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Neuroimmunology Laboratory

Neuroimmunology Laboratory

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.

Aim

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.

When to suspect autoimmune etiology?

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.

Clinical features

History Clinical examination
  • History or family history of cancer
  • History or family history of systemic autoimmunity
  • History of chronic smoking
  • Elderly age group
  • History of cachexia, anorexia and fever
  • Sub acute onset<12 weeks
  • Multifocal involvement
  • Significant autonomic involvement
  • Features of systemic autoimmunity

 

Laboratory Radiological
  • Inflammatory CSF
  • Elevated CSF protein
  • OCB
  • Markers of systemic autoimmunity
  • Limbic encephalitis
  • Longituidinally extensive transverse myelitis
  • Longituidinal signal changes in spinal tracts

Autoimmune etiology should be strongly sought in all neurological syndromes of unexplained etiology.
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.

Investigations offered by the Neuroimmunology Laboratory

1. Acetylcholine Receptor Autoantibody in Serum by indirect ELISA

TAT 7 Working days

2. Adenylate Kinase 5 antibody in CSF by tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

3. Adenylate Kinase 5 antibody in Serum by tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

4. Alpha Synuclein quatitation in CSF by Sandwich ELISA

TAT 7 Working days

5. Alpha Synuclein quatitation in Serum by Sandwich ELISA

TAT 7 Working days

6. Autoimmune Encephalitis Panel of Antibodies in CSF by cell-based Indirect Immunofluorescence Assay with sub-titles
  1. GABA B receptor
  2. LGI 1protein
  3. CASPR 2 protein
  4. AMPA 1 receptor
  5. AMPA 2 recepror
  6. NMDA (NR1) receptor

TAT 24 working hours

7. Autoimmune Encephalitis Panel of Antibodies in Serum by cell-based Indirect Immunofluorescence Assay with sub-titles
  1. GABA B receptor
  2. LGI 1protein
  3. CASPR 2 protein
  4. AMPA 1 receptor
  5. AMPA 2 receptor
  6. NMDA (NR1) receptor

TAT 24 working hours

8. Autoimmune Atypical Parkinsonism antibody panel in CSF with sub-titles
  1. ANNA-1 (anti-Hu)-antineuronal nuclear antibody1.
  2. ANNA-2 (anti-Ri)- antineuronal nuclear antibody 2.
  3. ANNA-3-antineuronal nuclear antibody 3.
  4. AGNA-1 – Anti Glial nuclear antibody-1.
  5. PCA-2-anti-Purkinje cell cytoplasmic antibody-2.
  6. PCA-Tr- anti-Purkinje cell cytoplasmic antibody-Tr.
  7. Amphiphysin antibody.
  8. CRMP-5{CollapsinResponseMediator Protein-5}(Anti CV-2 ) antibody.
  9. Ma/Ta antibody.
  10. IgLON5 antibody
  11. LGI-1 (Leucine-rich glioma- inactivated -1)
  12. CASPR-2 (Contactin-associated protein-2)
  13. Unclassified neuronal antibody

TAT 24 working hours

9. Autoimmune Atypical Parkinsonism antibody panel in Serum with sub-titles
  1. ANNA-1 (anti-Hu)-antineuronal nuclear antibody1.
  2. ANNA-2 (anti-Ri)- antineuronal nuclear antibody 2.
  3. ANNA-3-antineuronal nuclear antibody 3.
  4. AGNA-1 – Anti Glial nuclear antibody-1.
  5. PCA-2-anti-Purkinje cell cytoplasmic antibody-2.
  6. PCA-Tr- anti-Purkinje cell cytoplasmic antibody-Tr.
  7. Amphiphysin antibody.
  8. CRMP-5{CollapsinResponseMediator Protein-5}(Anti CV-2 ) antibody.
  9. Ma/Ta antibody.
  10. IgLON5 antibody
  11. LGI-1 (Leucine-rich glioma- inactivated -1)
  12. CASPR-2 (Contactin-associated protein-2)
  13. Unclassified neuronal antibody

TAT 24 working hours

10. Autoimmune Epilepsy Profile in CSF with sub-titles
  1. ANNA-1(anti-Hu)-antineuronal nuclear antibody1.
  2. ANNA-2(anti-Ri)- antineuronal nuclear antibody 2.
  3. ANNA-3-antineuronal nuclear antibody 3.
  4. AGNA-1 – Anti Glial nuclear antibody-1.
  5. PCA-2-anti-Purkinje cell cytoplasmic antibody-2.
  6. PCA-Tr- anti-Purkinje cell cytoplasmic antibody-Tr.
  7. Amphiphysin antibody.
  8. CRMP-5{CollapsinResponseMediator Protein-5}(Anti CV-2 ) antibody.
  9. Ma/Ta antibody
  10. LGI-1 (Leucine-rich glioma- inactivated -1)
  11. CASPR-2 (Contactin-associated protein-2)
  12. NMDA R( NR1) antibody
  13. AMPA Receptor1 antibody
  14. AMPA Receptor 2 antibody
  15. GABA B Receptor antibody
  16. GABA A Receptor antibody
  17. GFAP antibody
  18. DPPX-6 Receptor antibody
  19. Glycine Receptor antibody
  20. Unclassified Neuronal antibody

