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Epic Test Code LAB25230 Ganglioside Antibody Panel, Serum

Additional Codes

MML Code: GM1B

 

NY State Approved

Yes

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Reporting Name

Ganglioside Ab Panel, S

Method Name

Enzyme-Linked Immunosorbent Assay (ELISA)

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  72 hours


Specimen Required


Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Specimen Volume: 1 mL


Specimen Type

Serum

Specimen Minimum Volume

0.5 mL

Reference Values

Profile Information:

IGG_M: Negative

IGM_M: Negative

IGG_A: Negative

IGM_A: Negative

IGG_D: Negative

IGM_D: Negative

 

Reflex Information:

IGMTS: <1:2000

IMMTS: <1:4000

IGATS: <1:16000

IMATS: <1:8000

IGDTS: <1:2000

IMDTS: <1:2000

Analytic Time

5 days

Day(s) and Time(s) Performed

Tuesday, Thursday; 12 p.m.

CPT Code Information

83516 x 6

83520 x 6 (if applicable)

Reject Due To

Hemolysis

Mild OK; Gross reject

Lipemia

Mild OK; Gross reject

Icterus

Mild OK; Gross reject

Other

NA

Clinical Information

Neuropathy patients have variable sensory disturbance (loss or exaggerated sensation including with pain), weakness and autonomic involvements (sweat abnormalities, gastrointestinal dysfunction, and lightheadedness on standing). These symptoms are a result of injury to the distal nerves, roots, and ganglia or their gathering points (nerve plexus in the thighs and arms). Patients may have symmetric or asymmetric involvements of the extremities, trunk, and head including extraocular muscles. Subacute onsets and asymmetric involvements favor inflammatory or immune causes over inherited or metabolic forms. Depending on the specific inflammatory or immune mediated causes other parts of the nervous system may also be affected (brain, cerebellum, spinal cord). Nerve conductions and needle electromyography can help to classify the neuropathy as either: 1) primary axonal; 2) primary demyelinating; or 3) mixed axonal and demyelinating.

 

Among the immune-mediated peripheral neuropathies, autoantibodies to gangliosides represent an important class of noncancer-associated autoimmune peripheral neuropathies. Gangliosides are glycosphingolipids that contain sialic acid and are present in many cell types most abundantly within neural tissues along their linings (myelin). Depending on the specific ganglioside autoantibody found and the antibody titer, in the appropriate clinical context, these findings may be supportive of a specific clinical diagnosis and may also be prognostic for treatment response.(1,2)

 

Specifically, in multifocal motor neuropathy (MMN) and multifocal acquired demyelinating sensory and motor (MADSAM) neuropathy, also known as Lewis-Sumner syndrome or multifocal chronic immune demyelinating polyradiculoneuropathy (CIDP), the presence ganglioside autoantibodies, particularly high-titer GM1-IgM autoantibodies, maybe supportive of the diagnosis in the correct clinical context. Furthermore, ganglioside seropositivity has been associated with favorable response to immunotherapy amongst patients suspected to have MMN during the initial clinical evaluation.(1)

 

Additionally, the presence of ganglioside antibodies may support a diagnosis of Guillain-Barre syndrome (GBS) in the appropriate clinical context.(3) GBS is one class of autoimmune peripheral neuropathies, and comprises a spectrum of disorders including acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, and acute motor and sensory axonal neuropathy. This class of autoimmune neuropathies is generally characterized by an acute onset. Although the diagnosis of these disorders is dependent on clinical evaluation and electrophysiologic studies, assessment of ganglioside antibodies can further support the diagnosis.

Interpretation

High titers (>1:8,000) favor the diagnosis of multifocal motor neuropathy (MMN) and multifocal acquired demyelinating sensory and motor (MADSAM) over motor neuron disease. About 30% to 50% of patients with these clinical syndromes or the pure motor variant of chronic inflammatory demyelinating polyneuropathy have ganglioside autoantibodies. High-antibody titers appear to be a specific, but not sensitive, marker of those related disorders.

Specimen Retention Time

28 days

Cautions

Positive titer values less than 1:16,000 may be found in motor neuron disease, monoclonal gammopathy of uncertain significance (MGUS), and healthy individuals. High titers are very specific of an autoimmune neuropathy.

 

This test is not diagnostic and should be interpreted in the appropriate clinical context.

 

This test does not include testing for GD1a or GQ1b autoantibodies.

Profile Information

Test ID Reporting Name Available Separately Always Performed
IGG_M IgG Monos. GM1 No Yes
IGM_M IgM Monos. GM1 No Yes
IGG_A IgG Asialo. GM1 No Yes
IGM_A IgM Asialo. GM1 No Yes
IGG_D IgG Disialo. GD1b No Yes
IGM_D IgM Disialo. GD1b No Yes

Useful For

Supporting the diagnosis of an autoimmune neuropathy

Forms

If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
IGMTS IgG Monos GM1 Titer, S No No
IMMTS IgM Monos GM1 Titer, S No No
IGATS IgG Asialo GM1 Titer, S No No
IMATS IgM Asialo GM1 Titer, S No No
IGDTS IgG Disialo GD1b Titer, S No No
IMDTS IgM Disialo GD1b Titer, S No No

Testing Algorithm

Screening tests are performed for IgG and IgM antibodies to GM1 and GD1b. If positive, the appropriate titer will be performed at an additional charge.

 

See Ganglioside Antibody Panel Algorithm in Special Instructions.