Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Serum

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.

This test should not be requested for 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 for 1 week and assayed if sufficiently decayed or canceled if radioactivity remains.

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 or intravenous immunoglobulin treatment.

Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 4 mL Serum

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.

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 serum specimens

Profile Information

Test ID	Reporting Name	Available Separately	Always Performed
MDSI	Movement Disorder Interp, S	No	Yes
AMPCS	AMPA-R Ab CBA, 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
APBIS	AP3B2 IFA, S	No	Yes
CS2CS	CASPR2-IgG CBA, S	No	Yes
CRMS	CRMP-5-IgG, S	No	Yes
DPPCS	DPPX Ab CBA, S	No	Yes
GABCS	GABA-B-R Ab CBA, S	No	Yes
GD65S	GAD65 Ab Assay, S	Yes	Yes
GRFIS	GRAF1 IFA, S	No	Yes
IG5CS	IgLON5 CBA, S	No	Yes
ITPIS	ITPR1 IFA, S	No	Yes
KLHCS	KLHL11-IgG CBA, S	Yes	Yes
LG1CS	LGI1-IgG CBA, S	No	Yes
MA2ES	Ma2 Ab ELISA, S	Yes	Yes
GL1IS	mGluR1 Ab IFA, S	No	Yes
GL5IS	mGluR5 Ab IFA, S	No	Yes
NCDIS	Neurochondrin IFA, S	No	Yes
NMDCS	NMDA-R Ab CBA, S	No	Yes
CCPQ	P/Q-Type Calcium Channel Ab	No	Yes
PDEIS	PDE10A Ab IFA, S	No	Yes
PCABP	Purkinje Cell Cytoplasmic Ab Type 1	No	Yes
PCAB2	Purkinje Cell Cytoplasmic Ab Type 2	No	Yes
PCATR	Purkinje Cell Cytoplasmic Ab Type Tr	No	Yes
SP5IS	Septin-5 IFA, S	No	Yes
SP7IS	Septin-7 IFA, S	No	Yes
T46IS	TRIM46 Ab IFA, S	No	Yes

Reflex Tests

Test ID	Reporting Name	Available Separately	Always Performed
AGNBS	AGNA-1 Immunoblot, 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
DPPTS	DPPX Ab IFA Titer, 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
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
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
AGNTS	AGNA-1 Titer, S	No	No
AN1TS	ANNA-1 Titer, S	No	No
AN2TS	ANNA-2 Titer, S	No	No
AN3TS	ANNA-3 Titer, S	No	No
APBCS	AP3B2 CBA, S	No	No
APBTS	AP3B2 IFA Titer, S	No	No
APHTS	Amphiphysin Ab Titer, S	No	No
CRMTS	CRMP-5-IgG Titer, S	No	No
CRMWS	CRMP-5-IgG Western Blot, S	No	No
NCDCS	Neurochondrin CBA, S	No	No
NCDTS	Neurochondrin IFA Titer, S	No	No
PC1TS	PCA-1 Titer, S	No	No
PC2TS	PCA-2 Titer, S	No	No
PCTTS	PCA-Tr Titer, S	No	No
SP5CS	Septin-5 CBA, S	No	No
SP5TS	Septin-5 IFA Titer, S	No	No
SP7CS	Septin-7 CBA, S	No	No
SP7TS	Septin-7 IFA Titer, S	No	No
PDETS	PDE10A Ab IFA Titer, S	No	No
T46CS	TRIM46 Ab CBA, S	No	No
T46TS	TRIM46 Ab IFA Titer, S	No	No
GL5CS	mGluR5 Ab CBA, S	No	No
GL5TS	mGluR5 Ab IFA Titer, S	No	No
MP1BS	MAP1B Immunoblot, S	No	No

Method Name

AGN1S, AMPHS, ANN1S, ANN2S, ANN3S, APBIS, CRMS, GL1IS, GL5IS, GRFIS, ITPIS, NCDIS, PCAB2, PCABP, PCATR, PDEIS, SP5IS, SP7IS, T46IS, AGNTS, AMPIS, AN1TS, AN2TS, AN3TS, APBTS, APHTS, CRMTS, DPPTS, GABIS, GL1TS, GL5TS, GRFTS, IG5TS, ITPTS, K11TS, NCDTS, NMDIS, PC1TS, PC2TS, PCTTS, PDETS, SP5TS, SP7TS, T46TS: Indirect Immunofluorescence Assay (IFA)

