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A comparison of NMDAR-antibody detection methods

Abstract:
N-Methyl-D-Aspartate receptor antibody (NMDAR-ab) encephalitis is the most common antibody-mediated encephalitis. We compared four NMDAR-Ab assay methods: 1) live (a, L-CBA) or fixed (b, F-CBA) cell-based assays (CBA); 2) immunohistochemistry (IHC); 3) a commercially available CBA (C-CBA, Euroimmun AG). 180 sera and 48 CSFs were tested. Sera previously positive by the Oxford L-CBA but with unlikely phenotypes were intentionally over-represented. The results of the four assays agreed in only 55.6% of sera and 82% of CSFs. C-CBA was least likely to agree with other methods (37.7% in serum). Diagnosis was available, so far, for 54 patients (NMDAR ab-encephalitis ‘definite’ in 34, ‘unlikely’ in 20). In serum, L-CBA detected NMDAR-abs in 88% of ‘definite’ patients, but had a high false-positive rate (consistent with the biased selection). IHC was negative in all unlikely patients, but positive in only 73.5% ‘definite’ patients. F-CBA and C-CBA had intermediate performances. There was a worrying lack of concordance between tests. Assay results should be interpreted in the light of clinical information and a combination of L-CBA and IHC may give the most useful results. Further clinical information is being made available in order to increase the serum numbers and determine assay performance using CSF alone.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1136/jnnp-2017-ABN.183

Authors

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Institution:
University of Oxford
Division:
MSD
Sub department:
Clinical Neurosciences
Oxford college:
St Hilda's College
Role:
Author
ORCID:
0000-0002-7667-9748


Publisher:
BMJ Publishing Group
Host title:
Journal of Neurology, Neurosurgery and Psychiatry
Journal:
Journal of Neurology, Neurosurgery and Psychiatry More from this journal
Volume:
88
Issue:
Supplement 1
Pages:
A53
Article number:
PO154
Publication date:
2017-12-01
Acceptance date:
2017-05-03
Event title:
Association of British Neurologists Annual Meeting 2017
Event location:
ACC, Liverpool
Event website:
https://jnnp.bmj.com/content/88/Suppl_1
Event start date:
2017-05-03
Event end date:
2017-05-05
DOI:
EISSN:
1468-330X
ISSN:
0022-3050
Commissioning body:
Association of British Neurologists


Language:
English
Keywords:
Subtype:
Abstract
Pubs id:
1027444
Local pid:
pubs:1027444
Deposit date:
2020-09-21
ARK identifier:

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