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Paraneoplastic syndrome/Neuronal Antibody Profile-3

Blood

12 parameters

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Report in 120Hrs

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At Home

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No Fasting Required

Details

Autoantibody panel.

₹22,999₹35,231

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Parameters

  • List of Tests
    • Amphiphysin
    • Pnma2
    • Ri
    • Yo
    • Hu
    • Recoverin
    • Sox-1
    • Titin
    • GAD-65
    • Zic4
    • TR
    • Oligoclonal band

Paraneoplastic Syndrome/Neuronal Antibody Profile-3

  • Why is it done?
    • This comprehensive antibody panel detects autoimmune neuronal antibodies associated with paraneoplastic neurological syndromes (PNS), which are neurological disorders triggered by malignant tumors outside the central nervous system
    • Used to diagnose autoimmune encephalitis, cerebellar degeneration, limbic encephalitis, sensory neuronopathy, and other neurological manifestations of occult or known malignancies
    • Ordered when patients present with unexplained neurological symptoms including cognitive decline, movement disorders, seizures, ataxia, or autonomic dysfunction
    • Amphiphysin antibodies indicate association with small cell lung cancer (SCLC) and breast cancer, often presenting with stiff-person syndrome or paraneoplastic myelopathy
    • PNMA2 (paraneoplastic Ma2) antibodies correlate with testicular cancer, lung cancer, and breast cancer, presenting with encephalitis or limbic dysfunction
    • Ri antibodies are associated with breast cancer and small cell lung cancer, manifesting as opsoclonus-myoclonus or brainstem encephalitis
    • Yo antibodies are highly specific for ovarian and breast cancer, primarily causing paraneoplastic cerebellar degeneration
    • Hu antibodies indicate association with small cell lung cancer (SCLC), presenting with sensory neuronopathy, encephalomyelitis, or autonomic dysfunction
    • Recoverin antibodies are associated with melanoma and lung cancer, causing cancer-associated retinopathy (CAR) with visual loss
    • Sox-1 antibodies correlate with small cell lung cancer and neurological manifestations including paraneoplastic encephalomyelitis
    • Titin antibodies are associated with thymoma and myasthenia gravis, important for identifying thymoma-associated paraneoplastic syndromes
    • GAD-65 antibodies indicate autoimmune neurological disorders including stiff-person syndrome and cerebellar ataxia, sometimes paraneoplastic
    • Zic4 antibodies are associated with small cell lung cancer and Hodgkin lymphoma, manifesting as paraneoplastic cerebellar degeneration
    • TR antibodies are associated with various cancers and paraneoplastic cardiac arrhythmias and neurological dysfunction
    • Oligoclonal bands identify intrathecal immunoglobulin synthesis, indicating CNS inflammation and immune activation commonly seen in paraneoplastic disease
    • Helps guide cancer screening protocols and directs oncological investigations when paraneoplastic syndrome is suspected
    • Enables early cancer detection and treatment initiation, improving neurological outcomes in paraneoplastic syndromes
  • Normal Range
    • Amphiphysin: Negative or <0.05 nmol/L (normal/non-reactive); positive ≥0.05 nmol/L indicates potential paraneoplastic association
    • PNMA2 (Ma2): Negative or <0.05 nmol/L (normal); positive ≥0.05 nmol/L suggests malignancy-associated encephalitis
    • Ri: Negative or <0.05 nmol/L (normal); positive ≥0.05 nmol/L indicates paraneoplastic neurological syndrome
    • Yo: Negative or <0.05 nmol/L (normal); positive ≥0.05 nmol/L highly specific for ovarian/breast cancer with cerebellar involvement
    • Hu: Negative or <0.05 nmol/L (normal); positive ≥0.05 nmol/L associated with SCLC and paraneoplastic neurological disorders
    • Recoverin: Negative or <0.05 nmol/L (normal); positive ≥0.05 nmol/L indicates cancer-associated retinopathy
    • Sox-1: Negative or <0.05 nmol/L (normal); positive ≥0.05 nmol/L associated with SCLC
    • Titin: Negative or <0.05 nmol/L (normal); positive ≥0.05 nmol/L associated with thymoma and myasthenia gravis
    • GAD-65: <5 IU/mL (negative); 5-10 IU/mL (borderline); >10 IU/mL (positive) indicates autoimmune neurological condition
    • Zic4: Negative or <0.05 nmol/L (normal); positive ≥0.05 nmol/L associated with paraneoplastic cerebellar degeneration
    • TR: Negative or <0.05 nmol/L (normal); positive ≥0.05 nmol/L indicates paraneoplastic disease
    • Oligoclonal Bands (CSF/Serum): Absent (negative/normal); present (positive) indicates intrathecal immunoglobulin synthesis and CNS inflammation
    • Most antibody tests use semiquantitative scoring: negative, low positive, moderate positive, or high positive based on titer or optical density values
    • Reference ranges may vary by laboratory methodology (immunofluorescence, immunohistochemistry, cell-based assay, or ELISA)
  • Interpretation