AMPCS, CS2CS, DPPCS, GABCS, IG5CS, KLHCS, LG1CS, NMDCS, APBCS, GL1CS, GL5CS, GRFCS, ITPCS, NCDCS, SP5CS, SP7CS, T46CS: Cell Binding Assay (CBA)

MA2ES: Enzyme-Linked Immunosorbent Assay (ELISA)

CRMWS: Western Blot (WB)

AGNBS, AMIBS, AN1BS, AN2BS, MP1BS, PC1BS, PCTBS: Immunoblot (IB)

CCPQ, GD65S: Radioimmunoassay (RIA)

MDSI: Technical Interpretation

Reporting Name

Movement, Autoimm/Paraneo, S

Specimen Type

Serum

Specimen Minimum Volume

Serum: 3 mL

Specimen Stability Information

Specimen Type	Temperature	Time
Serum	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 type 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
MDSI	Movement Disorder Interp, S	Technical interpretation	Interpretive report
AMPCS	AMPA-R Ab CBA, S	CBA	Negative
AMPHS	Amphiphysin Ab, S	IFA	Negative
AGN1S	Anti-Glial Nuclear Ab, Type 1	IFA	Negative
ANN1S	Anti-Neuronal Nuclear Ab, Type 1	IFA	Negative
ANN2S	Anti-Neuronal Nuclear Ab, Type 2	IFA	Negative
ANN3S	Anti-Neuronal Nuclear Ab, Type 3	IFA	Negative
APBIS	AP3B2 IFA, S	IFA	Negative
CS2CS	CASPR2-IgG CBA, S	CBA	Negative
CRMS	CRMP-5-IgG, S	IFA	Negative
DPPCS	DPPX Ab CBA, S	CBA	Negative
GABCS	GABA-B-R Ab CBA, S	CBA	Negative
GD65S	GAD65 Ab Assay, S	RIA	≤0.02 nmol/L
GRFIS	GRAF1 IFA, S	IFA	Negative
IG5CS	IgLON5 CBA, S	CBA	Negative
ITPIS	ITPR1 IFA, S	IFA	Negative
KLHCS	KLHL11-IgG CBA, S	CBA	Negative
LG1CS	LGI1-IgG CBA, S	CBA	Negative
MA2ES	Ma2 Ab ELISA, S	ELISA	Negative
GL1IS	mGluR1 Ab IFA, S	IFA	Negative
GL5IS	mGluR5 Ab IFA, S	IFA	Negative
NCDIS	Neurochondrin IFA, S	IFA	Negative
NMDCS	NMDA-R Ab CBA, S	CBA	Negative
CCPQ	P/Q-Type Calcium Channel Ab	RIA	≤0.02 nmol/L
PDEIS	PDE10A Ab IFA, S	IFA	Negative
PCABP	Purkinje Cell Cytoplasmic Ab Type 1	IFA	Negative
PCAB2	Purkinje Cell Cytoplasmic Ab Type 2	IFA	Negative
PCATR	Purkinje Cell Cytoplasmic Ab Type Tr	IFA	Negative
SP5IS	Septin-5 IFA, S	IFA	Negative
SP7IS	Septin-7 IFA, S	IFA	Negative
T46IS	TRIM46 Ab IFA, S	IFA	Negative

Reflex Information:

Test ID	Reporting Name	Methodology*	Reference Value
AGNBS	AGNA-1 Immunoblot, S	IB	Negative
AGNTS	AGNA-1 Titer, S	IFA	<1:240
AMPIS	AMPA-R Ab IF Titer Assay, S	IFA	<1:240
APHTS	Amphiphysin Ab Titer, S	IFA	<1:240
AMIBS	Amphiphysin Immunoblot, S	IB	Negative
AN1BS	ANNA-1 Immunoblot, S	IB	Negative
AN1TS	ANNA-1 Titer, S	IFA	<1:240
AN2BS	ANNA-2 Immunoblot, S	IB	Negative
AN2TS	ANNA-2 Titer, S	IFA	<1:240
AN3TS	ANNA-3 Titer, S	IFA	<1:240
APBCS	AP3B2 CBA, S	CBA	Negative
APBTS	AP3B2 IFA Titer, S	IFA	<1:240
CRMTS	CRMP-5-IgG Titer, S	IFA	<1:240
CRMWS	CRMP-5-IgG Western Blot, S	WB	Negative
DPPTS	DPPX Ab IFA Titer, S	IFA	<1:240
GABIS	GABA-B-R Ab IF Titer Assay, S	IFA	<1:240
GRFCS	GRAF1 CBA, S	CBA	Negative
GRFTS	GRAF1 IFA Titer, S	IFA	<1:240
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
MP1BS	MAP1B Immunoblot, S	IB	Negative
GL1CS	mGluR1 Ab CBA, S	CBA	Negative
GL1TS	mGluR1 Ab IFA Titer, S	IFA	<1:240
GL5CS	mGluR5 Ab CBA, S	CBA	Negative
GL5TS	mGluR5 Ab IFA Titer, S	IFA	<1:240
NCDCS	Neurochondrin CBA, S	CBA	Negative
NCDTS	Neurochondrin IFA Titer, S	IFA	<1:240
NMDIS	NMDA-R Ab IF Titer Assay, S	IFA	<1:240
PC1BS	PCA-1 Immunoblot, S	IB	Negative
PC1TS	PCA-1 Titer, S	IFA	<1:240
PC2TS	PCA-2 Titer, S	IFA	<1:240
PCTBS	PCA-Tr Immunoblot, S	IB	Negative
PCTTS	PCA-Tr Titer, S	IFA	<1:240
PDETS	PDE10A Ab IFA Titer, S	IFA	<1:240
SP5CS	Septin-5 CBA, S	CBA	Negative
SP5TS	Septin-5 IFA Titer, S	IFA	<1:240
SP7CS	Septin-7 CBA, S	CBA	Negative
SP7TS	Septin-7 IFA Titer, S	IFA	<1:240
T46CS	TRIM46 Ab CBA, S	CBA	Negative
T46TS	TRIM46 Ab IFA Titer, S	IFA	<1:240

*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

86596

86255 x 26

83516

86341

0432U

84182 AGNBS (if appropriate)

86256 AGNTS (if appropriate)

86256 AMPIS (if appropriate)

86256 APHTS (if appropriate)

84182 AMIBS (if appropriate)

84182 AN1BS (if appropriate)

86256 AN1TS (if appropriate)

84182 AN2BS (if appropriate)

86256 AN2TS (if appropriate)

86256 AN3TS (if appropriate)

86255 APBCS (if appropriate)

86256 APBTS (if appropriate)

86256 CRMTS (if appropriate)

84182 CRMWS (if appropriate)

86256 DPPTS (if appropriate)

86256 GABIS (if appropriate)

86255 GRFCS (if appropriate)

86256 GRFTS (if appropriate)

86256 IG5TS (if appropriate)

86255 ITPCS (if appropriate)

86256 ITPTS (if appropriate)

86256 K11TS (if appropriate)

84182 MP1BS (if appropriate)

86255 GL1CS (if appropriate)

86256 GL1TS (if appropriate)

86255 GL5CS (if appropriate)

86256 GL5TS (if appropriate)

86255 NCDCS (if appropriate)

86256 NCDTS (if appropriate)

86256 NMDIS (if appropriate)

84182 PC1BS (if appropriate)

86256 PC1TS (if appropriate)

86256 PC2TS (if appropriate)

84182 PCTBS (if appropriate)

86256 PCTTS (if appropriate)

86256 PDETS (if appropriate)

86255 SP5CS (if appropriate)

86256 SP5TS (if appropriate)

86255 SP7CS (if appropriate)

86256 SP7TS (if appropriate)

86255 T46CS (if appropriate)

86256 T46TS (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 MDS2 Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Serum