Autoantibodies associated with autoimmune neurological syndromes are known for more the 50 years. In the past 13 years, with the discovery of cell surface antibodies, the field of autoimmune neurology has been developing rapidly. New antibodies are discovered every month.

Many clinical laboratories test for commercially available antibodies only, in the evaluation of autoimmune/paraneoplastic neurological syndromes

In the past 3 years we have tested the serum or CSF of 2163 patients either hospitalized in our institution, other institutions or from ambulatory clinics.

Apart from commercially available kits, we also tested samples by indirect immunofluorescence utilizing mouse brain tissue.

This method differs from commercial kits, since, it also enables detection of known but not yet commercially available or not yet discovered antibodies.

Samples from 2163 patients underwent evaluation in our lab in the past 3 years.

1421 patients underwent paraneoplastic evaluation with 43 positives (3%), 1436 patients underwent autoimmune encephalitis evaluation with 32 positives (2.2%) and 1949  underwent indierect immunofluorescence assay with 60 positives (3.1%)

Out of 60 samples that were positive for immunofluorescence, 42 were positive only on immunofluorescence and negative for other panels tested.  

Out of the 42 samples, positive only on IFA, more than half were clinically relevant and changed/dictated medical treatment.

Immunofluorescence assay is an important method of testing, that in many cases can establish or confirm diagnosis. Many antibodies are not commercially available or have not yet been discovered and a method that can detect these antibodies is important and should be utilized at least as a screening tool.

A combined clinical-laboratory approach is important in the field of autoimmune neurology in-order to correctly interpret antibody testing results.