    • Amphiphysin positive result: Strong indicator of paraneoplastic syndrome; highly associated with SCLC (70-80% of cases) and breast cancer; warrants urgent malignancy screening
    • PNMA2 positive result: Indicates paraneoplastic encephalitis or limbic dysfunction; most commonly associated with testicular cancer, lung cancer, or breast cancer; high specificity for malignancy
    • Ri positive result: Indicates paraneoplastic opsoclonus-myoclonus or brainstem encephalitis; associated with breast cancer (80-90%) and SCLC; requires malignancy evaluation
    • Yo positive result: Highly specific (95%+) for ovarian or breast cancer with paraneoplastic cerebellar degeneration; warrants aggressive gynecological and oncological screening
    • Hu positive result: Highly specific (95%+) for SCLC; associated with sensory neuronopathy, encephalomyelitis, or autonomic dysfunction; majority of patients have or will develop SCLC
    • Recoverin positive result: Indicates cancer-associated retinopathy (CAR); associated with melanoma, lung cancer, and other malignancies; requires ophthalmological and oncological evaluation
    • Sox-1 positive result: Strongly associated with SCLC (90%+ specificity); indicates paraneoplastic encephalomyelitis; warrants urgent pulmonary imaging and staging
    • Titin positive result: Indicates thymoma-related paraneoplastic syndrome; associated with myasthenia gravis; requires chest imaging and thymoma evaluation
    • GAD-65 >10 IU/mL: Indicates autoimmune neurological disease (stiff-person syndrome, cerebellar ataxia); may be paraneoplastic in some cases; associated with various malignancies
    • Zic4 positive result: Associated with SCLC and Hodgkin lymphoma; indicates paraneoplastic cerebellar degeneration; requires malignancy screening
    • TR positive result: Associated with various cancers; indicates paraneoplastic cardiac and neurological dysfunction; warrants comprehensive malignancy evaluation
    • Oligoclonal Bands positive: Indicates intrathecal immunoglobulin synthesis supporting CNS inflammation; consistent with paraneoplastic disease, autoimmune encephalitis, or infection
    • Multiple positive antibodies: Increases likelihood of paraneoplastic syndrome; some patients may have multiple antibodies simultaneously
    • Negative results: Do not exclude paraneoplastic syndrome; approximately 40% of paraneoplastic cases have seronegative antibodies; clinical correlation and neuroimaging are essential
    • False negatives may occur in early disease, during certain antibody windows, or with low antibody titers not reaching detection threshold
    • False positives are rare but can occur; laboratory confirmation and clinical correlation are mandatory before initiating cancer screening
  • Associated Organs
    • Amphiphysin: Associated organs include brain (paraneoplastic myelopathy, encephalitis), spinal cord (stiff-person syndrome), and neuromuscular junction; linked to lung (SCLC) and breast tissue malignancy
    • PNMA2: Targets limbic system (memory, emotional regulation), hypothalamus, brainstem; associated with testis, lung, and breast cancers; affects temporal lobe and medial temporal structures
    • Ri: Primarily affects brainstem nuclei and cerebellum; associated with breast and lung cancers; causes opsoclonus (eye movements), myoclonus (muscle jerks), and ataxia
    • Yo: Highly specific for cerebellum targeting; associated with ovarian and breast malignancies; causes progressive cerebellar degeneration with ataxia and coordination loss
    • Hu: Targets dorsal root ganglia (sensory neurons), brain, and autonomic nervous system; associated with SCLC; causes sensory neuronopathy, encephalomyelitis, or autonomic dysfunction
    • Recoverin: Targets retina and photoreceptor cells; associated with melanoma and lung cancer; causes cancer-associated retinopathy (CAR) with vision loss and photopsia
    • Sox-1: Affects central nervous system including brain and spinal cord; associated with SCLC; causes paraneoplastic encephalomyelitis with multifocal involvement
    • Titin: Targets skeletal muscle, thymus gland, and neuromuscular junction; associated with thymoma; causes myasthenia gravis and paraneoplastic myositis
    • GAD-65: Targets inhibitory neurons throughout CNS including cerebellum, brainstem, and spinal cord; causes stiff-person syndrome, cerebellar ataxia, and seizures; may be paraneoplastic with various malignancies
    • Zic4: Affects cerebellar development and function; associated with SCLC and Hodgkin lymphoma; causes cerebellar degeneration and ataxia
    • TR: Targets cardiac tissue and central nervous system; associated with various malignancies; causes paraneoplastic cardiac arrhythmias and neurological dysfunction
    • Oligoclonal Bands: Indicates CNS-specific inflammation; reflects intrathecal antibody synthesis in brain and spinal cord; supports diagnosis of autoimmune CNS disease
    • Overall: This antibody profile evaluates central nervous system, peripheral nervous system, and autonomic nervous system involvement associated with malignancy
    • Complications from untreated paraneoplastic syndromes include progressive neurological disability, permanent neurological damage, autonomic failure, seizures, coma, and death if malignancy not identified and treated
