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. These disorders can be associated with a cancer (paraneoplastic) as well without cancer association (non-paraneoplastic).    

If properly investigated and diagnosed as an autoimmune neurological syndrome, it becomes potentially treatable and often fully reversible. Here comes the importance of comprehensive neuroimmunology service which can provide an early diagnosis.

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 develop a nationwide 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?

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.     
 

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.

Paraneoplastic antibodies are cancer specific, not disease-specific. Hence we discourage testing for single antibodies in the panel. Sometimes same patient can have multiple antibodies which in fact help us to locate cancer easily.

Investigations and Turn Around Time (TAT)                

1.  Acetylcholine Receptor antibody quantitation 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. Agrin antibody quantitation in Serum by Competitive ELISA TAT 7 working days .
5. Alpha Synuclein quantitation in CSF by Sandwich ELISA TAT 7 Working days.
6. Alpha Synuclein quantitation in Serum by Sandwich ELISA TAT 7 Working days      
7. Autoimmune Atypical Parkinsonism antibody panel in CSF
   1. ANNA-1(anti-Hu) Anti Neuronal Nuclear Antibody-1.
   2. ANNA-2 (anti-Ri) Anti Neuronal Nuclear Antibody -2.
   3. ANNA-3 Anti Neuronal Nuclear Antibody- 3.
   4. AGNA-1 Anti Glial Nuclear Antibody-1.
   5. PCA-2 Purkinje Cell Cytoplasmic Antibody-2.
   6. PCA-Tr Purkinje Cell Cytoplasmic Antibody-Tr.
   7.  Amphiphysin Antibody
   8. CRMP-5{Collapsin Response Mediator Protein-5} (CV-2) Antibody.
   9. Ma2/Ta Antibody. 
   10. IgLON5 Antibody
   11. LGI-1 (Leucine-rich Glioma- Inactivated Protein-1) Antibody (VGKC associated) 
   12. CASPR-2 (Contactin-Associated Protein-2) Antibody (VGKC associated)
   13. Unclassified Neuronal Antibody                                                                                              
       TAT 24 working hours
8.  Autoimmune Atypical Parkinsonism antibody panel in Serum
   1. ANNA-1 (anti-Hu) Anti Neuronal Nuclear Antibody-1.
   2. ANNA-2 (anti-Ri) Anti Neuronal Nuclear Antibody -2.
   3. ANNA-3 Anti Neuronal Nuclear Antibody -3.
   4. AGNA-1 Anti Glial Nuclear Antibody-1. 
   5. PCA-2 Purkinje Cell Cytoplasmic Antibody-2.
   6. PCA-Tr Purkinje Cell Cytoplasmic Antibody-Tr. 
   7. Amphiphysin Antibody.
   8. CRMP-5{Collapsin Response Mediator Protein-5} (CV-2) Antibody. 
   9. Ma2/Ta Antibody 
   10. IgLON5 Antibody
   11. LGI- 1 (Leucine-rich Glioma- Inactivated Protein-1) Antibody (VGKC associated) 2 /13
   12. CASPR-2 (Contactin-Associated Protein-2) Antibody (VGKC associated) 
   13. Unclassified Neuronal Antibody                                                                              
       TAT 24 working hours
9. Autoimmune Dementia Evaluation Panel – Optimised
   1. ANNA-1 (anti-Hu) Anti Neuronal Nuclear Antibody1 in Serum 
   2. ANNA-2 (anti-Ri) Anti Neuronal Nuclear Antibody 2 in Serum
   3. ANNA-3 Anti Neuronal Nuclear Antibody 3 in Serum
   4. AGNA-1 Anti Glial Nuclear Antibody-1 in Serum 
   5. PCA-2 Purkinje Cell Cytoplasmic Antibody-2 in Serum
   6. PCA-Tr Purkinje Cell Cytoplasmic Antibody-Tr in Serum
   7. Amphiphysin Antibody in Serum
   8. CRMP-5{Collapsin Response Mediator Protein-5} (Anti CV-2) Antibody in Serum
   9. Ma2/Ta Antibody in Serum
   10. GABA A Receptor Antibody in Serum
   11. GFAP Antibody in CSF
   12. DPPX-6 Receptor Antibody in Serum 
   13. Glycine Receptor Antibody in Serum 
   14. IgLON5 Antibody in Serum 
   15. LGI-1(Leucine-rich glioma- inactivated Protein-1) Antibody (VGKC associated) in Serum 
   16. CASPR-2(Contactin-associated protein-2) Antibody (VGKC associated) in Serum 
   17. NMDA (NR1) Receptor Antibody in CSF
   18. .AMPA1 Receptor Antibody in CSF
   19. AMPA2 Receptor Antibody in CSF
