Develop and validate paraneoplastic syndrome and other autoimmune neurological tests and panels based on Paraneoplastic Syndrome (PNS)-Care panel recommendations and phenotype-based focus.

Autoantibody testing for neurological diseases such as paraneoplastic disorders, encephalopathies, and myelopathies has become increasingly complex over time due to the discovery of new biomarkers. The growing number of options for antibody panel testing can create confusion amongst ordering clinicians and lead to either ordering concurrently several overlapping panels or repeat panel evaluations. There is an urgent need for the development and standardization of neurological autoimmune and paraneoplastic autoantibody testing based on new practice standards and phenotype-based selection.

We designed and validated a comprehensive paraneoplastic profile that included a combination of high-, intermediate- and low-probability antibodies associated with cancer. A “catch-all algorithm” consisting of 25 antibody markers was designed for the situation when a clear clinical presentation is absent, but a neurological condition associated with a neoplasm is suspected. A phenotype-based algorithm was designed by choosing neurological condition-specific markers and the appropriate methods for optimal sensitivity and specificity. A combination of assay methods such as immunofluorescence on multiple neural and non-neural tissue substrates, immunofluorescence on HEK293 target transfected substrate, enzyme immunoassay, radioimmunoassay, and line blot assay was used to design testing profiles suitable for different autoimmune neurological conditions.