TAT 24 working hours

11. Autoimmune Epilepsy Profile in Serum with sub-titles
  1. ANNA-1 (anti-Hu)-antineuronal nuclear antibody1.
  2. ANNA-2 (anti-Ri)- antineuronal nuclear antibody 2.
  3. ANNA-3-antineuronal nuclear antibody 3.
  4. AGNA-1 – Anti Glial nuclear antibody-1.
  5. PCA-2-anti-Purkinje cell cytoplasmic antibody-2.
  6. PCA-Tr- anti-Purkinje cell cytoplasmic antibody-Tr.
  7. Amphiphysin antibody.
  8. CRMP-5{CollapsinResponseMediator Protein-5}(Anti CV-2 ) antibody.
  9. Ma/Ta antibody
  10. LGI-1 (Leucine-rich glioma- inactivated -1)
  11. CASPR-2 (Contactin-associated protein-2)
  12. NMDA R( NR1) antibody
  13. AMPA Receptor1 antibody
  14. AMPA Receptor 2 antibody
  15. GABA B Receptor antibody
  16. GABA A Receptor antibody
  17. GFAP antibody
  18. DPPX-6 Receptor antibody
  19. Glycine Receptor antibody
  20. Unclassified Neuronal antibody

TAT 24 working hours

12. Autoimmune Dementia Evaluation Panel Optimised with sub-titles
  1. ANNA-1 (anti-Hu)-antineuronal nuclear antibody1.
  2. ANNA-2 (anti-Ri)- antineuronal nuclear antibody 2.
  3. ANNA-3-antineuronal nuclear antibody 3.
  4. AGNA-1 – Anti Glial nuclear antibody-1.
  5. PCA-2-anti-Purkinje cell cytoplasmic antibody-2.
  6. PCA-Tr- anti-Purkinje cell cytoplasmic antibody-Tr.
  7. Amphiphysin antibody.
  8. CRMP-5{CollapsinResponseMediator Protein-5}(Anti CV-2 ) antibody.
  9. Ma/Ta antibody
  10. GABA A receptor antibody-Serum
  11. GFAP antibody-CSF
  12. DPPX Antibody-Serum
  13. Glycine Receptor alpha1 antibody –Serum
  14. IgLON5 antibody –Serum
  15. LGI-1 (Leucine-rich glioma- inactivated -1) – CSF
  16. CAPR-2 (Contactin-associated protein-2) – CSF
  17. NMDA R( NR1) antibody -CSF
  18. AMPA Receptor1 antibody -CSF
  19. AMPA Receptor 2 antibody -CSF
  20. GABA B Receptor antibody -CSF
  21. Zic 4 antibody-Serum
  22. Voltage-gated Calcium Channel antibody (VGCC IgG ) detection in serum
  23. Unclassified neuronal antibody-Serum

TAT 7 Working days

13. Autoimmune Dementia Evaluation Panel CSF with sub-titles
  1. ANNA-1 (anti-Hu)-antineuronal nuclear antibody1.
  2. ANNA-2 (anti-Ri)- antineuronal nuclear antibody 2.
  3. ANNA-3-antineuronal nuclear antibody 3.
  4. AGNA-1 – Anti Glial nuclear antibody-1.
  5. PCA-2-anti-Purkinje cell cytoplasmic antibody-2.
  6. PCA-Tr- anti-Purkinje cell cytoplasmic antibody-Tr.
  7. Amphiphysin antibody.
  8. CRMP-5{CollapsinResponseMediator Protein-5}(Anti CV-2 ) antibody.
  9. Ma/Ta antibody
  10. GABA A receptor antibody
  11. GFAP antibody
  12. DPPX Antibody
  13. Glycine Receptor alpha1 antibody
  14. IgLON5 antibody
  15. LGI-1 (Leucine-rich glioma- inactivated -1)
  16. CASPR-2 (Contactin-associated protein-2)
  17. NMDA R( NR1) antibody
  18. AMPA Receptor1 antibody
  19. AMPA Receptor 2 antibody
  20. GABA B Receptor antibody
  21. Zic 4 antibody
  22. Voltage-gated Calcium Channel antibody (VGCC IgG ) detection
  23. Unclassified neuronal antibody

TAT 7 Working days

14. Autoimmune Dementia Evaluation Panel Serum with sub-titles
  1. ANNA-1 (anti-Hu)-antineuronal nuclear antibody1.
  2. ANNA-2 (anti-Ri)- antineuronal nuclear antibody 2.
  3. ANNA-3-antineuronal nuclear antibody 3.
  4. AGNA-1 – Anti Glial nuclear antibody-1.
  5. PCA-2-anti-Purkinje cell cytoplasmic antibody-2.
  6. PCA-Tr- anti-Purkinje cell cytoplasmic antibody-Tr.
  7. Amphiphysin antibody.
  8. CRMP-5{CollapsinResponseMediator Protein-5}(Anti CV-2 ) antibody.
  9. Ma/Ta antibody
  10. GABA A receptor antibody
  11. GFAP antibody
  12. DPPX Antibody
  13. Glycine Receptor alpha1 antibody
  14. IgLON5 antibody
  15. LGI-1 (Leucine-rich glioma- inactivated -1)
  16. CASPR-2 (Contactin-associated protein-2)
  17. NMDA R( NR1) antibody
  18. AMPA Receptor1 antibody
  19. AMPA Receptor 2 antibody
  20. GABA B Receptor antibody
  21. Zic 4 antibody
  22. Unclassified neuronal antibody

TAT 7 Working days

15. CNS inflammation evaluation panel by Isoelectric focusing and immunofixation method with sub-titles
  1. Serum albumin quantitation
  2. Serum IgG quantitation
  3. CSF albumin quantitation
  4. CSF IgG quantitation
  5. CSF IgG index- formula-based calculation
  6. CSF IgG synthesis rate- formula-based calculation
  7. Intrathecal IgG synthesis rate- formula-based calculation
  8. Albumin index- formula-based calculation
  9. Serum Oligoclonal Bands
  10. CSF Oligoclonal Bands

TAT10 working days; Paired Serum and CSF samples are necessary.
CSF in Polypropylene tube

16. CARP VIII (Carbonic anhydrase - related Protein VIII) antibodies in CSF

TAT-48 working hrs

17. CARP VIII (Carbonic anhydrase - related Protein VIII) antibodies in Serum

TAT-48 working hrs

18. DPPX (Dipeptidyl Aminopeptidase like Protein 6) antibody screening in CSF by tissue-based Indirect Immunofluorescence Assay and confirmation of positive by cell-based immunofluorescence assay using Anti-DPPX kit, Euroimmune-Lubeck, Germany.

TAT 24 working hours

19. DPPX (Dipeptidyl Aminopeptidase like Protein 6) antibody screening in Serum by tissue- based Indirect Immunofluorescence Assay and confirmation of positive by cell-based immunofluorescence assay using Anti-DPPX kit, Euroimmune-Lubeck, Germany.

TAT 24 working hours

20. Detection of Anti glutamic acid decarboxylase(GAD) antibody in CSF by tissue- based Indirect Immunofluorescence Assay and confirmation of positive by immune dot blot.

TAT 48 working hours

21. GABA A Receptor antibody in Serum by tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

22. GABA A Receptor antibody in CSF by tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

23. GABA B receptor antibody in Serum by cell-based Indirect Immunofluorescence Assay

TAT 24 working hours

24. GABA B receptor antibody in CSF by cell-based Indirect Immunofluorescence Assay

TAT 24 working hours

25. Ganglioside Antibody Evaluation Panel in Serum by Indirect ELISA with sub-titles
  1. Anti Ganglioside IgG in Serum (GM1,GD1b and GQ1b).
  2. Anti Ganglioside IgM in Serum (GM1,GD1b and GQ1b).

TAT 24 working hours

26. Ganglioside Antibody Evaluation Panel in Serum (IgG and IgM combined- Gangliocombi) Anti Ganglioside (GM1 GD1b and GQ1b)

TAT 24 working hours

27. GFAP antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay

TAT 24 working hours

28. GFAP antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay

TAT 24 working hours

29. Glycine Receptor Antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

30. Glycine Receptor Antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

31. HOMER3(Homer protein homolog 3 antibodies)in CSF by tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

32. HOMER3 (Homer protein homolog 3 antibodies)in Serum by tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

33. IgLON5 antibody screening in CSF by tissue-based Indirect Immunofluorescence Assay and confirmation of positive by cell-based immunofluorescence assay using Anti- IgLON 5 kit, Euroimmune- Lubeck, Germany.

TAT 24 working hours

34. IgLON5 antibody screening in Serum by tissue-based Indirect Immunofluorescence Assay and confirmation of positive by cell-based immunofluorescence assay using Anti- IgLON 5 kit, Euroimmune- Lubeck, Germany.

TAT 24 working hours

35. ITPR1 (Inositol 1 4 5-trisphosphate receptor type 1) antibodies in CSF- by tissue-based Indirect Immunofluorescence

TAT-48 working hrs

36. ITPR1 (Inositol 1 4 5-trisphosphate receptor type 1) antibodies in serum- by tissue-based Indirect Immunofluorescence

TAT-48 working hrs

37. Kelch - like protein11 (KLHL11) antibodies in CSF- by tissue-based Indirect Immunofluorescence

TAT-48 working hrs

38. Kelch - like protein11 (KLHL11) antibodies in Serum- by tissue-based Indirect Immunofluorescence

TAT-48 working hrs

39. mGlur 1(metabotrophicglutamate receptor 1)antibodies in CSF by tissue-based Indirect Immunofluorescence

TAT 48 working hours

40. mGlur 1 (metabotrophic glutamate receptor 1)antibodies in Serum by tissue-based Indirect Immunofluorescence

TAT 48 working hours

41. mGlur 3(metabotrophicglutamate receptor 3)antibodies in CSF by tissue-based Indirect Immunofluorescence

TAT 48 working hours

42. mGlur 3 (metabotrophic glutamate receptor 3)antibodies in Serum by tissue-based Indirect Immunofluorescence

TAT 48 working hours

43. mGlur 5(metabotrophic glutamate receptor 5)antibodies in CSF by tissue-based Indirect Immunofluorescence

TAT 48 working hours

44. mGlur 5 (metabotrophic glutamate receptor 5)antibodies in Serum by tissue-based Indirect Immunofluorescence

TAT 48 working hours

45. Multiple Sclerosis Evaluation Panel by Isoelectric focusing and immunofixation method with sub-titles
  1. Serum Albumin- quantitation
  2. Serum IgG- quantitation
  3. CSF Albumin- quantitation
  4. CSF IgG -quantitation
  5. CSF IgG index – formula-based calculation
  6. CSF IgG synthesis rate- formula-based calculation
  7. Intrathecal IgG synthesis rate- formula-based calculation
  8. Albumin index- formula-based calculation
  9. Serum Oligoclonal Bands
  10. CSF Oligoclonal Band

TAT 10 working days

Paired Serum and CSF samples are necessary

Polypropylene tube recommended for CSF collection;

46. MUSK antibody in Serum by ELISA

TAT 7 working days

47. Myelin Associated Glycoprotein (MAG) Antibody quantitation in Serum by ELISA

TAT 7 Working days

48. NeuromyelitisOptica Spectrum Disorders (NMOSD) antibody screen panel in CSF by cell-based Indirect Immunofluorescence Assay with sub-titles
  1. 1.Myelin Oligodendrocyte Glycoprotein (MOG)
  2. 2 NeuromyelitisOptica (NMO/Aquaporin-4)

TAT 24 working hours

49. NeuromyelitisOptica Spectrum Disorders (NMOSD) antibody screen panel in Serum by cell-based Indirect Immunofluorescence Assay with sub-titles
  1. Myelin Oligodendrocyte Glycoprotein (MOG)
  2. NeuromyelitisOptica (NMO/ Aquaporin-4)

TAT 24 working hours

50. NMDA (N- methyl –D-aspartate) NR-1 receptor antibody in CSF by cell-based Indirect Immunofluorescence Assay

TAT 24 working hours

51. NMDA (N- methyl –D-aspartate) NR-1 receptor antibody in Serum by cell-based Indirect Immunofluorescence Assay

TAT 24 working hours

52. NMDA Receptor antibody - IgG CSF with Reflex to Titer on positives by cell-based Indirect Immunofluorescence Assay

TAT 24 working hours

53. NMDA Receptor antibody - IgG Serum with Reflex to Titer on positives by cell-based Indirect Immunofluorescence Assay

TAT 24 working hours

54. NMO-IgG (Aquaporin-4) antibody in CSF by cell-based Indirect Immunofluorescence Assay

TAT 24 working hours

55. NMO-IgG (Aquaporin-4) antibody in Serum by cell-based Indirect Immunofluorescence Assay

TAT 24 working hours

56. Neurexin - 3 alpha antibodies in CSF- by tissue-based Indirect Immunofluorescence

TAT-48 working hrs

57. Neurexin - 3 alpha antibodies in Serum- by tissue-based Indirect Immunofluorescence

TAT-48 working hrs

58. Neurochondrin antibodies in CSF- by tissue-based Indirect Immunofluorescence

TAT-48 working hrs

59. Neurochondrin antibodies in Serum- by tissue-based Indirect Immunofluorescence

TAT-48 working hrs

60. Neurofilament Light Polypeptide quantitation in CSF by Sandwich ELISA

TAT-7 working days

61. Neurofilament Light Polypeptide quantitation in Serum by Sandwich ELISA

TAT-7 working days

62. NIF (Neuronal Intermediate filament detection in CSF)- tissue-based Indirect Immunofluorescence

TAT-48 working hrs

63. NIF (Neuronal Intermediate filament detection in Serum)- tissue-based Indirect Immunofluorescence

TAT-48 working hrs

64. Neuron Specific Enolase quantitation in CSF by ELISA

TAT-7 working days

65. Neuron Specific Enolase quantitation in Serum by ELISA

TAT-7 working Days

66. Oligoclonal band in CSF profile with sub-titles
  1. CSF albumin Quantitation
  2. CSF IgG qunntitation
  3. CSF IgG//CSF Albumin ratio
  4. CSF Oligoclonal Bands

TAT 10 working days

Polypropylene tube recommended for CSF collection

67. Paraneoplastic panel of neuronal antibodies in CSF by tissue-based Indirect Immunofluorescence Assay and confirmation of IFA positive by immune dot blot assay using Euroimmune- Lubeck Germany, Euroline with 12 antigens, line- blots with sub-titles
  1. ANNA-1(anti-Hu)-antineuronal nuclear antibody1
  2. ANNA-2(anti Ri)-antineuronal nuclear antibody 2.
  3. ANNA-3 -antineuronal nuclear antibody 3.
  4. AGNA-1 – Anti Glial nuclear antibody-1.
  5. PCA-1 (anti-Yo) – anti-Purkinje cell cytoplasmic antibody-1.
  6. PCA-2- anti-Purkinje cell cytoplasmic antibody-2.
  7. PCA-Tr- anti-Purkinje cell cytoplasmic antibody-Tr.
  8. Amphiphysin antibody.
  9. CRMP-5{Collapsin Response Mediator Protein-5} (Anti CV-2 ) antibody.
  10. Ma/Ta antibody.

TAT 24 working hours

68. Paraneoplastic panel of neuronal antibodies in Serum by tissue-based Indirect Immunofluorescence Assay and confirmation of IFA positive by immune dot blot assay using Euroimmune- Lubeck Germany,Euroline with 12 antigens, line- blots with sub-titles
  1. ANNA-1 (anti-Hu)-antineuronal nuclear antibody 1.
  2. ANNA-2 (anti Ri)-antineuronal nuclear antibody 2.
  3. ANNA-3 -antineuronal nuclear antibody 3.
  4. AGNA-1 – Anti Glial nuclear antibody- 1.
  5. PCA-1 (anti-Yo) – anti-Purkinje cell cytoplasmic antibody-1.
  6. PCA-2- anti-Purkinje cell cytoplasmic antibody-2.
  7. PCA-Tr- anti-Purkinje cell cytoplasmic antibody -Tr.
  8. Amphiphysin antibody.
  9. CRMP-5{Collapsin Response Mediator Protein-5} (Anti CV-2 ) antibody.
  10. Ma/Ta antibody.

TAT 24 working hours

69. 14-3-3 Protein Gamma quantitation in CSF by ELISA

TAT 7 Working days

CSF sample collected in Polypropylene tube

70. Recoverin antibody Screening in CSF by tissue-based Indirect Immunofluorescence Assay and Confirmation of IFA positive by Immunoblot assay using Euroimmune- Lubeck Germany, Euroline with 12 antigens, line- blots.

TAT 48 working hours

71. Recoverin antibody Screening in Serum by tissue-based Indirect Immunofluorescence Assay and Confirmation of IFA positive by Immunoblot assay using Euroimmune- Lubeck Germany, Euroline with 12 antigens,line- blots.

TAT 48 working hours

72. Striational (Striated Muscle) Antibody inSerum by tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

73. Septin 5 antibody in CSF tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

74. Septin 5 antibody in Serum tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

75. SEZ6L2 (Seizure related 6 homolog like 2) antibody in CSF tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

76. SEZ6L2 (Seizure related 6 homolog like 2) antibody in Serum tissue-based Indirect Immunofluorescence Assay

TAT 48 working hours

77. Titin antibody Screening in Serum by tissue-based Indirect Immunofluorescence Assay and Confirmation of IFA positive by Immunoblot assay using Euroimmune- Lubeck Germany, Euroline with 12 antigens,line-blots.

TAT 48 working hours

78. Voltage-gated potassium channel antibody (VGKC)- in CSF by cell-based Indirect Immunofluorescence Assay with sub-titles
  1. LGI-1 (Leucine-rich glioma- inactivated -1)
  2. CASPR-2 (Contactin-associated protein-2)

TAT 24 working hours

79. Voltage-gated potassium channel antibody (VGKC)- in Serum by cell-based Indirect Immunofluorescence Assay with sub-titles
  1. LGI-1 (Leucine-rich glioma inactivated protein -1)
  2. CASPR-2 (Contactin-associated protein-2

TAT 24 working hours

80. Voltage-gated Calcium Channel antibody (VGCC IgG ) detection in Serum By ELISA

TAT 7 Working days

81. Zic 4 antibody Screening in CSF by tissue-based Indirect Immunofluorescence Assay and Confirmation of IFA positive by Immunoblot assay using Euroimmune- Lubeck Germany, Euroline with 12 antigens, line- blots.

TAT 48 working hours

82. Zic 4 antibody Screening in Serum by tissue-based Indirect Immunofluorescence Assay and Confirmation of IFA positive by Immunoblot assay using Euroimmune- Lubeck Germany, Euroline with 12 antigens, line- blots.

TAT 48 working hours

(Total – 82 investigations)

* Laboratory working time 8.30 am to 6.00 pm. (Except Sundays and Institute Holidays)

Specimen: Serum (Volume one ml)

Specimen: *CSF (Volume one ml)

*CSF Sample collection for all tests: sterile leakproof, polypropylene/ plastic tube

Please send relevant clinical information, investigation details, name, phone number, email, and contact address of referring physician. As part of quality assurance, the following information needs to be provided:

  • Date of collection of sample
  • Date/Time to send the sample

For Sample Pick-up, Please Contact:
V K Srinivasan - CMO +91 7349410305
ZeiniX Life Sciences
Ground Flr, Sy No 27,
Degenahalli, Budihal Post,
Nelamangala, Bangalore - 562 123
support@zeinixlife.com

Method of sample transportation

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).

Method of payment

    • 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.
    • Online / Internet Fund Transfer
      National Electronic Fund Transfer (NEFT)
      For format >> click here
  2. Cash (to be paid at the Casualty Billing Counter at Amrita Hospital)

Publications Related to Neuroimmunology Laboratory

  • Kesavan S, Chari A, Kandasamy S, Sangaralingam T, Kannoth S. MRI-Negative MOG Antibody-Associated Disease in Meningitis. Indian Journal of Pediatrics. 2022 Dec 10:1-.
  • Sasikumar S, Vincent J, Gopinath S, Nambiar V, Umesh SU, Kannoth S, Antony D, Mathai A, Anandakuttan A. Autoimmune parkinsonism with faciobrachiocrural dystonic seizures: a new phenotype of leucine-rich glioma-inactivated 1 (LGI1) autoimmunity. Acta Neurologica Belgica. 2022 Oct;122(5):1323-8.
  • Lalwani CS, Thushara IM, Kannoth S, Kumar A, Mathai A. First case report of anti-AMPA receptor encephalitis presenting with features of parkinsonism. Neurological Sciences. 2022 May 11:1-3.
  • Mathai A, Panicker S, Kannoth S, Anandakuttan A. Prozone phenomenon observed in indirect immunofluorescence assay by antibodies against neuronal antigens. Journal of Neuroimmunology. 2020 Dec 15;349:577415
  • Cherian A, Divya KP, Shetty SC, Kannoth S, Thomas B. Coexistent MOG, NMDAR, CASPR2 antibody positivity: Triumph over the triumvirate. Multiple Sclerosis and Related Disorders. 2020 Nov 1;46:102468
  • Occurence of Myasthenia Gravis in Post Stroke Fatigue. Vivek K. Nambiar, 2019 (Won the Paul Dudley White International Scholar Award To Recognize the Authors with the Highest Ranked Abstract from India at the International Stroke Conference 2019)
  • Sankaranarayanan M, Shah S, Thomas P, Kannoth S, Radhakrishnan K. Persistent extreme delta brush in anti-NMDA-receptor encephalitis: Does it portend a poor prognosis?. Epilepsy & behavior reports. 2019 Jan 1;12:100324.
  • Kannoth S, Nambiar V, Gopinath S, Anandakuttan A, Mathai A, Rajan PK. Expanding spectrum of contactin-associated protein 2 (CASPR2) autoimmunity—syndrome of parkinsonism and ataxia. Neurological Sciences. 2018 Mar 1;39(3):455-60.
  • Makhija P, Gopinath S, Kannoth S, Radhakrishnan K. A case of post‐leptospirosis autoimmune epilepsy presenting with sleep‐related hypermotor seizures. Epileptic Disorders. 2017 Dec;19(4):456-60.
  • Kannoth S, Anandakkuttan A, Mathai A, Sasikumar AN, Nambiar V. Autoimmune atypical parkinsonism—a group of treatable parkinsonism. Journal of the neurological sciences. 2016 Mar 15;362:40-6.
  • Aghoram R, Srijithesh PR, Kannoth S. Adult-onset Satoyoshi syndrome and response to plasmapheresis. Annals of Indian Academy of Neurology. 2016 Jan;19(1):131.
  • Sudan YS, Vinayan KP, Roy AG, Wagh A, Kannoth S, Patil S. Clinical characteristics and follow-up of South Indian children with autoimmune encephalopathy. The Indian Journal of Pediatrics. 2016 Dec 1;83(12-13):1367-73.
  • Cyril AC, Nair SS, Mathai A, Kannoth S, Thomas SV. Autoimmune encephalitis: Clinical diagnosis versus antibody confirmation. Annals of Indian Academy of Neurology. 2015 Oct;18(4):408.

References:

Paraneoplastic syndromes in general
Kannoth.S.Paraneoplastic neurologic syndrome:A practical approach.Ann Indian Acad Neurol 1.(2012) 6-12

Different antibodies

Different antibodies include :
  • ANNA-1(anti Hu)- antineuronal nuclear antibody 1-Lucchinetti CF, Kimmel DW, Lennon VA. Paraneoplastic and oncological profiles of patients seropositive for type 1 anti-neuronal nuclear auto antibodies. Neurology 1998; 50:652-657
  • ANNA-2(anti Ri)- antineuronal nuclear antibody 2-Pittock SJ, Lucchinetti CF, Lennon VA. Anti-neuronal nuclear autoantibody type 2: Paraneoplastic accompaniments. Ann Neurol 2003; 53:580-597.
  • ANNA-3 (antineuronal nuclear antibody 3) –Chan KH, Vernino S, Lennon VA. ANNA-3 anti-neuronal nuclear antibody: Marker of lung cancer-related autoimmunity. Ann Neurol 2001; 50:301-311.
  • AGNA-1 (Anti Glial nuclear antibody-1) – Graus F,Vincent A,Pozo –Rosich P et al. Antiglial nuclear antibody :Marker of lung cancer – related paraneoplastic neurological syndromes.J Neuroimm 2005 ; 165 :166-71
  • PCA-1 (anti Yo) (anti Purkinje cell cytoplasmic antibody-1) – Peterson K, Rosenblum MK, Kotanides H, Posner JB. Paraneoplastic cerebellar degeneration. I. A clinical analysis of 55 anti-Yo antibody-positive patients. Neurology 1992; 42:1931-1937.
  • PCA-2 (anti Purkinje cell cytoplasmic antibody-2) – Vernino S, Lennon VA. New Purkinje cell antibody (PCA-2): marker of lung cancer-related neurological autoimmunity. Ann Neurol 2000; 47:297-305.
  • PCA-Tr- (anti Purkinje cell cytoplasmic antibody Tr) – Bernal F, Shams’ili S, Rojas I et al: Anti-Tr antibodies as markers of paraneoplastic cerebellar degeneration and Hodgkin’s disease. Neurology 2003; 60:230-234.
  • Anti Amphiphysin antibody – Pittock SJ, Lucchinetti CF, Parisi JE, et al.Amphiphysin autoimmunity: Paraneoplastic accompaniments. Ann Neurol. 2005; 58:96-107.
  • AntiCRMP-5 {Collapsin Response Mediator Protein-5} (Anti CV-2) antibody – Yu Z, Kryzer TJ, Griesmann GE, Kim K, Benarroch EE, Lennon VA. CRMP-5 neuronal autoantibody: marker of lung cancer and thymoma-related autoimmunity. Ann Neurol 2001; 49:146-154.
  • Anti Ma/Ta antibody – Dalmau J. Graus F. Villarejo A. et al.Clinical analysis of anti-Ma2-associated encephalitis. Brain 2004; 127(Pt 8):1831-44.
  • Voltage gated potassium channel antibody (VGKC). LGI-1 (Leucine rich glioma inactivated protein-1). CASPR-2 (Contactin associated protein-2) –
    1.Irani SR, Alexander S, Waters P et al. Antibodies to Kv1 potassium channel-complex proteins leucine-rich, glioma inactivated 1 protein and contactin-associated protein-2 in limbic encephalitis, Morvan’s syndrome and acquired neuromyotonia. Brain. 2010; 133 :2734-48.
    2.Lai M, Huijbers MG, Lancaster E et al. Investigation of LGI1 as the antigen in limbic encephalitis previously attributed to potassium channels: a case series. Lancet Neurol. 2010; 9:776-85.
  • NMDA (N- methyl –D-aspartate) receptor antibody – Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R.Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis.Lancet Neurol. 2011;10:63-74.
  • NMO-IgG(Aquaporin-4) antibody – Jacob A, McKeon .A, Nakashima I, Sato DK, Elsone L, Fujihara., de Seze .J.Current concept of neuromyelitis optica (NMO) and NMO spectrum disorders J Neurol Neurosurg Psychiatry jnnp-2012-302310Published Online First: 10 November 2012 doi:10.1136/jnnp-2012-302310.
  • Musk antibody – Sanders, Donald B., et al. “Clinical aspects of MuSK antibody positive seronegative MG.” Neurology 60.12 (2003): 1978-1980.
  • Acetylcholine receptor antibody – Vincent, A., and J. Newsom-Davis. “Acetylcholine receptor antibody as a diagnostic test for myasthenia gravis: results in 153 validated cases and 2967 diagnostic assays.” Journal of Neurology, Neurosurgery & Psychiatry 48.12 (1985): 1246-1252.
  • Ganglionic acetylcholine receptor antibody – Vernino, Steven, et al. “Autoantibodies to ganglionic acetylcholine receptors in autoimmune autonomic neuropathies.” New England Journal of Medicine 343.12 (2000): 847-855.
  • Dopamine-2 receptor antibody – Dale, Russell C., et al. “Antibodies to surface dopamine-2 receptor in autoimmune movement and psychiatric disorders.” Brain 135.11 (2012): 3453-3468.
  • MOG auto antibody – Reindl, Markus, et al. “The spectrum of MOG autoantibody-associated demyelinating diseases.” Nature reviews neurology 9.8 (2013): 455-461.
  • DPPX antibody – Boronat, Anna, et al. “Encephalitis and antibodies to dipeptidyl‐peptidase–like protein‐6, a subunit of Kv4. 2 potassium channels.” Annals of neurology 73.1 (2013): 120-128.
  • GFAP antibody – Flanagan, Eoin P., et al. “Glial fibrillary acidic protein immunoglobulin G as biomarker of autoimmune astrocytopathy: Analysis of 102 patients.” Annals of neurology 81.2 (2017): 298-309.
  • Ganglioside antibody – Pestronk, A., et al. “A treatable multifocal motor neuropathy with antibodies to GM1 ganglioside.” Annals of neurology 24.1 (1988): 73-78.
    Willison, H. J., et al. “Miller Fisher syndrome is associated with serum antibodies to GQ1b ganglioside.” Journal of Neurology, Neurosurgery & Psychiatry 56.2 (1993): 204-206.
    Odaka, Masaaki, et al. “Bickerstaff’s brainstem encephalitis: clinical features of 62 cases and a subgroup associated with Guillain–Barré syndrome.” Brain 126.10 (2003): 2279-2290.
  • GABA B receptor antibody – Lancaster, Eric, et al. “Antibodies to the GABA B receptor in limbic encephalitis with seizures: case series and characterisation of the antigen.” The Lancet Neurology 9.1 (2010): 67-76.
  • AMPA receptor antibody – Lai, Meizan, et al. “AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location.” Annals of neurology 65.4 (2009): 424-434.
  • Multiple sclerosis evaluation – OCB detection -Hans Link,Yu-Min Huang:Oligoclonal bands in Multiple Sclerosis cerebrospinal fluid; An update on methodology and clinical usefulness. J Neuroimmunol, 2006;180;17-28
  • IgLon-5 – Honorat JA, Komorowski L, Josephs KA et al IgLON5 antibody Neurological accompaniments and outcomes in 20 patients. Neurology-Neuroimmunology Neuroinflammation. 2017 Sep 1;4(5):e385.

Useful links for information:

Doctors /Faculties

September 17, 2021

Dr. Sudheeran Kannoth

September 17, 2021

Dr. Annamma Mathai

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Address for sending Samples
  • Address: Dr.Sudheeran Kannoth, Neuroimmunology laboratory (T6F3) Amrita Institute of Medical Sciences Ponekkara PO 682041, or Elamakkara PO 682026 Kochi, Kerala, India
  • Phone:+91 484 285 1234, 0484 6681234 Extension - 1356 & 6318
  • Mobile no: 09400998656 (Dr. Annamma Mathai-on call mobile)
  • Email: neuroimmunology@aims.amrita.edu