronal Antibody (Amphiphysin) 94385-2
0092629 P/Q-Type Calcium Channel Antibody 33980-4
2001772 Glutamic Acid Decarboxylase Antibody 56540-8
2004222 N-methyl-D-Aspartate Receptor Ab, Serum 80221-5
2004890 Voltage-Gated Potassium Channel Ab, Ser 41871-5
2007962 Purkinje Cell/Neuronal Nuclear IgG Scrn 61177-2
2009453 CASPR2 Ab IgG Screen by IFA, Serum 82979-6
2009457 LGI1 Ab IgG Screen by IFA, Serum 82978-8
2013322 Neuromyelitis Optica/AQP4-IgG, Serum 63439-4
2013959 CV2.1 Antibody IgG Screen by IFA 72504-4
3001261 AMPA Receptor Ab IgG Screen, Serum 82733-7
3001271 GABA-B Receptor Ab IgG Screen, Serum 93428-1
3001278 MOG Antibody IgG Screen, Serum 91545-4
3002903 SOX1 Antibody, IgG by Immunoblot, Serum 82444-1
3003019 Ganglionic Acetylcholine Receptor Ab 42233-7
3004361 DPPX Ab IgG CBA IFA Screen, Serum 94676-4
3006009 GABA-AR Ab IgG CBA-IFA Screen, Serum
3006019 IgLON5 Ab IgG CBA-IFA Screen, Serum 96478-3
3006032 ITPR1 Ab IgG CBA-IFA Screen, Serum 96466-8
3006045 mGluR1 Ab IgG CBA-IFA Screen, Serum 93498-4
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.

Aliases

  • AMPA
  • amphiphysin
  • ANNA
  • AQP4
  • CASPR2
  • CRMP5
  • CV2
  • dementia
  • DNER
  • DPPX
  • dysautonomia
  • encephalitis
  • encephalopathy
  • epilepsy
  • GABA-A
  • GABA-B
  • GAD
  • GAD 65
  • GAD65
  • ganglionic
  • Hu
  • IgLON5
  • ITPR1
  • LGI1
  • mGluR1
  • MOG
  • movement disorders
  • myelopathy
  • NMDA
  • paraneoplastic
  • PCCA
  • Ri
  • Sox-1
  • Tr
  • VGCC
  • VGKC
  • Yo
Autoimmune Neurologic Disease Panel with Reflex, Serum