  • Follow-up Tests
    • For positive Amphiphysin: CT/MRI chest with contrast to screen for SCLC; mammography for breast cancer evaluation; PET-CT for staging if malignancy identified
    • For positive PNMA2: Testicular ultrasound, chest imaging, and breast imaging depending on clinical context; MRI brain for encephalitis confirmation
    • For positive Ri: Mammography and chest CT recommended; MRI brain to assess brainstem involvement; neurophysiological testing for opsoclonus documentation
    • For positive Yo: Pelvic ultrasound and gynecological examination for ovarian cancer; mammography for breast cancer; urgent oncological consultation
    • For positive Hu: High-resolution CT chest for SCLC screening (primary imaging); consider bronchoscopy if CT findings suspicious; urgent pulmonary oncology evaluation
    • For positive Recoverin: Ophthalmological evaluation including visual fields and electro-oculography; skin examination for melanoma; chest imaging for lung cancer
    • For positive Sox-1: CT chest with contrast as primary screening for SCLC; bronchoscopy if chest CT abnormalities; sputum cytology considered
    • For positive Titin: Chest CT with mediastinal imaging for thymoma; myasthenia gravis confirmatory testing (repetitive stimulation, single-fiber EMG); acetylcholine receptor antibodies
    • For positive GAD-65: MRI brain and spine to assess for autoimmune myelitis or encephalitis; comprehensive malignancy screening if paraneoplastic suspected; lumbar puncture for CSF analysis
    • For positive Zic4: CT chest for SCLC screening; lymph node biopsy if Hodgkin lymphoma suspected; comprehensive oncological evaluation
    • For positive TR: Electrocardiography and echocardiography for cardiac evaluation; comprehensive cancer screening based on clinical presentation
    • For positive Oligoclonal Bands: Brain and spine MRI to assess for inflammatory changes; CSF analysis for inflammatory markers and infectious workup; LP with culture and PCR if not already performed
    • All positive cases: MRI brain with and without contrast to assess for paraneoplastic encephalitis, demyelination, or mass effect; assess for complications
    • All positive cases: Lumbar puncture with CSF analysis including protein, glucose, cell count, culture, and viral PCR panel when indicated
    • All positive cases: Electromyography and nerve conduction studies to assess for peripheral nervous system involvement
    • All positive cases: Comprehensive oncological evaluation and cancer screening appropriate to antibody profile and clinical presentation; may include PET-CT, endoscopy, or biopsy
    • Seronegative cases with high clinical suspicion: Repeat antibody testing at 2-4 week intervals; cell-based assays with live or fixed cells; tissue immunostaining; specialist consultation with neuro-oncology
    • Monitoring frequency: Follow-up imaging every 3-6 months for malignancy surveillance; serial antibody titers to assess treatment response; neurological assessment at regular intervals
    • Supportive testing: Onconeural antibody panel expansion if initial panel negative but clinical suspicion remains high; immunoglobulin quantification; complement levels in some cases
  • Fasting Required?
    • No fasting is required for the Paraneoplastic Syndrome/Neuronal Antibody Profile-3 test package
    • Patient may eat and drink normally before blood draw; normal dietary intake does not affect antibody detection or test results
    • Specific antibody levels are not influenced by feeding state or recent food consumption
    • No medications need to be withheld before testing; immunosuppressive medications, corticosteroids, and antibiotics do not require interruption
    • Note: If immunosuppressive or immunomodulatory therapy has been started recently, inform the laboratory as treatment response may affect antibody titers
    • No special dietary restrictions are necessary before test; patient may maintain normal hydration with water
    • Test can be performed at any time of day; no circadian variation affects antibody levels
    • Serum collection is standard venipuncture; no special collection tubes beyond routine serum separator tubes (SST) are required
    • For comprehensive evaluation, cerebrospinal fluid (CSF) may be collected via lumbar puncture in addition to serum; this requires informed consent and specific sterile collection protocols
    • Patient should be in good general health on day of test; acute illness or infection may transiently affect immune parameters
    • Avoid excessive physical exertion immediately before blood draw; allow brief rest period (5-10 minutes) if patient is fatigued or anxious
    • Inform phlebotomist of any recent blood transfusions, immunoglobulin therapy, or monoclonal antibody infusions as these may temporarily alter antibody patterns
    • Allow adequate time (typically 2-3 business days) for test processing and result reporting; some specialized antibody assays may require 5-10 business days

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