Neuroimmunology
testing

Quest Diagnostics offers an accessible neuroimmunology portfolio to help diagnose your complex cases so you can focus on patient care 

Why neuroimmunology from Quest

Expansive test menu

  • Neuroimmunology testing is performed only at Quest facilities to ensure test quality and performance
  • Over 40 neurologic antibodies available

Single antibody test offerings

  • Over 40 antibodies that can be ordered individually

Gold standard methodologies

  • Target tissues and/or cells are specifically selected for optimal diagnostic detection
  • Methodologies include CBA, RIA, and line blot

Wide-ranging medical expertise

  • Over 650 medical and scientific experts on staff
  • Available for one-on-one consultations


Extensive health plan coverage

  • Participating provider with most major health plans, including traditional Medicare and Medicaid
  • UnitedHealthcare® Preferred Lab Network provider

Access to 2,200 Patient Service Centers (PSCs)

  • Accessible service where your patients live, work, and shop

EHR integration

  • Interfaces with over 600 EHR systems, more than any other lab company

Sign up to stay informed

*Indicates a required field.

In most cases, early detection and prompt therapy can improve patient outcomes1

One patient’s story

In the field of rare diseases, all too often patients can find themselves caught in a long, stress-evoking diagnostic odyssey. Finding a name for the condition that plagues them can take many years that are filled with seemingly endless tests, procedures, and physician visits.

Click here to read Maddy Boehme’s inspiring story about her search for a diagnosis that began when she was only 16.

Quest Diagnostics is your source for neuroimmunological testing with expanded offerings for several autoimmune neurological disorders 

Autoimmune neurological disorders
Brain function disorders Autoimmune dementia, encephalopathy
Demyelinating Multiple sclerosis (MS), neuromyelitis optica (NMO), myelin oligodendrocyte glycoprotein (MOG)
Movement disorders Autoimmune ataxia, epilepsy, chorea
Neuromuscular disorders Myasthenia gravis, Lambert-Eaton
Neuro-oncology Paraneoplastic neurological syndrome (PNS)
Peripheral nervous system (PNS) disorders Guillain-Barré syndrome (GBS), peripheral and sensory neuropathies

Quest offers a portfolio of neuroimmunology tests

Comprehensive testing may: 
  • Identify idiopathic neurological disease in the absence of a tumor 
  • Identify a malignancy early to optimize treatment and help improve outcomes 
  • Inform targeted immunosuppressive therapy for immunological disease 
In 60% of patients with paraneoplastic neurological syndromes (PNS), the symptoms occur before the diagnosis of cancer is made(3)

Early detection and quick treatment can make a difference in patient outcomes

The Paraneoplastic Antibody Expanded Evaluation from Quest always uses CBA as part of the initial panel assessment

Detection of central nervous system autoantibodies is generally better achieved with CBAs4

Utilizing CBA increases the likelihood of identifying membrane-embedded protein targets, LGI1, CASPR2, NMDA (NR1), AMPAR, and GABABR

Reasons to test with Quest’s expanded panel:

Identify PNS antibodies that can increase the likelihood of early diagnosis and treatment

Understand disease progression and prognosis so you and your patients know what to expect

Discover comorbidities or underlying conditions such as encephalitis, ataxia, or myasthenia gravis so you can plan the right care pathway

The Paraneoplastic Antibody Expanded Evaluation has the ability to identify 25 prevalent antibodies, including Ma2/Ta and Zic4

Autoimmune encephalitis is a relatively new category of immune-mediated disease involving the central nervous system.5 It can impair function, and present via a subacute onset of memory disturbance, cognitive impairment, seizures, psychosis, and a loss of consciousness or even coma. 

The direct causes of autoimmune encephalitis are unknown; it is often accompanied by a paraneoplastic disorder or exposure to common bacteria (streptococcus or mycoplasma pneumonia, with or without active infection). 

The importance of an early diagnosis

Autoimmune encephalitis can be a difficult clinical diagnosis for physicians due to:

  • Overlapping clinical, imaging, and laboratory features that mimic other disorders
  • Symptoms that can appear at various times and intensities

3 reasons to order autoimmune encephalitis testing from Quest Diagnostics

  1. Turnaround time of 3 to 14 days can help physicians make a differential diagnosis and initiate appropriate treatment.
  2. Cell-based assay (CBA) panel is always performed, and includes NMDA antibodies that are consistent with limbic encephalitis.
  3. This panel includes the most prevalent encephalitis antibodies, including Ma2/Ta.

