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When should we test for voltage-gated potassium channel complex antibodies? A retrospective case control study
B J O'Sullivan1, T Steele1, M A Ellul2
1Department of Neuroscience, The Walton Centre NHS Foundation Trust, Liverpool, UK.
Summary
Voltage-gated potassium channel (VGKC)-complex antibody disease diagnosis is aided by seizures and hyponatraemia. Alkaline phosphatase may serve as a novel biomarker, especially for peripheral VGKC-complex antibody disease.
Area of Science:
- Neurology
- Immunology
Background:
- Voltage-gated potassium channel (VGKC)-complex antibodies are associated with diverse neurological phenotypes.
- Increasing awareness leads to more testing, expanding the known clinical spectrum.
- Clinicians face challenges in identifying patients who warrant VGKC-complex antibody testing.
Purpose of the Study:
- To identify clinical and biochemical features predictive of VGKC-complex antibody-positive disease.
- To assess the diagnostic utility of specific clinical signs and laboratory values.
Main Methods:
- A 10-year case-control study was conducted at a tertiary neurology center.
- Patients tested for VGKC-complex antibodies were analyzed for clinical and biochemical data.
- Multivariate logistic regression was used to identify predictive features.
Main Results:
- Seizures (OR 10.3) and hyponatraemia were significant predictors of VGKC-complex antibody disease (sensitivity 75%, specificity 82%).
- Higher antibody titres correlated with central disease phenotypes.
- Elevated serum alkaline phosphatase (ALP > 70 u/L) was associated with antibody positivity (OR 4.11), particularly in peripheral disease.
Conclusions:
- Seizures, faciobrachial dystonic movements, and hyponatraemia should increase suspicion for VGKC-complex antibody disease.
- Serum alkaline phosphatase may represent a novel, valuable biomarker for diagnosing VGKC-complex antibody-associated neurological disorders.
