Adult minimum: 12 mL whole blood in two 6 ml red top tubes to yield (min: 4.0 mL serum) Pediatric minimum: 6 mL whole blood in one red top tube to yield (min: 2.0 mL serum)

NEURONAL NUCLEAR ANTIBODIES Antineuronal Nuclear Antibody-Type 1 (ANNA-1) <1:240 Antineuronal Nuclear Antibody -Type 2 (ANNA-2) <1:240 Antineuronal Nuclear Antibody -Type 3 (ANNA-3) <1:240 Anti-Glial/Neuronal Nuclear Antibody-Type 1 (AGNA-1) <1:240 NEURONAL AND MUSCLE CYTOPLASMIC ANTIBODIES Purkinje Cell Cytoplasmic Antibody, Type 1 (PCA-1) <1:240 Purkinje Cell Cytoplasmic Antibody, Type 2 (PCA-2) <1:240 Purkinje Cell Cytoplasmic Antibody, Type Tr (PCA-Tr) <1:240 Amphiphysin Antibody <1:240 CRMP-5-IgG <1:240 Note: Titers lower than 1:240 are detectable by recombinant CRMP-5 Western blot analysis. CRMP-5 Western blot analysis will be done on request on stored serum (held 4 weeks). This supplemental testing is recommended in cases of chorea, vision loss, cranial neuropathy, and myelopathy. Call the Neuroimmunology Laboratory at 800-533-1710 or 507-266-5700 to request CRMP-5 Western blot. Striational (Striated Muscle) Antibodies <1:60 CATION CHANNEL ANTIBODIES N-Type Calcium Channel Antibody < or = 0.03 nmol/L P/Q-Type Calcium Channel Antibody < or = 0.02 nmol/L ACh Receptor (Muscle) Binding Antibody < or = 0.02 nmol/L AChR Ganglionic Neuronal Antibody < or = 0.02 nmol/L Voltage-Gated Potassium Channel Antibody < or = 0.02 nmol/L GAD65 Antibody < or = 0.02 nmol/L Neuron-restricted patterns of IgG staining that do not fulfill criteria for amphiphysin, ANNA-1, ANNA-2, ANNA-3, PCA-1, PCA-2, PCA-Tr, or CRMP-5-IgG may be reported as "unclassified antineuronal IgG." Complex patterns that include non-neuronal elements may be reported as "uninterpretable."

Antibodies directed at onconeural proteins shared by neurons, glia, muscle, and certain cancers are valuable serological markers of a patient's immune response to cancer. They are not found in healthy subjects, and are usually accompanied by subacute neurological symptoms and signs. Several autoantibodies have a syndromic association, but no autoantibody predicts a specific neurological syndrome. Conversely, a positive autoantibody profile has 80% to 90% predictive value for a specific cancer. It is not uncommon for more than 1 paraneoplastic autoantibody to be detected, each predictive of the same cancer. Cautions: Negative results do not exclude cancer. The neuronal voltage-gated potassium channel Ab assay will not be performed for children (aged 18 years or younger) because normal values are not yet established for the pediatric population. This evaluation does not include Ma2 autoantibody (alias: MaTa) or the NMDA receptor (NR2B). Ma2 autoantibody has been described in patients with brainstem and limbic encephalitis in the context of testicular germ cell neoplasms. Scrotal ultrasound is advisable in men who present with unexplained subacute encephalitis. NMDA receptor antibodies have been reported in women with paraneoplastic encephalitis related to ovarian teratoma.

Indirect Immunofluorescence (IFA) Enzyme Immunoassay (EIA) Radioimmunoassay (RIA) Western Blot

83519-59/ACh receptor (muscle) binding antibody 83519-59/AChR ganglionic neuronal antibody 83519-59/N-type calcium channel antibody 83519-59/P/Q-type calcium channel antibody 83520/Striational (striated muscle) antibodies 86256/AGNA-1 86256/Amphiphysin 86256/ANNA-1 86256/ANNA-2 86256/ANNA-3 86256/CRMP-5-IgG 86256/PCA-1 86256/PCA-2 86256/PCA-Tr 83519-59/ACh receptor (muscle) blocking antibodies (if appropriate) 83519-59/ ACh receptor (muscle) modulating antibodies (if appropriate) 83519-59/Neuronal (V-G) K Channel Ab, S (if appropriate) 84182/CRMP-5-IgG Western blot (if appropriate) 84182/Paraneoplastic autoantibody Western blot confirmation (if appropriate) 86341/GAD65 antibody assay (if appropriate) 84182/Amphiphysin Western Blot (if appropriate)