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A B C D E F G H I J K L M N O P Q

Test Identifier Information

 
Registration CodeNMDA
Method

Indirect immunofluorescence on transfected HEK cell line

Serum screened at 1 in 10 & 1 in 100

CSF screened neat.

External Price$355.29(Exclusive of GST)
  

Specimen Collection

 
Specimen Collection Protocols

 NMDA assay will be performed on either serum or CSF, however CSF is the preferred sample. Serum may give an equivocal result if other autoantibodies are present in which case CSF would be required.

Patient Specimen4.0mL Red Top, however CSF is preferred
  

CHLabs Laboratory

 
DepartmentBiochemistry - Immunology
Contact Details Email Email
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Contact Phone Number(03) 364 0414 | x80414
Turnaround Time2-3 weeks
Interpretation

 Interpretive comments

Result: Negative on serum
Comment: In NMDAR antibody associated disease specific antibodies may not be detectable in serum yet are detectable in CSF. If there is a strong clinical suspicion of NMDAR encephalitis we recommend testing of CSF. The clinical spectrum typically affects a younger age group, in both males and females (<30 years). Most patients will have a non-specific prodromal inflammatory phase progressing to a psychotic phase and neurological phase.
 
Result: Indeterminate on Serum
Comment: ANA and / or non-specific cytoplasmic staining present which may obscure the detection of anti-NMDAR antibodies. If there is strong clinical suspicion of NMDAR encephalitis we recommend testing of CSF. The clinical spectrum typically affects a younger age group, in both males and females (<30 years). Most patients will have a non-specific prodromal inflammatory phase progressing to a psychotic phase and neurological phase.
 
 
Result: Positive on Serum
Comment: Strongly recommend testing of CSF. CSF is less prone to false positive results.
 
Result: Positive on CSF
Comment: Supports a diagnosis of NMDAR encephalitis, a disorder affecting both male and females. A proportion of females have an associated ovarian teratoma or more rarely extra-ovarian tumours
 
Result: Negative on CSF
Comment: No support for a diagnosis of NMDAR encephalitis
Additional Information
Antibodies (in both serum and CSF) can be low or subthreshold in first samples but rise subsequently. We recommend sending further samples with CSF if the diagnostic suspicion remains high.
 
 NMDAR-antibodies are found in patients with behavioural and cognitive problems and seizures. These can commonly progress over time to a movement disorder autonomic fluctuations and coma.

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibodies are neuronal surface-directed antibodies.

Since their discovery in 2007 (Dalmau J etal, Ann Neurol), anti-NMDAR antibodies have been shown to be a frequent cause of a severe but treatable form of immune-mediated encephalitis (Titulaer M et al, Lancet Neurol 2013). Anti-NMDAR encephalitis typically evolves from a viral prodrome to a neuropsychiatric presentation (Irani SR et al, Brain 2010). W

While the disease was originally associated with tumours, typically ovarian teratomas, many patients do not have tumours. 

 

Also known as Anti-Glutamate Receptor antibodies


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