Autoantibody testing in neuromuscular disorders, part I: peripheral neuropathies

A large number of autoantibodies with reactivity to glycoconjugate components of peripheral nerve have been described in the last two decades. Serum autoantibodies to gangliosides and glycoproteins have received the most attention and have been implicated in a variety of sensory and motor neuropathy syndromes. Commercial laboratories market panels of autoantibodies and heavily promote them to clinicians as an important step in the evaluation of neuropathies of unclear etiology. Certainly, detection of these autoantibodies raises the possibility that peripheral nerve disturbance is immune-mediated and that immunosuppressive therapy may be effective treatment. However, most of these autoantibodies do not define a specific clinical syndrome, and patients with and without the antibody may present with an identical neuropathy pattern. Furthermore, a pathogenic role remains to be proven for essentially all of the autoantibodies. In this review, we summarize the peripheral nerve syndromes associated with autoantibodies and present a rational approach to autoantibody testing in routine practice.