Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid

Ordering Guidance

Multiple neurological phenotype-specific autoimmune/paraneoplastic evaluations are available. For more information as well as phenotype-specific testing options, see Autoimmune Neurology Test Ordering Guide.

When more than one evaluation is ordered on the same order number the duplicate will be canceled.

For a list of antibodies performed with each evaluation, see Autoimmune Neurology Antibody Matrix.

Necessary Information

Provide the following information:

-Relevant clinical information

-Ordering healthcare professional’s name, phone number, mailing address, and e-mail address

Specimen Required

Patient Preparation: For optimal antibody detection, collect specimen before starting immunosuppressant medication, corticosteroids, or intravenous immunoglobulin treatment.

Container/Tube: Sterile vial

Preferred: Collection vial number 1

Acceptable: Any collection 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 using spinal fluid specimens

Profile Information

Test ID	Reporting Name	Available Separately	Always Performed
MDCI	Movement Disorder Interp, CSF	No	Yes
AMPCC	AMPA-R Ab CBA, CSF	No	Yes
AMPHC	Amphiphysin Ab, CSF	No	Yes
AGN1C	Anti-Glial Nuclear Ab, Type 1	No	Yes
ANN1C	Anti-Neuronal Nuclear Ab, Type 1	No	Yes
ANN2C	Anti-Neuronal Nuclear Ab, Type 2	No	Yes
ANN3C	Anti-Neuronal Nuclear Ab, Type 3	No	Yes
APBIC	AP3B2 IFA, CSF	No	Yes
CS2CC	CASPR2-IgG CBA, CSF	No	Yes
CRMC	CRMP-5-IgG, CSF	No	Yes
DPPCC	DPPX Ab CBA, CSF	No	Yes
GABCC	GABA-B-R Ab CBA, CSF	No	Yes
GD65C	GAD65 Ab Assay, CSF	Yes	Yes
GFAIC	GFAP IFA, CSF	No	Yes
GRFIC	GRAF1 IFA, CSF	No	Yes
IG5CC	IgLON5 CBA, CSF	No	Yes
ITPIC	ITPR1 IFA, CSF	No	Yes
KLHCC	KLHL11-IgG CBA, CSF	Yes	Yes
LG1CC	LGI1-IgG CBA, CSF	No	Yes
MA2EC	Ma2 Ab ELISA, CSF	Yes	Yes
GL1IC	mGluR1 Ab IFA, CSF	No	Yes
GL5IC	mGluR5 Ab IFA, CSF	No	Yes
NCDIC	Neurochondrin IFA, CSF	No	Yes
NIFIC	NIF IFA, CSF	No	Yes
NMDCC	NMDA-R Ab CBA, CSF	No	Yes
PDEIC	PDE10A Ab IFA, CSF	No	Yes
PCTRC	Purkinje Cell Cytoplasmc Ab Type Tr	No	Yes
PCA1C	Purkinje Cell Cytoplasmic Ab Type 1	No	Yes
PCA2C	Purkinje Cell Cytoplasmic Ab Type 2	No	Yes
SP5IC	Septin-5 IFA, CSF	No	Yes
SP7IC	Septin-7 IFA, CSF	No	Yes
T46IC	TRIM46 Ab IFA, CSF	No	Yes

