Epilepsy, Autoimmune Evaluation, Serum

Test Code

31204

CPT Codes
86341, 86255 (x17)<br>Limited Access Code

Includes

If client requests or if indirect immunofluorescence assay (IFA) patterns suggest collapsin response-mediator protein-5-IgG (CRMP-5-IgG), then CRMP-5-IgG Western blot and acetylcholine receptor (AChR) muscle binding are performed at an additional charge (CPT code(s): 84182, 83519).

If IFA patterns suggest amphiphysin antibody, then amphiphysin immunoblot is performed at an additional charge (CPT code(s): 84182).

If IFA pattern suggests antiglial nuclear antibody (AGNA)-1, then AGNA-1 immunoblot is performed at an additional charge (CPT code(s): 84182).

If IFA pattern suggests antineuronal nuclear antibodies (ANNA)-1, then ANNA-1 immunoblot is performed at an additional charge (CPT code(s): 84182).

If IFA pattern suggests ANNA-2 antibody, then ANNA-2 immunoblot is performed at an additional charge (CPT code(s): 84182).

If IFA pattern suggests Purkinje cytoplasmic antibody (PCA)-1, then PCA-1 immunoblot is performed at an additional charge (CPT code(s): 84182).

If IFA pattern suggests PCA-Tr antibody, then PCA-Tr immunoblot is performed at an additional charge (CPT code(s): 84182).

If IFA pattern suggests alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPA-R) antibody, and AMPA-R antibody cell-binding assay (CBA) is positive, then AMPA-R antibody IF titer assay is performed at an additional charge (CPT code(s): 86256).

If AMPA-R antibody CBA is positive, then CRMP-5-IgG Western blot and AChR (muscle) binding antibody are performed at an additional charge (CPT code(s): 84182, 83519).

If contactin-associated protein-like-2 (CASPR2)-receptor antibody CBA is positive, then CRMP-5-IgG Western blot, and AChR (muscle) binding antibody are performed at an additional charge (CPT code(s): 84182, 83519).

If IFA pattern suggests gamma-aminobutyric acid B (GABA-B)-receptor antibody, and GABA-B-receptor antibody is positive, then GABA-B-receptor antibody IF titer assay is performed at an additional charge (CPT code(s): 86256).

If IFA pattern suggests glial fibrillary acidic protein (GFAP) antibody, then GFAP IFA titer and GFAP CBA are performed at If IFA pattern suggests glial fibrillary acidic protein (GFAP) antibody, then GFAP IFA titer and GFAP CBA are performed at an additional charge (CPT code(s): 86256, 86255).

If IFA pattern suggests N-methyl-D-aspartate (NMDA) receptor antibody, and NMDA-receptor antibody CBA is positive, then NMDA-receptor antibody IF titer assay is performed at an additional charge (CPT code(s): 86256).

If IFA pattern suggests dipeptidyl-peptidase-like protein-6 (DPPX) antibody, then DPPX antibody CBA and DPPX titer are performed at an additional charge (CPT code(s): 86255, 86256).

If IFA pattern suggests metabotropic glutamate receptor 1 (mGluR1) antibody, then mGluR1 antibody CBA and mGluR1 titer are performed at an additional charge (CPT code(s): 86255, 86256).

Preferred Specimen

4 mL serum

Patient Preparation
1. For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication or intravenous immunoglobulin (IVIg) treatment.

2. This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed, or canceled if radio-activity remains.

3. Patient should have no general anesthetic or muscle-relaxant drugs in the previous 24 hours.

Minimum Volume

2.5 mL

Transport Temperature

Refrigerated (cold packs)

Specimen Stability

Room temperature: 72 hours
Refrigerated: 28 days
Frozen: 28 days

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Gross hemolysis • Grossly lipemic • Grossly icteric

Methodology
Indirect Immunofluorescence Assay (IFA) • Cell Binding Assay (CBA) • Western Blot (WB) • Immunoblot (IB) • Radioimmunoassay (RIA)

FDA Status
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

Setup Schedule

Monday-Sunday Morning
Report available: 10 Days

Reference Range

See Laboratory Report

Clinical Significance

Investigating new onset cryptogenic epilepsy with incomplete seizure control and duration of less than 2 years using serum specimens
Investigating new onset cryptogenic epilepsy plus 1 or more of the following accompaniments:
-Psychiatric accompaniments (psychosis, hallucinations)
-Movement disorder (myoclonus, tremor, dyskinesias)
-Headache
-Cognitive impairment/encephalopathy
-Autoimmune stigmata (personal history or family history or signs of diabetes mellitus, thyroid disorder, vitiligo, premature graying of hair, myasthenia gravis, rheumatoid arthritis, systemic lupus erythematosus, idiopathic adrenocortical insufficiency), or multiple sclerosis
-History of cancer
-Smoking history (over 20 pack-years) or other cancer risk factors
-Investigating seizures occurring within the context of a subacute multifocal neurological disorder without obvious cause, especially in a patient with a past or family history of cancer
-A rising autoantibody titer in a previously seropositive patient suggests cancer recurrence

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.