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Abstract Details

Autoantibody Prevalence in Cerebrospinal Fluid in Autoimmune Encephalitis and Related Disorders: The Need for a More Targeted Screening Approach
Autoimmune Neurology
P11 - Poster Session 11 (8:00 AM-9:00 AM)
15-008
Autoimmune encephalitis-associated and other autoimmune neurologic disorder-associated autoantibody prevalence was evaluated in conjunction with ordering patterns for cerebrospinal fluid (CSF) testing only or paired with serum testing to evaluate the clinical relevance of autoantibody testing in CSF.
Detection of a neural autoantibody can confirm diagnosis and provide guidance in patient management and treatment. Recent recommendations suggest both serum and CSF should be tested concurrently. However, most studies on prevalence of these autoantibodies have focused on serum testing. Limited data exists regarding autoantibody prevalence in CSF.
Results from CSF specimens submitted to Mayo Clinic Laboratories for CSF panel (Encephalopathy, Dementia, Paraneoplastic or Epilepsy) testing were retrospectively reviewed to evaluate positivity rates, testing strategies and utilization.
An overall positivity rate of 4.63% (112/2420) was observed, with 95.54% (107/112) CSF specimens positive for a single autoantibody. The CSF positivity rates were highest for antibodies associated with autoimmune encephalitis (GAD65>NMDA>GABA-B>LGI1>AMPA>VGKC) except CASPR2 which was not detected, while antibodies associated with paraneoplastic syndrome were less prevalent (ANNA-1/Hu>PCA-1/Yo>CRMP-5/CV2>AGNA-1/SOX-1>PCA-2) or not detected (amphyphysin, ANNA-2/Ri, ANNA-3 and PCA-Tr). Most CSF specimens (62.56%; n=1514) did not have a paired serum submitted for testing. Of 906 CSF/serum pairs, only 49 were CSF autoantibody positive. Rarely were antibodies identified in CSF with negative serum results. Conversely, antibodies were more frequently identified in serum with negative CSF results.
Evaluation of CSF in the absence of serum results is not recommended. However, rare CSF positive–serum negative patients were identified suggesting follow-up CSF testing in seronegative patients where strong suspicion of autoimmune neurologic disease might prove informative. Detection of multiple autoantibodies in CSF was less common than previously reported for serum. The data indicate that test utilization for neural autoantibodies in CSF could be substantially improved by basing ordering practices on clinical manifestations and autoantibody prevalence.
Authors/Disclosures
Thomas R. Haven, PhD (ARUP Laboratories)
PRESENTER 		Dr. Haven has nothing to disclose.
No disclosure on file
Lisa K. Peterson, PhD (ARUP Laboratories) Dr. Peterson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Werfen. Dr. Peterson has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Werfen. Dr. Peterson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AliveDx. Dr. Peterson has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Clinical Biochemistry. Dr. Peterson has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Lab Q for ASCP. Dr. Peterson has a non-compensated relationship as a President with Association of Medical Laboratory Immunologists that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.