NEW TESTS

 

Test Code	Test Name
MAC1	Autoimmune Myelopathy Eval, CSF
MAS1	Autoimmune Myelopathy Eval, S
MDC2	Movement Autoimmune Eval, CSF
MDS2	Movement Autoimmune Eval, S
PCDEC	Peds Autoimmune CNS Eval, CSF
PCDES	Peds Autoimmune CNS Eval, S
AIAES	Autoimmune Axonal Eval, S

 

OBSOLETE TESTS

Test Code	Test Name
DMS2	Dementia Autoimmune Evaluation, Serum
DMC2	Dementia, Autoimmune Evaluation, CSF
EPS2	Epilepsy Autoimmune Evaluation, Serum
EPC2	Epilepsy, Autoimmune Evaluation, CSF
PAVL	Paraneoplastic Autoantibody Evaluation

 

Effective December 1, 2021, MLabs will build new tests to follow the Michigan Medicine laboratory formulary algorithm and inactivate the test options that are not recommended due to very low diagnostic yield. 

 

Michigan Medicine Pathology and Neurology Departments recently led an effort to better utilize neurology-related paraneoplastic antibody testing, which is sent to Mayo Clinic Laboratories.  The team developed test recommendations to guide best ordering practices.  MLabs now offers autoantibody screening panels that align with various neurologic paraneoplastic syndromes (e.g., movement disorders, myelitis, peripheral neuropathy, etc.) as detailed below:

 

Test Recommendations for Neurologic Autoimmune and Paraneoplastic Syndromes

 

1. Encephalitis (limbic, brainstem, autoimmune epilepsy)

Reconsider if patient does not have one of the following acute/subacute presentation, focal neurologic deficits, new seizures, CSF abnormalities, supportive imaging. If high pre-test probability, it is likely appropriate to order both serum and CSF testing.

• Encephalopathy, Autoimmune Evaluation, Serum (ENS2)
• Encephalopathy, Autoimmune Evaluation, Spinal Fluid (ENC2)

 

2. Movement disorders (including ataxia, opsoclonus/myoclonus, chorea, etc.)
   • Movement Disorder, Autoimmune Evaluation, Serum (MDS2)
   • Movement Disorder, Autoimmune Evaluation, Spinal Fluid (MDC2)

 

3. Myelitis and/or optic neuritis (NMO spectrum disorders)
   • CNS Demyelinating Evaluation, Serum (CDS1)

 

4. Autoimmune peripheral neuropathy (neuronopathy, polyradiculopathy)
   • Autoimmune Axonal Evaluation, Serum (AIAES)

 

5. Autoimmune autonomic neuropathy (acute/subacute presentation)
   • Autoimmune Dysautonomia Evaluation, Serum (DYS2)

 

6. Myasthenia gravis
   • Myasthenia Gravis Evaluation with MuSK Reflex, Serum (MGMR)

 

7. LEMS
   • Voltage-Gated Calcium Channel (VGCC) Antibody (AVGCC) (sent to ARUP Laboratories)

 

The following panels are seldom appropriate and should be used in limited circumstances:

• Pediatric Autoimmune Central Nervous System Disorders Evaluation, Serum (PCDES)
• Pediatric Autoimmune Central Nervous System Disorders Evaluation, Spinal Fluid (PCDEC)
• Autoimmune Myelopathy Evaluation, Serum (MAS1)
• Autoimmune Myelopathy Evaluation, Spinal Fluid (MAC1)

 

The following panels are not recommended:

• Dementia, Autoimmune Evaluation, Serum (DMS2), recommend ENS2 instead
• Dementia, Autoimmune Evaluation, Spinal Fluid (DMC2), recommend ENC2 instead
• Epilepsy, Autoimmune Evaluation, Serum (EPS2), recommend ENS2 instead
• Epilepsy, Autoimmune Evaluation, Spinal Fluid (EPC2), recommend ENC2 instead
• Paraneoplastic, Autoantibody Evaluation, Serum (PAVAL)