What is NMOSD?

Neuromyelitis optica spectrum disorder (NMOSD) is an immune-mediated, chronic, and often relapsing inflammatory disease that predominantly affects the optic nerve and spinal cord.4 It can sometimes be mistaken for multiple sclerosis (MS) because many of the symptoms between the 2 diseases overlap.

NMOSD attacks generally have a sudden, severe onset, causing immediate disability, including blindness and paralysis, while MS episodes tend to be more variable or milder, especially in the early stages of the disease
NMOSD patients often simultaneously present with optic neuritis and transverse myelitis6
NMOSD is generally mediated by anti-aquaporin (AQP4) antibodies. An AQP4 test is generally negative in MS patients7

Early diagnosis is critical because treatments that are effective for MS or other demyelinating disorders might be ineffective, or even harmful, for patients with NMOSD. When used in conjunction with other clinical testing, the NMO Spectrum Evaluation (AQP4 with Reflex to MOG) can help physicians make an informed diagnosis, and aid in clinical decision management.

MOG antibody disease testing

AQP4 is not the only antibody that can play a role in NMOSD. A growing body of research indicates that 10% to 50% of patients with NMOSD often test negative for AQP4,6 and 15% to 35% of these patients test positive for MOG antibodies.6, 9-11

The comprehensive test menu from Quest Diagnostics includes MOG, AQP4, and reflex options that can deliver clear, positive identification.

Myasthenia Gravis Panel 2 with reflex-quantitative AChR binding, blocking, modulating antibodies with reflex to MuSK antibody testing 

Myasthenia gravis (MG) is an autoimmune disorder characterized by muscle weakness that ranges from mild to severe for multiple muscle groups. MG affects approximately 20 per 100,00012 patients and most commonly involves either acetylcholine receptors (AChR) or muscle-specific kinase receptors (MuSK) that ultimately inhibit muscle contraction. 90% have ptosis or diplopia with pupillary involvement. Onset of symptoms is generally gradual but can sometimes be acute following viral infection or pregnancy. 
Binding antibodies in 82% of patients with moderate/severe disease12
LRP4 antibodies detected in subset of MG patients lacking detectable AChR and MuSK. LRP4 antibodies observed in double seronegative ocular MG13
RyR antibodies found in 13% to 38% of all AChR-positive patients14
Titin is associated with more severe and late-onset MG and can provide a strong indication of thymoma15
30% to 40% of seronegative AChR patients have antibodies to MuSK. MuSK antibodies seen in 7% to 10% of all MG patients16

Quest Diagnostics myasthenia gravis portfolio includes testing for LRP4 antibodies 

Get the diagnosis you need so you can focus on treatment and patient care.
LRP4 antibodies are believed to be the third-leading cause of myasthenia gravis (MG)17 The mean age of patients testing positively for LRP4 is 57 years, with approximately equal gender distribution19
LRP4 antibodies were found in 13% of patients testing negative for other MG antibodies (ACHR, MuSK), according to a recent study18 Most LRP4-positive patients improve after standard MG therapy18

Click the test name below to visit the test directory.

