To evaluate antineural antibody testing practices and diagnostic accuracy in patients referred for suspected autoimmune neurological disease, comparing pre-referral evaluation with subspecialty-guided assessment.

Inappropriate testing of antineural antibody panels contributes to diagnostic uncertainty and unnecessary treatment. Standardized application of pre-test probability tools, such as APE2 score, may improve antibody panel stewardship.

We retrospectively analyzed 50 consecutive patients evaluated in a newly established autoimmune neurology outpatient clinic. Antineural antibody testing by referring providers was compared with subspecialty-guided testing practices incorporating standardized approaches. Outcomes included appropriateness of testing, need for repeat testing, and concordance between referral and final diagnoses.

Most referral patients underwent antineural antibody testing prior to referral, frequently without structured clinical phenotype characterization. Many positive panels required repeat testing for confirmatory, gold-standard assessment often due to non-standard methodologies or incomplete evaluation. Subspecialty-guided application of clinical scores reduced unnecessary testing and improved alignment between clinical phenotype and testing strategy. Diagnostic discordance between referral and final diagnosis was common, with frequent reclassification to non-autoimmune conditions.

Non-standardized antineural antibody testing prior to subspecialty evaluation is common and contributes to false positive and diagnostic uncertainty. Use of clinical scores may improve antibody stewardship, reduce unnecessary testing, and enhance diagnostic accuracy. These findings support broader adoption of standardized diagnostic frameworks for suspected autoimmune neurological disease.