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HelpTest Code DMNES Peripheral Nervous System Demyelinating Neuropathy, Autoimmune Evaluation, 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 to occur prior to initiation of immunosuppressant medication or intravenous immunoglobulin treatment.
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.
Forms
If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.
Useful For
Evaluating patients with a suspected immune-mediated demyelinating peripheral neuropathy
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| DMNI | Demyelinating Neuropathy Interp, S | No | Yes |
| CONCS | Contactin-1 IgG CBA, S | No | Yes |
| GQ1ES | GQ1b-IgG ELISA, S | Yes | Yes |
| IGG_D | IgG Disialo. GD1b | No | Yes |
| IGM_D | IgM Disialo. GD1b | No | Yes |
| IGG_M | IgG Monos. GM1 | No | Yes |
| IGM_M | IgM Monos. GM1 | No | Yes |
| MAGES | MAG IgM, S | Yes | Yes |
| NF4FS | Neurofascin-155 IgG4, S | No | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| IGDTS | IgG Disialo GD1b Titer, S | No | No |
| IMDTS | IgM Disialo GD1b Titer, S | No | No |
| IGMTS | IgG Monos GM1 Titer, S | No | No |
| IMMTS | IgM Monos GM1 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.
For more information see:
Method Name
DMNI: Technical Interpretation
CONCS: Cell-Binding Assay (CBA)
GQ1ES, IGG_D, IGM_D, IGG_M, IGM_M, IGDTS, IMDTS, IGMTS, IMMTS, MAGES: Enzyme-Linked Immunosorbent Assay (ELISA)
NF4FS: Flow Cytometry
Reporting Name
Demyelinating Neuropathy Ab Eval, SSpecimen 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 |
Reference Values
Contactin-1 IgG CBA: Negative
GQ1b-IgG ELISA: Negative
IgG Disialo. GD1b: Negative
IgM Disialo. GD1b: Negative
IgG Monos. GM1: Negative
IgM Monos. GM1: Negative
MAG IgM: <1500 Buhlmann titer unit
Neurofascin-155 IgG4: Negative
Reflex Information:
IgG Disialo GD1b Titer: <1:2000
IgM Disialo GD1b Titer: <1:2000
IgG Monos GD1b Titer: <1:2000
IgM Monos GD1b Titer: <1:4000
Interpretation
The presence of specific autoantibodies or combinations of antibodies in this panel provides supportive evidence of an immune-mediated demyelinating peripheral neuropathy. However, these results must be interpretated in the appropriate clinical context. A negative result does not exclude the possibility of an immune-mediated demyelinating peripheral neuropathy.
Clinical Reference
1. Asati A, Kachurina O, Kachurin A. Simultaneous measurements of auto-immune and infectious disease specific antibodies using a high throughput multiplexing tool. PLoS One. 2012;7(8):e42681
2. Beecher G, Shelly S, Dyck PJB, et al. Pure motor onset and IgM-gammopathy occurrence in multifocal acquired demyelinating sensory and motor neuropathy. 2021;97(14):e1392-e1403
3. Dubey D, Honorat J, Shelly S, et al. Contactin-1 autoimmunity: Serologic, neurologic, and pathologic correlates. Neurol Neuroimmunol Neuroinflamm. 2020;7(4):e771
4. Klein CJ. Autoimmune-mediated peripheral neuropathies and autoimmune pain. Handb Clin Neurol. 2016;133:417-446
5. Klein CJ. Charcot-Marie-Tooth disease and other hereditary neuropathies [published correction appears in Continuum (Minneap Minn). 2021;27(1):289
6. Le Cann M, Bouhour F, Viala K, et al. CANOMAD: a neurological monoclonal gammopathy of clinical significance that benefits from B-cell-targeted therapies. Blood. 2020;136(21):2428-2436
7. Le Quintrec M, Teisseyre M, Bec N, et al. Contactin-1 is a novel target antigen in membranous nephropathy associated with chronic inflammatory demyelinating polyneuropathy. Kidney Int. 2021;100(6):1240-1249
8. Liberatore G, Giannotta C, Sajeev BP, et al. Sensitivity and specificity of a commercial ELISA test for anti-MAG antibodies in patients with neuropathy. J Neuroimmunol. 2020;345:577288
9. Martinez-Thompson JM, Snyder MR, Ettore M, et al. Composite ganglioside autoantibodies and immune treatment response in MMN and MADSAM. Muscle Nerve. 2018;57(6):1000-1005
10. Querol L, Nogales-Gadea G, Rojas-Garcia R, et al. Neurofascin IgG4 antibodies in CIDP associate with disabling tremor and poor response to IVIg. Neurology. 2014;82(10):879-886
11. Shahrizaila N, Yuki N. Bickerstaff brainstem encephalitis and Fisher syndrome: anti-GQ1b antibody syndrome. J Neurol Neurosurg Psychiatry. 2013;84(5):576-583
12. Shelly S, Klein CJ, Dyck PJB, et al. Neurofascin-155 Immunoglobulin Subtypes: Clinicopathologic Associations and Neurologic Outcomes. Neurology. 2021;97(24):e2392-e2403
13. Shelly S, Dubey D, Mills JR, Klein CJ. Paraneoplastic neuropathies and peripheral nerve hyperexcitability disorders. In: Giometto B, Pittock S, eds. Paraneoplastic Neurologic Disorders. Elsevier; 2024:chap 15 Handbook of Clinical Neurology, Vol 200
14. Svahn J, Petiot P, Antoine JC, et al. Anti-MAG antibodies in 202 patients: clinicopathological and therapeutic features. J Neurol Neurosurg Psychiatry. 2018;89(5):499-505
15. Yuki N, Uncini A. Acute and chronic ataxic neuropathies with disialosyl antibodies: a continuous clinical spectrum and a common pathophysiological mechanism. Muscle Nerve. 2014;49(5):629-635
Day(s) Performed
Monday through Sunday
Report Available
5 to 8 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
83516 x5
83520
86255 x2
83520 x4 (if applicable)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| DMNES | Demyelinating Neuropathy Ab Eval, S | 82455-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 621107 | GQ1b-IgG ELISA, S | 63254-7 |
| 621104 | Demyelinating Neuropathy Interpretation, S | 69048-7 |
| 4416 | IgG Disialo. GD1b | 94868-7 |
| 4412 | IgG Monos. GM1 | 63243-0 |
| 4417 | IgM Disialo. GD1b | 94870-3 |
| 4413 | IgM Monos. GM1 | 63247-1 |
| 607034 | MAG IgM, S | 39087-2 |
| 614591 | Neurofascin-155 IgG4, S | 100845-7 |
| 616442 | Contactin-1 IgG CBA, S | 101448-9 |