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Test Code:
090-31-2877

Order Name:
CNS Demyelinating Disease Evaluation, Serum **

 
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

 
Methodology:
Flow Cytometry
Fluorescence-Activated Cell Sorting Assay (FACS)
 
AliasesName:
CDS1 panel (AQP4+MOG)
NMO/AQP4 & MOG 
ADEM
AQP4
Aquaporin
Devic's Antibody
NMO (Neruomyelitis Optica)
NMO-IgG
Optic Neuritis Antibody
Transverse Myelitis Antibody
Vision Loss Antibody
 
 
 
Test Code:
090-31-2877

Order Name:
CNS Demyelinating Disease Evaluation, Serum **

 
Patient Preparation:
For optimal antibody detection, we recommend blood drawing the specimen before initiation of immunosuppressant medication.
 
Collection Specimen Or Container:
Blood/ Plain blood (Red top) 6 mL, 3 tubes
 
Specimen Testing Type:
Serum, minimum volume 5 mL
 
Sub Mission Container:
Plastic tube
 
Rejection Criteria:
Gross hemolysis    Reject
Gross lipemia    Reject
Gross icterus    Reject
 
Specimen Stabillity:
Specimen Type Temperature Time
Serum Refrigerated (preferred) 28 days
Serum Frozen  28 days
Serum Ambient  72 hours
 
 
 
Test Code:
090-31-2877

Order Name:
CNS Demyelinating Disease Evaluation, Serum **

 
Method detail:
Flow Cytometry
Fluorescence-Activated Cell Sorting Assay (FACS)
 
Schedule:
N/A **Sent out to MAYO, USA
 
Turnaround Time:
Received specimen to report within 14 days
 
Performing Location:
MAYO Laboratory
Referral Lab Services, Laboratory Department 14160-2
 
 
 
Test Code:
090-31-2877

Order Name:
CNS Demyelinating Disease Evaluation, Serum **

 
 
Clinical Information:
  1. Superior methodology of live CBA with flow quantification. The implications for using live cell is the ability for antibodies to bind to a cell in its native conformation more accurately reflects what is happening in vivo + Mayo using the FACS-based technology to objectively (not subjective) quantitate positive cells = increased in 15% sensitivity.
  2. This panel is highly encouraged for greater diagnostic yields and much more significant clinical value.
  3. In some patients with symptoms of NMOSD, no AQP4-Abs but Abs against myelin-oligodendrocyte-glycoprotein (MOG) are detectable. Approximately 80% of patients with neuromyelitis optica (NMO) are seropositive for aquaporin-4 (AQP4)-IgG. In the remaining 20% of patients, myelin oligodendrocyte glycoprotein (MOG)-IgG is detected in up to a third (30%).
  4. Detection of MOG-IgG is diagnostic of central nervous system (CNS) inflammatory demyelination, where the clinical phenotype (e.g., NMOSD, optic neuritis, transverse myelitis, ADEM) may be similar, but the immunopathology (astrocytopathy versus oligodendrocytopathy) and clinical outcome (worse versus better) is different.
  5. Due to significant overlap in the clinical phenotypes, synchronized testing for AQP4 and MOG-IgGs at the same time allows for a faster diagnosis and treatment plan decision.
 
Reference Value:

MOG FACS, S
Negative
Reference values apply to all ages.
 
NMO/AQP4 FACS, S
Negative
Reference values apply to all ages.

 
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.

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).

 
Clinical Reference:
www.mayomedicallaboratories.com (Retrieved: 4 Feb 2021)