Test ID: NMOC
Neuromyelitis Optica (NMO) Autoantibody, IgG, Spinal Fluid
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Establishing the diagnosis of neuromyelitis optica (NMO) and related disorders (eg, relapsing transverse myelitis or relapsing optic neuritis), predicting with 60% probability, relapse or progression to NMO in patients presenting with an initial episode of longitudinally extensive transverse myelitis. Seropositivity distinguishes these disorders from multiple sclerosis early in the course of disease. This allows initiation and maintenance of optimal therapy.
Serum is the preferred specimen for detection of NMO-IgG (see NMOER/60796 Neuromyelitis Optica (NMO) Evaluation with Reflex, Serum); cerebrospinal fluid is usually less informative.
Method Name A short description of the method used to perform the test
Indirect Immunofluorescence Assay (IFA)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
AQP4
Aquaporin (-4)
Devic's Disease Antibody
Neuromyelitis Optica (NMO)
Optic Neuritix Antibody
Optic-Spinal MS Antibody
Vision Loss Antibody
Transverse Myelitis Antibody
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Sterile vial
Specimen Volume: 2 mL
Additional Information: Include relevant clinical information, name, phone number, mailing address, and e-mail address (if applicable) of ordering physician.
Forms: If not ordering electronically, submit a General Request Form (Supply T239) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | Mild OK; Gross reject |
| Icterus | Mild OK; Gross reject |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| CSF | Refrigerated (preferred) | 14 days |
| Ambient | 72 hours | |
| Frozen | ||
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Neuromyelitis optica (NMO, also known as Devic's disease and optic-spinal multiple sclerosis) is a severe idiopathic inflammatory demyelinating disease that selectively affects optic nerves and the spinal cord, typically spares the brain, and generally follows a relapsing course. Within 5 years, 50% of patients lose functional vision in at least 1 eye or are unable to walk independently. In North America, the proportion of nonwhite individuals is higher among patients with NMO than among those with classic multiple sclerosis. During acute attacks, the cerebrospinal fluid contains inflammatory cells, but often lacks evidence of intrathecal IgG synthesis.
Many patients with NMO are misdiagnosed as having multiple sclerosis, due to earlier misconceptions that NMO was a monophasic disorder, and was not associated with brain imaging abnormalities. Importantly the prognosis and optimal treatments for the 2 diseases differ. NMO typically has a worse outcome than multiple sclerosis, with frequent and early relapses. Plasmapheresis is more beneficial for patients with NMO than for those with multiple sclerosis. Early diagnosis and treatment are important to reduce the morbidity of NMO.
Seropositivity for NMO autoantibody IgG (NMO-IgG) allows early diagnostic distinction between NMO (73% positive; 91% specific) and multiple sclerosis (0% positive). NMO-IgG is uniformly negative in patients with classical multiple sclerosis, for which no biomarker is currently recognized. This distinction is important both prognostically and therapeutically, because optimal treatments differ for NMO (immunosuppression) and multiple sclerosis (immunomodulation with beta-IFN or glatiramer acetate).
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Negative
Interpretation Provides information to assist in interpretation of the test results
A positive value is consistent with neuromyelitis optica (NMO) or a related disorder, and justifies initiation of appropriate immunosuppressive therapy at the earliest possible time.
Our prospective studies have revealed that 40% of adult patients with longitudinally-extensive transverse myelitis are seropositive and, of that group, 60% relapse or progress to NMO within 2 years. No seronegative patient relapsed in up to 7 years of follow-up.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Seronegativity does not exclude the diagnosis of NMO (current seronegativity rate is 27%).
Immunosuppressive therapy may result in negative results.
High levels of nonorgan-specific autoantibodies (which are frequent in patients with NMO) may preclude interpretation of a positive immunofluorescence pattern.
Serum (NMOER/60796 Neuromyelitis Optica [NMO] Evaluation with Reflex, Serum) is the preferred specimen. Cerebrospinal (CSF) is usually less informative than serum for detection of NMO-IgG. However, testing of accompanying CSF for CRMP-5-IgG (CRMWC/21747 Collapsin Response-Mediator Protein-5-IgG [CRMP-5-IgG] Western Blot, Spinal Fluid) is recommended as a sensitive assay for paraneoplastic myelitis and optic neuritis.
Supportive Data
1. Lennon VA, Wingerchuk DM, Kryzer TJ, et al: A serum autoantibody marker of neuromyelitis optica; distinction from multiple sclerosis. Lancet 2004;364:2106-2112
2. Scolding N: Devic's disease and autoantibodies. Lancet Neurol 2005;4:136-137
3. Lennon VA, Kryzer TJ, Pittock SJ, et al: IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 channel. J Exp Med 2005;202:473-477
4. Weinshenker BG, Wingerchuk DM, Vukusic S, et al: NMO-IgG predicts relapse following longitudinally extensive transverse myelitis. Ann Neurol 2006;59:566-569
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Wingerchuk DM, Lennon VA, Pittock SJ, et al: Revised diagnostic criteria for neuromyelitis optica. Neurol 2006;66:1485-1489
2. Kerr DA: The lumping and splitting of inflammatory CNS diseases. Neurol 2006;66:1466-1467
3. Luccinnetti CF, Mandler RN, McGavern D, et al: A role for humoral mechanisms in the pathogenesis of Devic's neuromyelitis optica. Brain 2002;125:1450-1461
3. Cross SA, Salomao DR, Parisi JE, et al: Paraneoplastic autoimmune optic neuritis with retinitis defined by CRMP-5-IgG. Ann Neurol 2003;54:38-50
5. Cross SA, Salomao DR, Parisi JE, et al: Paraneoplastic autoimmune optic neuritis with retinitis defined by CRMP-5-IgG. Am J Ophthalmol 2003;136(6):1200 (abstract)
Method Description Describes how the test is performed and provides a method-specific reference
The detection method is indirect immunofluorescence. The substrate is a frozen composite block of mouse kidney, gut, and cerebellum. Bound IgG is detected by a fluorescein-conjugated goat IgG reactive with human IgG. To eliminate staining of neurons by nonorgan-specific IgG, each serum is preabsorbed at 1:120 dilution with liver powder. Results are reported as positive or negative.(Lennon VA, Wingerchuk DM, Kryzer TJ, et al: A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet 2004;364:2106-2112)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday; 7 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
86255
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 83936 | NMO-IgG, CSF | In Process |
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