Routine diagnostics for neural antibodies, clinical correlates, treatment and functional outcome

Area of Science:

• Neuroscience
• Immunology
• Clinical Diagnostics

Background:

• Autoimmune conditions affecting the nervous system are increasingly recognized.
• Neural antibodies play a crucial role in diagnosing these conditions.
• Establishing reliable diagnostic methods in routine settings is essential.

Purpose of the Study:

• To assess the frequency and reproducibility of neural antibody testing in a routine laboratory.
• To evaluate the clinical relevance and prognostic value of detected neural antibodies.
• To determine the impact of these antibodies on patient outcomes in suspected autoimmune neuropsychiatric disorders.

Main Methods:

• Analysis of 10,919 patient samples for a broad panel of neural antibodies.
• Interlaboratory retesting for specific antibodies (LGI1, CASPR2) to ensure reproducibility.
• Retrospective clinical data collection from physicians regarding patient presentation, treatment, and outcomes.

Main Results:

• 5.3% of patients tested positive for neural antibodies.
• High agreement between laboratories for LGI1 and CASPR2 antibody detection (κ=0.95).
• Antibodies against AMPA receptor, NMDAR, GABABR, and LGI1 were frequently rated as autoimmune by clinicians; 64% of patients with surface antibodies improved with immunotherapy.

Conclusions:

• Routine neural antibody testing provides reliable and clinically valuable diagnostic information.
• The findings support the use of a dedicated laboratory approach for autoimmune neuropsychiatric conditions.
• Clinical correlation, including presentation and antibody titers, is crucial for patient management and counseling.