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HelpTest Code LAB8637 CNS Demyelinating Disease Evaluation, Serum
Additional Codes
CDS1, CNS DEMYELINATING DISEASE, SERUM
Ordering Guidance
Multiple neurological phenotype-specific autoimmune/paraneoplastic evaluations are available. For more information as well as phenotype-specific testing options, refer to Autoimmune Neurology Test Ordering Guide.
For a list of antibodies performed with each evaluation, see Autoimmune Neurology Antibody Matrix.
Specimen Required
Patient Preparation: For optimal antibody detection, specimen collection is recommended before initiation of immunosuppressant medication.
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: Plastic vial
Specimen Volume: 3 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
On-campus collections: Send in plastic vial, Refrigerated.
Off-campus collections: Centrifuge and aliquot within 1 hour. Specimen to be stored/transported at Refrigerated temp.
Forms
If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.
Secondary ID
65565Useful For
Diagnosis of inflammatory demyelinating diseases (IDDs) with similar phenotype to neuromyelitis optica spectrum disorder (NMOSD), including optic neuritis (single or bilateral) and transverse myelitis
Diagnosis of autoimmune myelin oligodendrocyte glycoprotein-opathy
Diagnosis of neuromyelitis optica
Distinguishing NMOSD, acute disseminated encephalomyelitis (ADEM), optic neuritis, and transverse myelitis from multiple sclerosis early in the course of disease
Diagnosis of ADEM
Prediction of a relapsing disease course
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CSI1 | CNS Demyelinating Disease Interp, S | No | Yes |
| NMOFS | NMO/AQP4 FACS, S | Yes | Yes |
| MOGFS | MOG FACS, S | Yes | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| NMOTS | NMO/AQP4 FACS Titer, S | No | No |
| MOGTS | MOG FACS Titer, S | No | No |
Testing Algorithm
When the results of this assay require further evaluation of myelin oligodendrocyte glycoprotein (MOG-IgG1), the MOG-IgG1 titer will be performed at an additional charge.
When the results of this assay require further evaluation of neuromyelitis optica (NMO)/Aquaporin-4-IgG, the neuromyelitis optica (NMO)/aquaporin-4-IgG titer will be performed at an additional charge.
For more information, see the following algorithms:
-Pediatric Autoimmune Central Nervous System Demyelinating Disease Diagnostic Algorithm
-Central Nervous System Demyelinating Disease Diagnostic Algorithm
Special Instructions
Method Name
Flow Cytometry
Specimen Type
SerumSpecimen Minimum Volume
2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days | ||
| Ambient | 72 hours |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
Reference Values
MYELIN OLIGODENDROCYTE GLYCOPROTEIN FLORESCENCE-ACTIVATED CELL SORTING(FACS)
Negative
Reference values apply to all ages.
NEUROMYELITIS OPTICA/AQUAPORIN-4-IgG FACS
Negative
Reference values apply to all ages.
Interpretation
A positive value for aquaporin-4 (AQP4)-IgG is consistent with an autoimmune astrocytopathy/neuromyelitis optica spectrum disorder (NMOSD) and justifies initiation of appropriate immunosuppressive therapy at the earliest possible time. This allows early initiation and maintenance of optimal therapy. Recommend follow-up in 3 to 6 months if NMOSD is suspected.
A positive value for myelin oligodendrocyte glycoprotein (MOG)-IgG is consistent with a neuromyelitis optica-like phenotype and in the setting of acute disseminated encephalomyelitis, optic neuritis and transverse myelitis, indicates an autoimmune oligodendrogliopathy with potential for relapsing course. Identification of MOG-IgG allows distinction from multiple sclerosis (MS) and may justify initiation of appropriate immunosuppressive therapy (not MS disease-modifying agents) at the earliest possible time. This allows early initiation and maintenance of optimal therapy. Recommend follow-up in 6 to 12 months as persistence of MOG-IgG seropositivity predicts a relapsing course.
Detection of both antibodies is rare and unusual.
AQP4-IgG and MOG-IgG are not found in MS or healthy subjects.
Method Description
NMO-IgG Fluorescence-Activated Cell Sorting Assay
Human embryonic kidney cells (HEK 293) are transfected transiently with a plasmid (pIRES2- Aequorea coerulescens green fluorescent protein [AcGFP]) encoding both green fluorescent protein (AcGFP) and AQP4-M1. After 36 hours, a mixed population of cells (transfected expressing AQP4 on the surface and AcGFP in the cytoplasm and nontransfected lacking AQP4 and AcGFP) are lifted and resuspended in live cell-binding buffer. Cells are incubated with patient serum and an AlexaFluor 647-labeled secondary antibody is added. Two populations are gated on the basis of AcGFP expression: positive (high AQP4 expression) and negative (low or no AQP4 expression). Positivity is based on the ratio (Positive >2.0) of the average MFI of each cell population (MFI GFP positive:MFI GFP negative).(Unpublished Mayo method)
If AQP4 cell based flow cytometry (FACS) assay is positive at screening dilution, AQP4 FACS Titer Assay is performed at an additional charge.
MOG-IgG1 Fluorescence-Activated Cell Sorting Assay
Human embryonic kidney cells (HEK 293) are transfected transiently with a DNA plasmid that allows coexpression of both a reporter fluorescent protein (green fluorescent protein [AcGFP]) and full-length MOG. After 36 hours, a mixed population of cells (transfected expressing MOG on the surface and AcGFP in the cytoplasm and nontransfected lacking MOG and AcGFP) are lifted and resuspended in live cell-binding buffer. Cells are incubated with patient serum and an AlexaFluor 647 labeled secondary antibody is added. Two populations are gated on the basis of AcGFP expression: positive (high MOG expression) and negative (low or no MOG expression). Positivity is based on the ratio (Positive >2.5) of the average MFI of each cell population (MFI GFP positive:MFI GFP negative).(Unpublished Mayo method)
If MOG-IgG1 cell based flow cytometry (FACS) assay is positive at screening dilution, the MOG-IgG1 flow cytometry titer assay is performed at an additional charge.
Day(s) Performed
Monday, Tuesday, Thursday
Report Available
7 to 10 daysSpecimen Retention Time
28 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
CPT Code Information
86053
86363
86053-Titer (if appropriate)
86363-Titer (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CDS1 | CNS Demyelinating Disease Eval, S | 102085-8 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 38324 | NMO/AQP4 FACS, S | 43638-6 |
| 65563 | MOG FACS, S | 90248-6 |
| 113625 | CNS Demyelinating Disease Interp, S | 69048-7 |