CNS Demyelinating Disease Evaluation, Serum (Sendout)

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General Information

Lab Name
Lab Code
1089
External Test Id
CDS1
Description

Useful 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 (MOG)-opathy
  • Diagnosis of neuromyelitis optica (NMO)
  • 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

Additional Resource: Mayo Central Nervous System Demyelinating Disease Diagnostic Algorithm

Testing Algorithm: When the results of this assay require further evaluation of myelin oligodendrocyte glycoprotein (MOG-IgG1) or neuromyelitis optica (NMO)/Aquaporin-4-IgG, a titer will be performed at additional charge.

Ordering Notes: Aquaporin-4 IgG Antibody, Serum (Sendout) [RAQP4A] and MOG Antibodies [RMOG] are also available for individual ordering.

Patient Preparation: For optimal antibody detection, it is recommended to collect the specimen before initiation of immunosuppressant medication.

Synonyms
ADEM, AQP4, Aquaporin, CDS1, Devic's Antibody, NMO (Neruomyelitis Optica), NMO-IgG, Optic Neuritis Antibody, Transverse Myelitis Antibody, Vision Loss Antibody

Interpretation

Method

Flow Cytometry

Ref. Range Notes

Reference Values:

MOG FACS: Negative
NMO/AQP4 FACS: Negative

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 an neuromyelitis optica (NMO)-like phenotype, and in the setting of acute disseminated encephalomyelitis (ADEM), optic neuritis (ON) and transverse myelitis (TM) 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 3 to 6 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.

Interferences and Limitations

Cautions: Aquaporin-4 (AQP4)-IgG and myelin oligodendrocyte glycoprotein (MOG)-IgG antibodies may drop below detectable levels in setting of therapies for acute attack (IV methylprednisolone or plasmapheresis) or attack prevention (immunosuppressants).

Guidelines

Ordering & Collection

Specimen Type
Serum
Collection

Collect 9 mL blood in RED TOP tube or GOLD SST

Handling Instructions

Outside Laboratories: Centrifuge sample and transfer serum to a separate plastic vial. Refrigerate serum.

Stability: Refrigerated (preferred): 28 days; Frozen: 28 days; Ambient: 72 hours.

Reject Due To: Gross hemolysis, lipemia, or icterus.

Quantity
requested: 3 mL serum
minimum: 2 mL serum

Processing

Processing

Centrifuge sample and transfer serum to a separate plastic vial. Refrigerate serum.

Login: SEND1-;REFRIG

  • RSNDT1: MAYO
  • RSTYP1: SRM
  • RTSRQ1: ;CNS Demyelinating Disease Evaluation, Serum (Mayo Test CDS1)

Sendouts:

  • Order Mayo Test: CDS1.

Stability: Refrigerated (preferred): 28 days; Frozen: 28 days; Ambient: 72 hours.

Reject Due To: Gross hemolysis, lipemia, or icterus.

Performance

LIS Dept Code
Performing Location(s)
Sendout Mayo Clinic Laboratories
800-533-1710

200 First Street Southwest
Rochester, MN 55901
Frequency
Performed: Monday, Tuesday, Thursday. Report Available: 7-10 days.
Available STAT?
No

Billing & Coding

CPT codes
Billing Comments

CPTs: 86053, 86363.

Reflex titers: 86053 (if appropriate) 86363 (if appropriate).

LOINC