Shooting in the Dark? A Single-Center Experience of Neural Autoantibody Panel Testing
Jasmine Pascoe1, Lisa Peterson2, Ka-Ho Wong1, Stacey Clardy1, Tammy Smith1
1University of Utah, 2ARUP Laboratories
Objective:
Determine the frequency of positive results from neural autoantibody panels performed on patients evaluated at the University of Utah Hospitals and Clinics.
Background:
Clinical reference laboratories offer autoantibody panels used in the diagnosis of rare antibody-associated neurologic conditions including autoimmune encephalitis, stiff-person spectrum disorders, autoimmune epilepsy, and paraneoplastic neurologic syndromes. With increased awareness of autoimmune neurologic diseases, these panels are frequently ordered by diverse medical specialists during the evaluation of patients with unexplained neurologic symptoms, even when the clinical suspicion for an autoimmune cause of symptoms is low.
Design/Methods:
We collected results from all neural autoantibody panels sent from the University of Utah Hospitals and Clinics to either ARUP or Mayo Clinic Laboratories (the two primary clinical reference laboratories our hospital system contracts with for this testing) from September 1, 2019 to August 31, 2024. We excluded panels that tested specifically for CNS demyelinating disease (AQP4-IgG, MOG-IgG) as well as any single autoantibody tests not sent as part of a panel. A retrospective review of the electronic medical record of patients with any positive result was performed.
Results:
In total, 1613 Mayo Clinic Laboratories panels (1033 serum and 580 CSF) and 1103 ARUP panels (722 serum and 381 CSF) were performed. Over 85% of neural autoantibody panel testing was negative for all antibodies assessed at either clinical reference laboratory. ARUP panels had a 16% positive rate in serum and 3% positive rate in CSF; Mayo panels had a 22% positive rate in serum and 4% positive rate in CSF. We report the demographics, final diagnoses, and clinical utility of neural autoantibody testing in this cohort.
Conclusions:
Consideration of pretest probability and consultation with an autoimmune neurologist prior to ordering panel testing can help maximize the yield of autoantibody panels and provide patients with high-value healthcare.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.