Test name
Autoimmune encephalitis
Encephalitis Antibody Evaluation with Reflex to Titer and Line Blot, Serum
Encephalitis Antibody Evaluation with Reflex to Titer and Line Blot, CSF
Neuro-oncology tests
Paraneoplastic Antibody Evaluation with Reflex to Titer and Line Blot, Basic
Paraneoplastic Antibody Evaluation with Reflex to Titer and LB, Basic, CSF
Paraneoplastic Antibody Expanded Evaluation with Reflex to Titer and LB, Serum
Autoimmune Neurology Antibody Comprehensive Panel with Reflexes, Serum
Neuromyelitis optica spectrum disorders
Aquaporin-4 (AQP4) Antibody (NMO-IgG), ELISA
Aquaporin-4 Antibody (IgG), CBA
Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum
Myelin Oligodendrocyte Glycoprotein (MOG) Antibody with Reflex to Titer, Serum
Myelin Oligodendrocyte Glycoprotein (MOG) Antibody with Reflex to Titer, CSF
NMO Spectrum Evaluation (AQP4 with Reflex to MOG), Serum
NMO Spectrum Evaluation (AQP4 with Reflex to MOG), CSF
Myasthenia gravis
Myasthenia Gravis Panel 2 with Reflex to MuSK Antibody
AChR Binding, Blocking, Modulating Antibody
Acetylcholine Receptor Binding Antibody
Acetylcholine Receptor Blocking Antibody
Acetylcholine Receptor Modulating Antibody
LRP4 Autoantibody Test
MuSK and LRP4
MuSK Antibody Test
RyR Autoantibody Test
Striated Muscle Antibody with Reflex to Titer
Myasthenia Gravis Panel 1
AChR Binding, Anti-Striated Muscle Antibody with Reflex
Myasthenia Gravis Panel 2
AChR Binding, Blocking, Modulating Antibody
Myasthenia Gravis Panel 3
AChR Binding, Blocking, Modulating Antibody, Anti-Striated Muscle Antibody with Reflex
Multiple sclerosis
Multiple Sclerosis Panel
Myelin Basic Protein, Oligoclonal Bands IgG
Multiple Sclerosis Panel 1
Albumin IgG, Oligoclonal Bands, IgG Synthesis Rate/Index
Multiple Sclerosis Panel 2
Albumin IgG, IgG Synthesis Rate/Index Myelin Basic Protein,Oligoclonal Bands
AChR ganglionic
Acetylcholine Receptor Ganglionic (Alpha 3) Antibody
Amphiphysin
Recombx® Amphiphysin Antibody Test
ANNA1 (Hu)
Hu Antibody Screen with Reflex to Titer and Western Blot
Includes ANNA1 (Hu) antibody (IFA) with reflex to WB with reflex to titer
Hu Antibody Screen with Reflex to Titer and Western Blot, CSF
Includes ANNA1 (Hu) antibody (IFA) with reflex to WB with reflex to titer
ANNA2 (Ri)
Ri Antibody Screen with Reflex to Titer and Western Blot
Includes ANNA2 (Ri) antibody (IFA) with reflex to WB with reflex to titer
Ri Antibody Screen with Reflex to Titer and Western Blot, CSF
Includes ANNA2 (Ri) antibody (IFA) with reflex to WB with reflex to titer
CASPR2
CASPR2 Antibody Test
CRMP5/CV2
Recombx® CV2 Autoantibody Test
DPPX
DPPX Receptor Antibody, CBA IFA
gACHR
Acetylcholine Receptor Ganglionic (Alpha 3) Antibody
GAD65
GAD65 Neurological Syndrome Antibody Test
LGI1
LGI1 Antibody Test
Ma2/Ta
Recombx® MaTa Autoantibody
Myelin and MAG
Myelin Antibody (IgG), IFA
Myelin Associated Glycoprotein (MAG) Antibody (IgM), EIA
Myelin Associated Glycoprotein (MAG)-SGPG Antibody (IgM)
Myelin Associated Glycoprotein (MAG) Antibody, with Reflex to MAG-SGPG and MAG, EIA
Includes MAG antibody (WB) with reflex to MAG-SGPG antibody and MAG antibody (EIA)
NMDAR1
NMDA Receptor (NR1-subunit) Autoantibody Test
PCA1 (Yo)
Yo Antibody Screen with Reflex to Titer and Western Blot
Includes PCA1 (Yo) antibody with reflex to WB with reflex to titer
Yo Antibody Screen with Reflex to Titer and Western Blot, CSF
Includes PCA1 (Yo) antibody with reflex to WB with reflex to titer
PCA-Tr
Purkinje Cell Cytoplasmic Antibody Type Tr (DNER), CBA IFA
Recoverin
Recombx® CAR (Anti-Recoverin) Autoantibody Test
Titin
Titin Autoantibody Test
VGCC (N-type)
Voltage-Gated Calcium Channel (VGCC) Type N Antibody
VGCC (P/Q-type)
Voltage-Gated Calcium Channel (VGCC) Type P/Q Antibody
VGKC
Voltage-Gated Potassium Channel (VGKC) Antibody
Zic4
Recombx® Zic4 Antibody Test
Notes: 
Reflex tests are performed at an additional charge
Components of panels can be ordered separately

For more information on how Quest Diagnostics can help your patients with autoantibody testing services for autoimmune neurology disorders, click here.

