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Autoimmune Dysautonomia Evaluation


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Autoimmune Dysautonomia Evaluation Testing Algorithm

Slide 14

February 2011

The autoimmune dysautonomia testing evaluation algorithm is documented and discussed on this slide. Starting from the top, there is some testing that is always performed and these antibodies are listed and these are the ANNA-1 antibody, striational antibody, anticalcium channel antibody, acetylcholine receptor muscle binding antibody, acetylcholine receptor ganglionic neuronal antibody, neuronal voltage-gated potassium channel antibody, PQ-type calcium channel antibody, and GAD-65 antibody.

After this there may be no further testing to be performed. However, there are four situations in which additional testing may be done and these are illustrated at the bottom of the screen. I will discuss these from left to right. The first is the immunofluorescence pattern is indeterminate. In this situation there may be an antibody staining pattern suspicious for antineuronal nuclear antibody type-1, but not all of the characteristic features are present. In that setting additionally a paraneoplastic Western blot is performed to look for the characteristic Western blot pattern associated with this antibody.

The second setting and the third setting would occur where an antibody pattern suggestive of amphiphysin antibody or CRMP-5 IgG were detected. Then the presence of these antibodies would be confirmed with recombinant Western blots for the appropriate antibody either Amphiphysin or CRMP-5 IgG.

The final setting in which additional testing may be done would be where the acetylcholine receptor binding antibody or striational antibody were detected. Then the possibility of an antibody profile supportive of thymoma would come to mind. This could be further explored by doing testing for the acetylcholine receptor modulating antibody and CRMP-5 IgG by Western blot.

Autoimmune Dysautonomia Evaluation Testing Algorithm

 


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