Reflex Tests

Test ID	Reporting Name	Available Separately	Always Performed
AGNBC	AGNA-1 Immunoblot, CSF	No	No
AINCC	Alpha Internexin CBA, CSF	No	No
AMPIC	AMPA-R Ab IF Titer Assay, CSF	No	No
AMIBC	Amphiphysin Immunoblot, CSF	No	No
AN1BC	ANNA-1 Immunoblot, CSF	No	No
AN2BC	ANNA-2 Immunoblot, CSF	No	No
DPPTC	DPPX Ab IFA Titer, CSF	No	No
GABIC	GABA-B-R Ab IF Titer Assay, CSF	No	No
GRFCC	GRAF1 CBA, CSF	No	No
GRFTC	GRAF1 IFA Titer, CSF	No	No
IG5TC	IgLON5 IFA Titer, CSF	No	No
ITPCC	ITPR1 CBA, CSF	No	No
ITPTC	ITPR1 IFA Titer, CSF	No	No
GL1TC	mGluR1 Ab IFA Titer, CSF	No	No
GL1CC	mGluR1 Ab CBA, CSF	No	No
NFHCC	NIF Heavy Chain CBA, CSF	No	No
NIFTC	NIF IFA Titer, CSF	No	No
NFLCC	NIF Light Chain CBA, CSF	No	No
NMDIC	NMDA-R Ab IF Titer Assay, CSF	No	No
PC1BC	PCA-1 Immunoblot, CSF	No	No
PCTBC	PCA-Tr Immunoblot, CSF	No	No
AN1TC	ANNA-1 Titer, CSF	No	No
AN2TC	ANNA-2 Titer, CSF	No	No
AN3TC	ANNA-3 Titer, CSF	No	No
APBCC	AP3B2 CBA, CSF	No	No
CRMTC	CRMP-5-IgG Titer, CSF	No	No
GFACC	GFAP CBA, CSF	No	No
GFATC	GFAP IFA Titer, CSF	No	No
NCDCC	Neurochondrin CBA, CSF	No	No
NCDTC	Neurochondrin IFA Titer, CSF	No	No
PC1TC	PCA-1 Titer, CSF	No	No
PC2TC	PCA-2 Titer, CSF	No	No
PCTTC	PCA-Tr Titer, CSF	No	No
PDETC	PDE10A Ab IFA Titer, CSF	No	No
SP5CC	Septin-5 CBA, CSF	No	No
SP5TC	Septin-5 IFA Titer, CSF	No	No
SP7CC	Septin-7 CBA, CSF	No	No
SP7TC	Septin-7 IFA Titer, CSF	No	No
T46CC	TRIM46 Ab CBA, CSF	No	No
T46TC	TRIM46 Ab IFA Titer, CSF	No	No
AGNTC	AGNA-1 Titer, CSF	No	No
K11TC	KLHL11 Ab IFA Titer, CSF	No	No
MP1BC	MAP1B Immunoblot, CSF	No	No
GL5CC	mGluR5 Ab CBA, CSF	No	No
GL5TC	mGluR5 Ab IFA Titer, CSF	No	No
APHTC	Amphiphysin Ab Titer, CSF	No	No
CRMWC	CRMP-5-IgG Western Blot, CSF	No	No
APBTC	AP3B2 IFA Titer, CSF	No	No

Method Name

AGN1C, AMPHC, ANN1C, ANN2C, ANN3C, APBIC, CRMC, GFAIC, GL1IC, GL5IC, GRFIC, ITPIC, NCDIC, NIFIC, PCA1C, PCA2C, PCTRC, PDEIC, SP5IC, SP7IC, T46IC, AGNTC, AMPIC, AN1TC, AN2TC, AN3TC, APHTC, CRMTC, DPPTC, GABIC, GFATC, GL1TC, GL5TC, GRFTC, IG5TC, ITPTC, K11TC, NCDTC, NIFTC, NMDIC, PC1TC, PC2TC, PCTTC, PDETC, SP5TC, SP7TC, T46TC: Indirect Immunofluorescence Assay (IFA)

AMPCC, CS2CC, DPPCC, GABCC, IG5CC, KLHCC, LG1CC, NMDCC, AINCC, APBCC, GFACC, GL1CC, GL5CC, GRFCC, ITPCC, NCDCC, NFHCC, NFLCC, SP5CC, SP7CC, T46CC: Cell Binding Assay (CBA)

MA2EC: Enzyme-Linked Immunosorbent Assay (ELISA)

CRMWC: Western Blot (WB)

GD65C: Radioimmunoassay (RIA)

AGNBC, AMIBC, AN1BC, AN2BC, MP1BC, PC1BC, PCTBC: Immunoblot (IB)

MDCI: Technical Interpretation

Reporting Name

Movement, Autoimm/Paraneo, CSF

Specimen Type

CSF

Specimen Minimum Volume

2 mL

Specimen Stability Information

Specimen Type	Temperature	Time
CSF	Refrigerated (preferred)	28 days
	Frozen	28 days
	Ambient	72 hours