   20. GABA B Receptor Antibody in CSF
   21. Zic 4 Antibody in Serum
   22. Voltage-Gated Calcium Channel (VGCC) Antibody quantitation in Serum
   23. Unclassified Neuronal Antibody in Serum                                                                   
       TAT 7 Working days
10. Autoimmune Dementia Evaluation Panel in CSF
    1. ANNA-1(anti-Hu) Anti Neuronal Nuclear Antibody-1.
    2. ANNA-2 (anti-Ri) Anti Neuronal Nuclear Antibody -2. 
    3. ANNA-3 Anti Neuronal Nuclear Antibody- 3.
    4.  AGNA-1 Anti Glial Nuclear Antibody-1. 
    5. PCA-2 Purkinje Cell Cytoplasmic Antibody-2. 
    6. PCA-Tr Purkinje Cell Cytoplasmic Antibody-Tr.
    7. Amphiphysin Antibody.
    8. CRMP-5{Collapsin Response Mediator Protein-5} (CV-2) Antibody.
    9. Ma2/Ta Antibody
    10. GABA A Receptor Antibody
    11. GFAP Antibody
    12. DPPX-6 Receptor Antibody
    13. Glycine Receptor Antibody
    14. IgLON5 Antibody
    15. LGI-1 (Leucine-rich Glioma- Inactivated Protein-1) Antibody (VGKC associated)
    16. CASPR-2 (Contactin-Associated Protein-2) Antibody (VGKC associated)
    17. NMDA (NR1) Receptor Antibody 
    18. AMPA 1 Receptor Antibody
    19. AMPA 2 Receptor Antibody
    20. GABA B Receptor Antibody 
    21. Zic 4 Antibody
    22. Unclassified Neuronal Antibody                                                                   
        TAT 48 Working hours
11. Autoimmune Dementia Evaluation Panel in Serum
    1. ANNA-1 (anti-Hu) Anti Neuronal Nuclear Antibody-1.
    2. ANNA-2 (anti-Ri) Anti Neuronal Nuclear Antibody -2. 
    3. ANNA-3 Anti Neuronal Nuclear Antibody -3. 
    4. AGNA-1 Anti Glial Nuclear Antibody-1.
    5. PCA-2 Purkinje cell Cytoplasmic Antibody-2. 
    6. PCA-Tr Purkinje cell Cytoplasmic Antibody-Tr. 
    7. Amphiphysin Antibody. 
    8. CRMP-5{Collapsin Response Mediator Protein-5} (CV-2) Antibody. 
    9. Ma2/Ta Antibody
    10. GABA A Receptor Antibody
    11. GFAP Antibody
    12. DPPX -6 Receptor Antibody
    13. Glycine Receptor Antibody
    14. IgLON5 Antibody 
    15. LGI-1(Leucine-rich Glioma- Inactivated Protein-1) Antibody (VGKC associated) 
    16. CASPR-2 (Contactin-Associated Protein-2) Antibody (VGKC associated) 
    17. NMDA (NR1) Receptor Antibody
    18. AMPA 1 Receptor Antibody 
    19. AMPA 2 Receptor Antibody 
    20. GABA B Receptor Antibody
    21. Voltage-Gated Calcium Channel (VGCC) Antibody quantitation 
    22. Zic 4 Antibody 23. Unclassified Neuronal Antibody                                                                
        TAT 7 Working days
12. Autoimmune Encephalitis Panel of antibodies in CSF by cell-based Indirect Immunofluorescence Assay
    1. GABA B Receptor Antibody
    2. LGI 1 (Leucine-rich Glioma- Inactivated Protein-1) Antibody (VGKC associated) 
    3. CASPR 2 (Contactin-Associated Protein-2) Antibody (VGKC associated)
    4. AMPA 1 Receptor Antibody 
    5. AMPA 2 Receptor Antibody 
    6. NMDA (NR1) Receptor Antibody                                                              
       TAT 24 working hours
13.  Autoimmune Encephalitis Panel of antibodies in Serum by cell-based Indirect Immunofluorescence Assay
    1. GABA B Receptor Antibody
    2.  LGI 1 (Leucine-rich Glioma- Inactivated Protein-1) Antibody (VGKC associated)
    3. CASPR 2 (Contactin-Associated Protein-2) Antibody (VGKC associated)
    4. AMPA 1 Receptor Antibody
    5. AMPA 2 Receptor Antibody 
    6. NMDA (NR1) Receptor Antibody                                                             
       TAT 24 working hours
14. Autoimmune Epilepsy Profile in CSF
    1. ANNA-1 (anti-Hu) Anti Neuronal Nuclear Antibody-1
    2. ANNA-2 (anti-Ri) Anti Neuronal Nuclear Antibody-2.
    3. ANNA-3 Anti Neuronal Nuclear Antibody 3.
    4. AGNA-1 Anti Glial Nuclear Antibody-1.
    5. PCA-2 Purkinje cell Cytoplasmic Antibody-2. 
    6. PCA-Tr Purkinje cell Cytoplasmic Antibody-Tr. 
    7. Amphiphysin Antibody. 4 /13 
    8. CRMP-5{Collapsin Response Mediator Protein-5} (CV-2) Antibody.
    9.  Ma2/Ta Antibody
    10. LGI-1 (Leucine-rich Glioma- Inactivated Protein-1) Antibody (VGKC associated) 
    11. CASPR-2 (Contactin-Associated Protein-2) Antibody (VGKC associated)
    12. NMDA (NR1) Receptor Antibody
    13. AMPA 1 Receptor Antibody
    14. AMPA 2 Receptor 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
15. Autoimmune Epilepsy Profile in Serum
    1. ANNA-1 (anti-Hu) Anti Neuronal Nuclear Antibody-1.
    2. ANNA-2 (anti-Ri) Anti Neuronal Nuclear Antibody-2. 
    3. ANNA-3 Anti Neuronal Nuclear Antibody-3. 
    4. AGNA-1 Anti Glial Nuclear Antibody-1. 
    5. PCA-2 Purkinje cell Cytoplasmic Antibody-2. 
    6. PCA-Tr Purkinje cell Cytoplasmic Antibody-Tr. 
    7. Amphiphysin Antibody.
    8. CRMP-5{Collapsin Response Mediator Protein-5} (CV-2) Antibody.
    9. Ma2/Ta Antibody
    10. LGI-1 (Leucine-rich Glioma- Inactivated Protein-1) Antibody (VGKC associated) 
    11. CASPR-2 (Contactin-Associated Protein-2) Antibody (VGKC associated) 
    12. NMDA (NR1) Receptor Antibody
    13. AMPA1 Receptor Antibody
    14. AMPA2 Receptor 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
16. Autoimmune Neuropathy Evaluation Panel in Serum
    1. Neurofascin 140 Antibody quantitation by Competitive ELISA
    2. Neurofascin 155 Antibody quantitation by Competitive ELISA
    3. Neurofascin 186 Antibody quantitation by Competitive ELISA 
    4. MAG antibody quantitation by Sandwich ELISA 
    5. Neuronal Antibody detection
    6. VGKC associated LGI-1 and CASPR-2 Antibody detection 
    7. GAD65 Antibody quantitation                                                         
       TAT 15 Working days
17. CARP VIII (Carbonic Anhydrase – Related Protein VIII) antibody detection in CSF by tissue – based Indirect Immunofluorescence Assay                                                         
    TAT 48 working hours
18. CARP VIII (Carbonic Anhydrase – Related Protein VIII) antibody detection in Serum by tissue – based Indirect Immunofluorescence Assay                                                       
    TAT 48 working hours
19. CNS inflammation evaluation panel by Isoelectric focusing and immunofixation method
    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. CSF IgG Intrathecal synthesis rate- formula-based calculation 
    8. Albumin index- formula-based calculation
    9. Serum Oligoclonal Bands
    10. CSF Oligoclonal Bands Paired Serum and CSF samples are necessary.                                                    
         CSF sample to be collected in polypropylene tube                                                     
        TAT 7 working days
20. CNS inflammation evaluation panel- Extended by Isoelectric focusing – immunofixation method and Indirect Immunofluorescence Assay
    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. CSF IgG Intrathecal synthesis rate- formula-based calculation
    8. Albumin index- formula-based calculation 
    9. CSFIgG/ CSF albumin ratio
    10. Serum Oligoclonal Bands
    11. CSF Oligoclonal Bands
    12. Serum Neuronal antibody 
    13. CSF Neuronal antibody                                                    
        Paired Serum and CSF samples are necessary.                                                     
        CSF sample to be collected in polypropylene tube                                                     
        TAT 7 working days.
21.  DPPX -6 (Dipeptidyl Aminopeptidase like Protein 6) antibody detection in CSF by tissue based Indirect Immunofluorescence Assay and confirmation of positive by cell-based immunofluorescence assay                                                   
    TAT 24 working hours
22.  DPPX -6 (Dipeptidyl Aminopeptidase like Protein 6) antibody detection in Serum by tissuebased Indirect Immunofluorescence Assay and confirmation of positive by cell-based immunofluorescence assay                                                  
    TAT 24 working hours
23. GABA A receptor antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay                                                  
    TAT 48 working hours
24.  GABA A receptor antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay                                                
    TAT 48 working hours
25. GABA B receptor antibody detection in CSF by cell-based Indirect Immunofluorescence Assay                                                
    TAT 24 working hours
26. GABA B receptor antibody detection in Serum by cell-based Indirect Immunofluorescence Assay                                               
    TAT 24 working hours
27. Ganglioside Antibody Evaluation Panel in Serum by Indirect ELISA
    1. Ganglioside IgG in Serum (GD1, GQ1b and GM1)
    2. Ganglioside IgM in Serum (GD1, GQ1b and GM1)                                              
       TAT 24 working hours
28. Ganglioside Antibody Evaluation Panel in Serum – IgG and IgM mix (Gangliocombi) to GM1, GD1b and GQ1b by indirect ELISA - (GD1b-IgG & IgM, GQ1b IgG & IgM, GM1-IgG & IgM).                                             
    TAT 24 working hours
29. GFAP (Glial Fibrillary Acidic Protein) antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay                                            
    TAT 24 working hours
30. GFAP (Glial Fibrillary Acidic Protein) antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay                                           
    TAT 24 working hours
31. GAD 65 (Glutamic Acid Decarboxylase 65) antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay and confirmation of positive by immune dot blot.                                          
    TAT 48 working hours
32. Glycine receptor antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay                                         
    TAT 48 working hours
33. Glycine receptor antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay                                        
    TAT 48 working hours
34. HOMER3 (Homer protein homolog 3) antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay                                       
    TAT 48 working hours
35. HOMER3 (Homer protein homolog 3) antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay                                      
    TAT 48 working hours
36. IgLON5 antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay and confirmation of positive by cell-based Indirect immunofluorescence assay                                     
    TAT 24 working hours
37.  IgLON5 antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay and confirmation of positive by cell-based Indirect immunofluorescence assay                                    
    TAT 24 working hours
38. ITPR1 (Inositol 1 4 5-trisphosphate receptor type 1) antibody detection in CSF- by tissuebased Indirect Immunofluorescence Assay                                  
    TAT 48 working hours
39. ITPR1 (Inositol 1 4 5-trisphosphate receptor type 1) antibody detection in Serum- by tissuebased Indirect Immunofluorescence Assay                                 
    TAT 48 working hours
40. KLHL11 (Kelch – like protein11) antibody detection in CSF- by tissue-based Indirect Immunofluorescence Assay                                 
    TAT 48 working hours
41.  KLHL11 (Kelch – like protein11) antibody detection in Serum- by tissue-based Indirect Immunofluorescence Assay                               
    TAT 48 working hours
42. LRP4 (Low density Lipoprotein Receptor related Protein 4) antibody quantitation in Serum by Competitive ELISA                               
    TAT 7 working Days
43.  MAG (Myelin Associated Glycoprotein) antibody quantitation in Serum by Sandwich ELISA                              
    TAT 7 Working days
44. mGlur 1(metabotrophic glutamate receptor 1) antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay                               
    TAT 48 working hours
45. mGlur 1 (metabotrophic glutamate receptor 1) antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay                               
    TAT 48 working hours
46. mGlur 3 (metabotrophic glutamate receptor 3) antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay                               
    TAT 48 working hours
47. mGlur 3 (metabotrophic glutamate receptor 3) antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay                               
    TAT 48 working hours
48. mGlur 5(metabotrophic glutamate receptor 5) antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay                               
    TAT 48 working hours
49. mGlur 5 (metabotrophic glutamate receptor 5) antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay                              
    TAT 48 working hours
50. MOG (Myelin Oligodendrocyte Glycoprotein) antibody detection in CSF by cell-based Indirect Immunofluorescence Assay                               
    TAT 24 working hours
51. MOG (Myelin Oligodendrocyte Glycoprotein) antibody detection in Serum by cell-based Indirect Immunofluorescence Assay                             
    TAT 24 working hours
52. Multiple Sclerosis Evaluation Panel by Isoelectric focusing and immunofixation method
    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. CSF IgG Intrathecal synthesis rate- formula-based calculation 
    8. Albumin index- formula-based calculation
    9. Serum Oligoclonal Bands
    10. CSF Oligoclonal Band Paired Serum and CSF samples are necessary CSF sample to be collected in polypropylene tube                             
        TAT 10 working days
53. MuSK (Muscle Specific Tyrosine Kinase) antibody quantitation in Serum by Sandwich ELISA                            
    TAT 7 working days
54. Myasthenia Gravis antibodies Evalution Panel in Serum
    1. Acetylcholine Receptor antibody quantitation by Indirect ELISA
    2. Agrin antibody quantitation by Competitive ELISA
    3. LRP4 (Low density Lipoprotein Receptor related Protein 4) antibody quantitation by Competitive ELISA
    4. MuSK (Muscle Specific Tyrosine Kinase) antibody quantitation by Sandwich ELISA
    5. Ryanodine receptor antibody quantitation by Competitive ELISA 
    6. Striatal Muscle antibody detection (Qualitative) by Tissue based Indirect Immunofluorescence Assay 
    7. Titin antibody quantitation by Competitive ELISA                           
       TAT 7 working days
55. Neurexin – 3 alpha antibody detection in CSF- by tissue-based Indirect Immunofluorescence Assay                          
    TAT 48 working hours
56. Neurexin – 3 alpha antibody detection in Serum- by tissue-based Indirect Immunofluorescence Assay                        
    TAT 48 working hours
57. Neurochondrin antibody detection in CSF- by tissue-based Indirect Immunofluorescence Assay                        
    TAT 48 working hours
58. Neurochondrin antibody detection in Serum- by tissue-based Indirect Immunofluorescence Assay                       
    TAT 48 working hours
59. Neurofascin 140 antibody quantitation in CSF by Competitive ELISA                     
    TAT 7 working days
60. Neurofascin 140 antibody quantitation in Serum by Competitive ELISA                     
    TAT 7 working days
61. Neurofascin 155 antibody quantitation in CSF by Competitive ELISA                   
    TAT 7 working days 
62. Neurofascin 155 antibody quantitation in Serum by Competitive ELISA                    
    TAT 7 working days
63. Neurofascin 186 antibody quantitation in CSF by Competitive ELISA                   
    TAT 7 working days 
64. Neurofascin 186 antibody quantitation in Serum by Competitive ELISA                    
    TAT 7 working days
65. Neurofilament Light Polypeptide quantitation in CSF by Sandwich ELISA                    
    TAT 7 working days
66. Neurofilament Light Polypeptide quantitation in Serum by Sandwich ELISA                   
    TAT 7 working days
67. NMOSD (Neuromyelitis Optica Spectrum Disorders) antibody panel detection in CSF by cell-based Indirect Immunofluorescence Assay 1.Myelin Oligodendrocyte Glycoprotein (MOG) 2 NeuromyelitisOptica (NMO/Aquaporin-4)                    
    TAT 24 working hours
68. NMOSD (Neuromyelitis Optica Spectrum Disorders) antibody panel detection in Serum by cell-based Indirect Immunofluorescence Assay 1.Myelin Oligodendrocyte Glycoprotein (MOG) 2 NeuromyelitisOptica (NMO/Aquaporin-4)                    
    TAT 24 working hours
69. Neuron Specific Enolase quantitation in CSF by Simple step ELISA                   
    TAT 7 working days
70. Neuron Specific Enolase quantitation in Serum by Simple step ELISA                    
    TAT 7 working days
71. Neuronal antibody detection in CSF- by tissue-based Indirect Immunofluorescence Assay                   
    TAT 48 working hours
72. Neuronal antibody detection in Serum – by tissue-based Indirect Immunofluorescence Assay                   
    TAT 48 working hours
73. NIF (Neuronal Intermediate Filament) detection in CSF- tissue-based Indirect Immunofluorescence Assay                  
    TAT 48 working hours
74. NIF (Neuronal Intermediate Filament) detection in Serum- tissue-based Indirect Immunofluorescence Assay                  
    TAT 48 working hours
75.  NMDA (N- methyl –D-aspartate) NR-1 receptor antibody detection in CSF by cell-based Indirect Immunofluorescence Assay                   
    TAT 24 working hours
76. NMDA (N- methyl –D-aspartate) NR-1 receptor antibody detection in Serum by cell-based Indirect Immunofluorescence Assay                   
    TAT 24 working hours
77. NMO-IgG (Aquaporin-4) antibody detection in CSF by cell-based Indirect Immunofluorescence Assay                   
    TAT 24 working hours
78.  NMO-IgG (Aquaporin-4) antibody detection in Serum by cell-based Indirect Immunofluorescence Assay                   
    TAT 24 working hours
79. Oligoclonal band in CSF profile by Isoelectric focusing and immunofixation method
    1. CSF albumin quantitation
    2. CSF IgG quantitation
    3. CSF IgG/CSF Albumin ratio
    4. CSF Oligoclonal Bands CSF sample to be collected in polypropylene tube                 
       TAT 10 working Days
80. Orexin – A quantitation in CSF by Sandwich ELSA                
    TAT 7 working days
81. Paraneoplastic panel of neuronal antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay and confirmation of IFA positive by immune dot blot assay
    1. ANNA-1(anti-Hu) Anti Neuronal Nuclear Antibody-1
    2. ANNA-2 (anti Ri) Anti Neuronal Nuclear Antibody-
    3. ANNA-3 Anti Neuronal Nuclear Antibody-3.
    4. AGNA-1 Anti Glial Nuclear Antibody-1.
    5. PCA-1 (anti-Yo) Purkinje cell Cytoplasmic Antibody-1.
    6. PCA-2 Purkinje Cell Cytoplasmic Antibody-2.
    7. PCA-Tr Purkinje Cell Cytoplasmic Antibody-Tr.
    8. Amphiphysin Antibody
    9. CRMP-5{Collapsin Response Mediator Protein-5} (CV-2) Antibody
    10. Ma2/Ta Antibody.                
        TAT 24 working hours
82. Paraneoplastic panel of neuronal antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay and confirmation of IFA positive by immune dot blot assay
    1. ANNA-1(anti-Hu) Anti Neuronal Nuclear Antibody-1
    2. ANNA-2(anti Ri) Anti Neuronal Nuclear Antibody-2.
    3. ANNA-3 Anti Neuronal Nuclear Antibody-3.
    4. AGNA-1 Anti Glial Nuclear Antibody-1.
    5. PCA-1 (anti-Yo) Purkinje Cell Cytoplasmic Antibody-1.
    6. PCA-2 Purkinje Cell Cytoplasmic Antibody-2.
    7. PCA-Tr Purkinje Cell Cytoplasmic Antibody-Tr.
    8. Amphiphysin Antibody
    9. CRMP-5{Collapsin Response Mediator Protein-5} (CV-2) Antibody
    10. Ma2/Ta Antibody.               
        TAT 24 working hours
83. 14-3-3 Protein Gamma quantitation in CSF by Sandwich ELISA CSF sample to be collected in polypropylene tube             
    TAT 7 Working days
84.  Recoverin antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay and confirmation of positive by Immunoblot assay              
    TAT 48 working hours
85. Recoverin antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay and confirmation of positive by Immunoblot assay             
    TAT 48 working hours
86. Reflex to titer assay for MOG (Myelin Oligodendrocyte Glycoprotein) antibody detection in CSF by cell-based Indirect Immunofluorescence Assay              
    TAT 48 working hours
87. Reflex to titer assay for MOG (Myelin Oligodendrocyte Glycoprotein) antibody detection in Serum by cell-based Indirect Immunofluorescence Assay              
    TAT 48 working hours
88. Reflex to titer assay for NMDA (NR-1) Receptor antibody detection in CSF by cell-based Indirect Immunofluorescence Assay              
    TAT 48 working hours
89.  Reflex to titer assay for NMDA (NR-1) Receptor antibody detection in Serum by cell-based Indirect Immunofluorescence Assay              
    TAT 48 working hours
90. Reflex to titer assay for NMOSD (Neuromyelitis Optica Spectrum Disorders) antibody detection in CSF by cell based Indirect Immunofluorescence Assay
    1. Myelin Oligodendrocyte Glycoprotein (MOG)
    2. Neuromyelitis Optica (NMO/Aquaporin-4)            
       TAT 48 working hours
91. Reflex to titer assay for NMOSD (Neuromyelitis Optica Spectrum Disorders) antibody detection in Serum by cell based Indirect Immunofluorescence Assay
    1. Myelin Oligodendrocyte Glycoprotein (MOG)
    2. Neuromyelitis Optica (NMO/Aquaporin-4)            
       TAT 48 working hours
92. Reflex to titer assay for VGKC (Voltage-gated potassium channel) antibody detection in CSF- by cell-based Indirect Immunofluorescence Assay
    1. LGI-1 (Leucine-rich glioma inactivated protein -1) Antibody (VGKC associated)
    2. .CASPR-2 (Contactin-associated protein-2) Antibody (VGKC associated)           
       TAT 48 working hours
93. Reflex to titer assay for VGKC (Voltage-gated potassium channel) antibody detection in Serum- by cell-based Indirect Immunofluorescence Assay
    1. LGI-1 (Leucine-rich glioma inactivated protein -1) Antibody (VGKC associated)
    2. CASPR-2 (Contactin-associated protein-2) Antibody (VGKC associated)          
       TAT 48 working hours
94. Ryanodine receptor antibody quantitation in Serum by Competitive ELISA         
    TAT 7 working days
95. Septin 5 antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay        
    TAT 48 working hours
96.  Septin 5 antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay      
    TAT 48 working hours
97.  SEZ6L2 (Seizure related 6 homolog like 2) antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay      
    TAT 48 working hours
98.  SEZ6L2 (Seizure related 6 homolog like 2) antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay       
    TAT 48 working hours
99. Striational (Striated Muscle) antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay       
    TAT 48 working hours
100. Titin antibody detection in Serum (Qualitative) by Immunoblot assay       
     TAT 48 working hours
101. Titin antibody detection in Serum (Qualitative) by Immunoblot assay      
     TAT 48 working hours
102. VGCC IgG (Voltage-gated Calcium Channel) antibody quantitation in Serum by qualitative ELISA       
     TAT 7 working days
103. VGKC (Voltage-gated potassium channel) antibody detection in CSF by cell-based Indirect Immunofluorescence Assay
     1. LGI-1(Leucine-rich glioma- inactivated Protein-1) Antibody (VGKC associated)
     2. .CASPR-2 (Contactin-associated protein-2) Antibody (VGKC associated)      
        TAT 24 working hours
104. VGKC (Voltage-gated potassium channel) antibody in Serum by cell-based Indirect Immunofluorescence Assay
     1. LGI-1 (Leucine-rich glioma inactivated protein -1) Antibody (VGKC associated)
     2. CASPR-2 (Contactin-associated protein-2) Antibody (VGKC associated)     
        TAT 24 working hours
105. Zic 4 antibody detection in CSF by tissue-based Indirect Immunofluorescence Assay and confirmation of positive by Immunoblot assay   
     TAT 48 working hours
106. Zic 4 antibody detection in Serum by tissue-based Indirect Immunofluorescence Assay and Confirmation of positive by Immunoblot assay  
     TAT 48 working hours

***Note: Reflex to titer on positives End point titer is performed at an additional charge with the request from your treating consultant.

Purpose of recommendation for Reflex to titer assay in antibody-positive cases

1. Reflex to titer is a measure of the amount of antibody in Serum and CSF; the higher the titer, the higher the autoantibodies present in the samples.
2. Reflex-to-titer assay is used in monitoring treatment response in autoantibody-positive patients. Decreasing antibody titer can be associated with therapeutic response, so clinical correlation must be strongly considered. 

* Laboratory working time 9.00 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 leak proof, 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

Bank Transfer details

Reference :- Patient Name and MRD No

Transfer details required for accounting purpose

Senders Name

Senders Bank Name

Date of transaction

Place of Senders

bank Amount of

Transfer

UTR No and transaction ID

Details submitted by

Patient Name and MRD No:-

Details submitted by

After transaction kindly send the UTR number / Transaction Number to these mail id neuroimmunology @aims.amrita .edu and ksgeethadevi@aims.amrita.edu and billingsupervisor@aims.amrita.edu

• http://www.pnseuronet.org/
• http://www.esni.org/
• http://www.birmingham.ac.uk/facilities/clinical-immunology-services/neuroimmunology/index.aspx
• http://www.isniweb.org/

Address: Dr.Sudheeran Kannoth, Neuroimmunology laboratory (T6F3) Amrita Institute of Medical Sciences(Amrita Hospital), Ponekkara PO 682041, or Elamakkara PO 682026 Kochi, Kerala, India
Phone:+91 484 285 1234, 0484 6681234 Extension - 1356 & 6318
Mobile: 09400998656 (Dr. Annamma Mathai-on call mobile)
Email: neuroimmunology@aims.amrita.edu