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

• 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