Reject Due To

Gross hemolysis	Reject
Gross lipemia	Reject
Gross icterus	Reject

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 65-kDa 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
MDCI	Movement Disorder Interp, CSF	Technical interpretation	Interpretive report
AMPCC	AMPA-R Ab CBA, CSF	CBA	Negative
AMPHC	Amphiphysin Ab, CSF	IFA	Negative
AGN1C	Anti-Glial Nuclear Ab, Type 1	IFA	Negative
ANN1C	Anti-Neuronal Nuclear Ab, Type 1	IFA	Negative
ANN2C	Anti-Neuronal Nuclear Ab, Type 2	IFA	Negative
ANN3C	Anti-Neuronal Nuclear Ab, Type 3	IFA	Negative
APBIC	AP3B2 IFA, CSF	IFA	Negative
CS2CC	CASPR2-IgG CBA, CSF	CBA	Negative
CRMC	CRMP-5-IgG, CSF	IFA	Negative
DPPCC	DPPX Ab CBA, CSF	CBA	Negative
GABCC	GABA-B-R Ab CBA, CSF	CBA	Negative
GD65C	GAD65 Ab Assay, CSF	RIA	≤0.02 nmol/L
GFAIC	GFAP IFA, CSF	IFA	Negative
GRFIC	GRAF1 IFA, CSF	IFA	Negative
IG5CC	IgLON5 CBA, CSF	CBA	Negative
ITPIC	ITPR1 IFA, CSF	IFA	Negative
KLHCC	KLHL11-IgG CBA, CSF	CBA	Negative
LG1CC	LGI1-IgG CBA, CSF	CBA	Negative
MA2EC	Ma2 Ab ELISA, CSF	ELISA	Negative
GL1IC	mGluR1 Ab IFA, CSF	IFA	Negative
GL5IC	mGluR5 Ab IFA, CSF	IFA	Negative
NCDIC	Neurochondrin IFA, CSF	IFA	Negative
NIFIC	NIF IFA, CSF	IFA	Negative
NMDCC	NMDA-R Ab CBA, CSF	CBA	Negative
PDEIC	PDE10A Ab IFA, CSF	IFA	Negative
PCTRC	Purkinje Cell Cytoplasmc Ab Type Tr	IFA	Negative
PCA1C	Purkinje Cell Cytoplasmic Ab Type 1	IFA	Negative
PCA2C	Purkinje Cell Cytoplasmic Ab Type 2	IFA	Negative
SP5IC	Septin-5 IFA, CSF	IFA	Negative
SP7IC	Septin-7 IFA, CSF	IFA	Negative
T46IC	TRIM46 Ab IFA, CSF	IFA	Negative

Reflex Information:

Test ID	Reporting name	Methodology*	Reference value
AGNBC	AGNA-1 Immunoblot, CSF	IB	Negative
AGNTC	AGNA-1 Titer, CSF	IFA	<1:2
AINCC	Alpha Internexin CBA, CSF	CBA	Negative
AMPIC	AMPA-R Ab IF Titer Assay, CSF	IFA	<1:2
APHTC	Amphiphysin Ab Titer, CSF	IFA	<1:2
AMIBC	Amphiphysin Immunoblot, CSF	IB	Negative
AN1BC	ANNA-1 Immunoblot, CSF	IB	Negative
AN1TC	ANNA-1 Titer, CSF	IFA	<1:2
AN2BC	ANNA-2 Immunoblot, CSF	IB	Negative
AN2TC	ANNA-2 Titer, CSF	IFA	<1:2
AN3TC	ANNA-3 Titer, CSF	IFA	<1:2
APBCC	AP3B2 CBA, CSF	CBA	Negative
CRMTC	CRMP-5-IgG Titer, CSF	IFA	<1:2
CRMWC	CRMP-5-IgG Western Blot, CSF	WB	Negative
DPPTC	DPPX Ab IFA Titer, CSF	IFA	<1:2
GABIC	GABA-B-R Ab IF Titer Assay, CSF	IFA	<1:2
GFACC	GFAP CBA, CSF	CBA	Negative
GFATC	GFAP IFA Titer, CSF	IFA	<1:2
GRFCC	GRAF1 CBA, CSF	CBA	Negative
GRFTC	GRAF1 IFA Titer, CSF	IFA	<1:2
IG5TC	IgLON5 IFA Titer, CSF	IFA	<1:2
ITPCC	ITPR1 CBA, CSF	CBA	Negative
ITPTC	ITPR1 IFA Titer, CSF	IFA	<1:2
K11TC	KLHL11 Ab IFA Titer, CSF	IFA	<1:2
MP1BC	MAP1B Immunoblot, CSF	IB	Negative
GL1CC	mGluR1 Ab CBA, CSF	CBA	Negative
GL1TC	mGluR1 Ab IFA Titer, CSF	IFA	<1:2
GL5CC	mGluR5 Ab CBA, CSF	CBA	Negative
GL5TC	mGluR5 Ab IFA Titer, CSF	IFA	<1:2
NCDCC	Neurochondrin CBA, CSF	CBA	Negative
NCDTC	Neurochondrin IFA Titer, CSF	IFA	<1:2
NFHCC	NIF Heavy Chain CBA, CSF	CBA	Negative
NIFTC	NIF IFA Titer, CSF	IFA	<1:2
NFLCC	NIF Light Chain CBA, CSF	CBA	Negative
NMDIC	NMDA-R Ab IF Titer Assay, CSF	IFA	<1:2
PC1BC	PCA-1 Immunoblot, CSF	IB	Negative
PC1TC	PCA-1 Titer, CSF	IFA	<1:2
PC2TC	PCA-2 Titer, CSF	IFA	<1:2
PCTBC	PCA-Tr Immunoblot, CSF	IB	Negative
PCTTC	PCA-Tr Titer, CSF	IFA	<1:2
PDETC	PDE10A Ab IFA Titer, CSF	IFA	<1:2
SP5CC	Septin-5 CBA, CSF	CBA	Negative
SP5TC	Septin-5 IFA Titer, CSF	IFA	<1:2
SP7CC	Septin-7 CBA, CSF	CBA	Negative
SP7TC	Septin-7 IFA Titer, CSF	IFA	<1:2
T46CC	TRIM46 Ab CBA, CSF	CBA	Negative
T46TC	TRIM46 Ab IFA Titer, CSF	IFA	<1:2

*Methodology abbreviations:

Cell-binding assay (CBA)

Enzyme-linked immunosorbent assay (ELISA)

Immunoblot (IB)

Indirect immunofluorescence assay (IFA)

Radioimmunoassay (RIA)

Western blot (WB)

Day(s) Performed

Profile tests: Monday through Sunday; Reflex tests: Varies

Report Available

8 to 12 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

CPT Code Information

86255 x28

83516

86341

0432U

84182 AGNBC (if appropriate)

86256 AGNTC (if appropriate)

86255 AINCC (if appropriate)

86256 AMPIC (if appropriate)

86256 APHTC (if appropriate)

84182 AMIBC (if appropriate)

84182 AN1BC (if appropriate)

86256 AN1TC (if appropriate)

84182 AN2BC (if appropriate)

86256 AN2TC (if appropriate)

86256 AN3TC (if appropriate)

86255 APBCC (if appropriate)

86256 CRMTC (if appropriate)

84182 CRMWC (if appropriate)

86256 DPPTC (if appropriate)

86256 GABIC (if appropriate)

86255 GFACC (if appropriate)

86256 GFATC (if appropriate)

86255 GRFCC (if appropriate)

86256 GRFTC (if appropriate)

86256 IG5TC (if appropriate)

86255 ITPCC (if appropriate)

86256 ITPTC (if appropriate)

86256 K11TC (if appropriate)

84182 MP1BC (if appropriate)

86255 GL1CC (if appropriate)

86256 GL1TC (if appropriate)

86255 GL5CC (if appropriate)

86256 GL5TC (if appropriate)

86255 NCDCC (if appropriate)

86256 NCDTC (if appropriate)

86255 NFHCC (if appropriate)

86256 NIFTC (if appropriate)

86255 NFLCC (if appropriate)

86256 NMDIC (if appropriate)

84182 PC1BC (if appropriate)

86256 PC1TC (if appropriate)

86256 PC2TC (if appropriate)

84182 PCTBC (if appropriate)

86256 PCTTC (if appropriate)

86256 PDETC (if appropriate)

86255 SP5CC (if appropriate)

86256 SP5TC (if appropriate)

86255 SP7CC (if appropriate)

86256 SP7TC (if appropriate)

86255 T46CC (if appropriate)

86256 T46TC (if appropriate)

Special Instructions

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

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Test Code MDC2 Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid