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Improving the antibody-based evaluation of autoimmune encephalitis
Lindsey McCracken1, Junxian Zhang1, Maxwell Greene1
1Department of Neurology (L.M., J.Z., M.G., E.L.), and Department of Pathology (A.C., J.G., M.K.), University of Pennsylvania, Philadelphia.
Neurology(R) Neuroimmunology & Neuroinflammation
|October 28, 2017
Summary
Additional research assays improve autoimmune encephalitis detection. Screening with brain reactivity tests and cell-based assays enhances diagnostic accuracy compared to standard clinical testing alone.
Area of Science:
- Neurology
- Immunology
- Clinical Diagnostics
Background:
- Autoimmune encephalitis diagnosis relies on detecting specific autoantibodies.
- Standard clinical testing may have limitations in sensitivity and indeterminate results.
Purpose of the Study:
- To evaluate if supplementary research assays improve autoimmune encephalitis detection.
- To compare research assay performance against standard clinical testing.
Main Methods:
- 731 samples from 623 patients with suspected autoimmune encephalitis were analyzed.
- Standard cell-based assays (CBAs) and research assays including brain section screening were employed.
- Antibodies to NMDA receptor (NMDAR), AMPAR, GABABR, LGI1, Caspr2, and GAD65 were tested.
Main Results:
- Standard clinical tests identified several positive cases but also yielded indeterminate results.
- Research assays confirmed most positive findings, resolved indeterminate results, and identified 15 additional positive cases.
- Informative autoantibodies were detected in 15.5% of all cases.
Conclusions:
- Standard clinical autoantibody tests for autoimmune encephalitis can be insensitive and produce indeterminate results.
- Integrating immunohistochemistry for brain reactivity and additional CBAs enhances diagnostic accuracy.
- This combined approach offers improved detection of autoimmune encephalitis.