References
  1. Vincent A, Bien CG, Irani SR, et al. Autoantibodies associated with diseases of the CNS: new developments and future challenges. Lancet Neurol. 2011;10(8):759-772. doi:10.1016/S1474-4422(11)70096-5
  2. Stocker W, Probst C, Teegen B, et al. Multiparameter autoantibody screening in the diagnosis of neurological autoimmune diseases. Paper presented at: 1st Congress of the European Academy of Neurology (EAN); June 2015; Berlin, Germany. 
  3. National Organization for Rare Disorders. Paraneoplastic neurologic syndromes. Updated 2016. Accessed October 20, 2021. https://rarediseases.org/rare-diseases/paraneoplastic-neurologic-syndromes/ 
  4. Abelhosn RW, Montana L, Rivera JG, et al. Tissue immunofluorescence confirmation of CNS autoantibodies identified by immunoblot or cell-based assay. Epub December 15, 2020. Preprint at J Neurosci Neuropsych. 2021; volume 4. https://www.researchsquare.com/article/rs-126755/v1. doi:10.21203/rs.3.rs-126755/v1
  5. Kelley BP, Patel SC, Marin HL, et al. Autoimmune encephalitis: pathophysiology and imaging review of an overlooked diagnosis. AJNR Am J Neuroradiol. 2017:38(6):1070-1078. doi:10.3174/ajnr.A5086
  6. Kitley J, Waters P, Woodhall M, et al. Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: a comparative study. JAMA Neurol. 2014;71(3):276-283. doi:10.1001/jamaneurol.2013.5857
  7. Kim SM, Kim SJ, Lee HJ, et al. Differential diagnosis of neuromyelitis optical spectrum disorders. Ther Adv Neurol Disord. 2017;10(7):265-289. doi:10.1177/1756285617709723
  8. Pröbstel AK, Rudolf G, Dornmair K, et al. Anti-MOG antibodies are present in a subgroup of patients with a neuromyelitis optica phenotype. J Neuroinflammation. 2015;12:46. doi:10.1186/s12974-015-0256-1
  9. Sato DK, Callegaro D, Lana-Peixoto MA, et al. Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders. Neurology. 2014;82(6):474-481. doi:10.1212/WNL.0000000000000101
  10. Kezuka T, Usui Y, Yamakawa N, et al. Relationship between NMO-antibody and anti-MOG antibody in optic neuritis. J Neuroophthalmol. 2012;32(2):107-110. doi:10.1097/WNO.0b013e31823c9b6c
  11. Waters P, Woodhall M, O’Connor KC, et al. MOG cell-based assay detects non-MS patients with inflammatory neurologic disease. Neurol Neuroimmunol Neuroinflamm. 2015;2(3): e89. doi:10.1212/NXI.0000000000000089
  12. Haven TR, Astill ME, Pasi BM, et al. An algorithm for acetylcholine receptor antibody testing in patients with suspected myasthenia gravis. Clin Chem. 2010;56(6):1028-1029.  doi:10.1373/clinchem.2009.140392
  13. Phillips WD, Vincent A. Pathogenesis of myasthenia gravis: update on disease types, models, and mechanisms. F1000Res. 2016;5(F1000 Faculty Rev):1513. doi:10.12688/f1000research.8206.1
  14. Suzuki S, Utsugisawa K, Nagane Y, et al. Three types of striational antibodies in myasthenia gravis. Autoimmune Dis. 2011;ID740583. doi:10.4061/2100/740583
  15. Titin antibodies. Antibodies.com. Accessed August 27, 2020. https://www.antibodies.com/products/primary-antibodies/target=Titin
  16. Rivner MH, Pasnoor M, Dimachkie MM, et al. Muscle-specific tyrosine kinase and myasthenia gravis owing to other antibodies. Neurol Clin. 2018;36(2):293-310. doi:10.1016/j.ncl.2018.01.004
  17. Zouvelou V, Zisimopoulou P, Rentzos M, et al. Double seronegative myasthenia gravis with anti-LRP4 antibodies. Neuromuscul Disord. 2013;23(7):568-570. doi:10.1016/j.nmd.2013.03.013
  18. Rivner MH, Quarles BM, Pan JX, et al. Clinical features of LRP4/agrin-antibody-positive myasthenia gravis: a multicenter study. Muscle Nerve. 2020;62(3):333-343. doi:10.1002/mus.26985
  19. Data on file. Athena Diagnostics, Inc; 2021.
Test codes may vary by location. Please contact your local laboratory for more information.

Image content features models and is intended for illustrative purposes only.