test directorySearch Results
Click here to search again.
Test Name:
Neuromyelitis Optica IgG Autoantibody, Cerebrospinal Fluid
- SBMF No:
42249 - Performance Lab Name:
Mayo Medical Laboratories - Test Mnemonic:
CSF NMOIGG - ABN:
Required – Not FDA-Approved - CPT Code:
86255 - LOINC Code:
19146-0 - Ref Lab Test No:
83936 - Also Known As:
AQP
AQP4
Aquaporin (-4)
Devic's Disease antibody
NMO-IgG
Optic Neuritix Antibody
Optic-Spinal MS Antibody
Transverse Myelitis Antibody
Vision Loss Antibody - Also See:
42231 Neuromyelitis Optica IgG Autoantibody, by ELISA, with IFA if Indicated, Serum - Spec Type:
Cerebrospinal fluid (CSF) - Spec Container:
Sterile plastic tube with screw-top cap - Pref Vol:
2.0 mL - Min Vol:
1.0 mL - Spec Collect:
Collected by physician - Spec Store Transport:
Refrigerated - Spec Stability:
72 hours room temperature (20-30°C)
60 days refrigerated (2-8°C) - Spec Reject:
Specimens other than CSF
Severely hemolyzed, lipemic, or icteric sample - Spec Remarks:
Include relevant clinical information, name, phone number, mailing address, and e-mail address (if applicable) of ordering physician - Methodology:
Indirect Immunofluorescence Assay (IFA) - Use:
Establishing the diagnosis of neuromyelitis optica (NMO) and related disorders (eg, relapsing transverse myelitis or relapsing optic neuritis), predicting with 60% probability, relapse or progression to NMO in patients presenting with an initial episode of longitudinally extensive transverse myelitis. Seropositivity distinguishes these disorders from multiple sclerosis early in the course of disease. This allows initiation and maintenance of optimal therapy.
Serum is the preferred specimen for detection of NMO-IgG (see #60796 Neuromyelitis Optica (NMO) Evaluation with Reflex, Serum); cerebrospinal fluid is usually less informative.
- Clinical Significance:
Neuromyelitis optica (NMO, also known as Devic's disease and optic-spinal multiple sclerosis) is a severe idiopathic inflammatory demyelinating disease that selectively affects optic nerves and the spinal cord, typically spares the brain, and generally follows a relapsing course. Within 5 years, 50% of patients lose functional vision in at least 1 eye or are unable to walk independently. In North America, the proportion of nonwhite individuals is higher among patients with NMO than among those with classic multiple sclerosis. During acute attacks, the cerebrospinal fluid contains inflammatory cells, but often lacks evidence of intrathecal IgG synthesis.
Many patients with NMO are misdiagnosed as having multiple sclerosis, due to earlier misconceptions that NMO was a monophasic disorder, and was not associated with brain imaging abnormalities. Importantly the prognosis and optimal treatments for the 2 diseases differ. NMO typically has a worse outcome than multiple sclerosis, with frequent and early relapses. Plasmapheresis is more beneficial for patients with NMO than for those with multiple sclerosis. Early diagnosis and treatment are important to reduce the morbidity of NMO.
Seropositivity for NMO autoantibody IgG (NMO-IgG) allows early diagnostic distinction between NMO (73% positive; 91% specific) and multiple sclerosis (0% positive). NMO-IgG is uniformly negative in patients with classical multiple sclerosis, for which no biomarker is currently recognized. This distinction is important both prognostically and therapeutically, because optimal treatments differ for NMO (immunosuppression) and multiple sclerosis (immunomodulation with beta-IFN or glatiramer acetate).
- Reference Range:
Negative
Interpretive Data:
A positive value is consistent with NMO or a related disorder, and justifies initiation of appropriate immunosuppressive therapy at the earliest possible time.Prospective studies have revealed that 40% of adult patients with longitudinally-extensive transverse myelitis are seropositive and, of that group, 60% relapse or progress to NMO within 2 years. No seronegative patient relapsed in up to 7 years of follow-up.
Cautions:
Seronegativity does not exclude the diagnosis of NMO (current seronegativity rate is 27%).Immunosuppressive therapy may result in negative results.
High levels of nonorgan-specific autoantibodies (which are frequent in patients with NMO) may preclude interpretation of a positive immunofluorescence pattern.
Serum is the preferred specimen. Cerebrospinal (CSF) is usually less informative than serum for detection of NMO-IgG. However, testing of accompanying CSF for CRMP-5-IgG is recommended as a sensitive assay for paraneoplastic myelitis and optic neuritis.
- Additional Test Info:
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.
Reference:
"Neuromyelitis Optica (NMO) Autoantibody, IgG, Spinal Fluid." 2011 Online Test Catalog, Mayo Medical Laboratories, 2011. Web. 30 July 2011 <http://www.mayomedicallaboratories.com/test-catalog/Overview/83936> - Day Run:
Mon-Fri - Time Run:
7:00 am - Time Reported:
6-11 days - Test Type:
IMMUNOLOGY
