Neuroimmunology laboratory under the department of neurology at Amrita Hospital, Kochi is the first of its kind in India- a dedicated comprehensive testing facility for autoimmune neurological disorders under a trained clinical autoimmune neurologist. Autoimmune neurology is the twenty-first century sub specialty in neurology. It includes disorders of all other sub specialties of neurology like epilepsy, movement disorder, cognition, neuromuscular but with an autoimmune etiology. These disorders can be associated with a cancer (paraneoplastic) as well without cancer association (non paraneoplastic).
These disorders are under diagnosed and often misdiagnosed. Many a times, these diseases are misdiagnosed as "neurodegenerative disorders" which means practically no effective treatment available. But in fact, if properly investigated with appropriate tools (which include disease marker testing in a neuroimmunology laboratory) and diagnosed as an autoimmune neurological syndrome, it becomes potentially treatable and often fully reversible. Early diagnosis is the key factor in recovery. Here comes the importance of comprehensive neuroimmunology service which can provide an early diagnosis.
Lack of testing facilities for markers of the disease and lack of awareness among care givers are the two important limitations in diagnosing and treating these diseases. Our aim is to provide a world class testing facility, define the spectrum of these disorders in our country as well as to disseminate information among the physician community. We are planning to do research on discovering new disease markers, to develop a nation wide registry for autoimmune neurological disorders and to develop a bio bank for these disorders in collaborations with physicians and institutions across the country.
The spectrum of autoimmune neurology is ever expanding. Starting with the traditional spectrum like Guillan-Barre syndrome, Myasthenia gravis, CIDP, vasculitis, ADEM, paraneoplastic neurological syndromes and NMO, now it has expanded to include autoimmune encephalitis, autoimmune dementia, autoimmune epilepsy, autoimmune ataxia and myelopathy, autoimmune brainstem encephalitis, NMO spectrum of disorders and autoimmune movement disorders. Virtually any part of central nervous system, autonomic nervous system, peripheral nervous system and muscle can be involved. They can present in any clinical form-from cortex down to skeletal muscle and autonomic nervous system dysfunction. High index of clinical suspicion is the earliest step in making an early diagnosis and treatment.
Here is a rough guideline about when to suspect an autoimmune neurological disorder-The clinical presentation can range from encephalitis, seizures, cognitive decline, optic neuritis, stroke like episodes, behavioral symptoms like psychosis, brainstem encephalitis characterized by cranial nerve and pyramidal involvement, ataxia, movement disorders like chorea and myoclonus ,dyskinesias, cerebellar ataxia, myelopathy, plexopathy, radiculopathy, neuropathy, autonomic neuropathy, myopathy and neuromuscular conduction defect-myasthenia
Though the classical description of VGKC is limbic encephalitis and Moorvan's syndrome,the other presentations like PCD, GI dysmotility, parkinsonism, tremor, chorea, sensory motor neuropathy, hyponatremias, dyssomnia , hyperphagia, facio brachial dystonic seizure, other seizures and presentation mimicking CJD are well described.
NMDA receptor antibodies classically associated with Psychiatric features and memory loss, orofacial dyskinesia, choreoathetoid movements, abnormal posturing or increased tone, catatonic state and central hypoventilation.
NMO IgG has expanded the spectrum of NMO to include optic neuritis and myelitis into NMO spectrum of disorder without the classical presentation of eye and spine involvement.
Paraneoplastic/autoimmune etiology should be considered in subacute sensory neuronopathy, cerebellar ataxia, limbic encephalitis, opsoclonus/myoclonus, encephalomyelitis, chronic gastrointestinal pseudo obstruction and Lambert Eaton myasthenic syndrome.
However remember that atypical presentations are more common in these disorders. Course can be variable. In view of the treatability and reversibility of the condition as well as the easy availability of an affordable treatment, autoimmune evaluation should be considered in other cases also.
Paraneoplastic antibodies are cancer specific, not disease specific. Hence we discourage testing for single antibodies in the panel. Some times same patient can have multiple antibodies which in fact help us to locate cancer easily.
1. Paraneoplastic panel of neuronal antibodies in serum (Indirect Immunofluorescence testing and confirmation by immune dot blot)
2. Paraneoplastic panel of neuronal antibodies in CSF (Indirect Immunofluorescence testing and confirmation by immune dot blot)
3. Voltage gated potassium channel antibody (VGKC)- in Serum (Indirect Immunofluorescence testing using transfected cells)
4. Voltage gated potassium channel antibody (VGKC)- in CSF (Indirect Immunofluorescence testing using transfected cells)
5. NMDA (N- methyal –D-aspartate) receptor antibody in Serum (Indirect Immunofluorescence testing using transfected cells)
6. NMDA (N- methyal –D-aspartate) receptor antibody in CSF (Indirect Immunofluorescence testing using transfected cells)
7. NMO-Ig G(Aquaporin-4) antibody in Serum (Indirect Immunofluorescence testing using transfected cells)
8. NMO-Ig G(Aquaporin-4) antibody in CSF (Indirect Immunofluorescence testing using transfected cells)
9. Autoimmune Encephalitis Panel of Antibodies in Serum (Indirect Immunofluorescence testing using transfected cells)
10. Autoimmune Encephalitis Panel of Antibodies in CSF (Indirect Immunofluorescence testing using transfected cells)
11. GABA B receptor antibody in Serum (Indirect Immunofluorescence testing using transfected cells)
12. GABA B receptor antibody in CSF (Indirect Immunofluorescence testing using transfected cells)
13. GAD 65 in Serum (Indirect ELISA)
14. Acetylcholine Receptor Autoantibody in serum(Indirect ELISA)
15. Multiple Sclerosis Evaluation Panel (Isoelectric Focusing and Immunoblotting method)
Paired serum and CSF samples are necessary.
16. Ganglioside Antibody Evaluation Panel in serum (Immune dot blot method)
17. MUSK antibody in serum (Indirect ELISA)
Please send relevant clinical information, investigation details, name, phone number, email and contact address of referring physician.
Use a screw top, leak proof container. Sample is stable at ambient temperature for 72 hours. By courier, should reach the lab within 72 hours. Avoid sending the sample at weekends to reduce the transport time to less than 72 hours. If any delay is expected, send samples refrigerated at 4 degree Celsius which is stable upto 14 days. Store sample in a refrigerator until sending. In case of small sample volume or any other problem, contact laboratory before sending.
Pro premium plan of Professional couriers is fast and economic option (next day afternoon delivery at Amrita Hospital, Kochi).
A. 1. Demand Draft in favour of Amrita Institute of Medical Sciences payable at Kochi
Call or write for any clarifications regarding sample collection, storing, sending, applying or interpreting a result.
Reporting time: Tests are performed every 2 days (Maximum laboratory time) except for multiple sclerosis evaluation panel
Working hours 8.30 am to 5.30pm. Sunday holiday.
2. Online / Internet Fund Transfer
National Electronic Fund Transfer (NEFT)
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B. Cash (to be paid at the Casualty Billing Counter at Amrita Hospital)
Neuroimmunology laboratory (T6F3)
Amrita Institute of Medical Sciences
Ponekkara PO 682041, or Elamakkara PO 682026
Phone: +91 484 285 1234, 0484 6681234 Extension - 1356 & 6318
Mobile no: 09400998656 (Dr. Annamma Mathai-on call mobile)
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