Autoantibody Testing Panels

Autoantibody panels are blood tests that detect antibodies the immune system has mistakenly made against the body's own tissues. In neuro-ophthalmology, these tests help diagnose autoimmune conditions affecting the eyes, optic nerves, and brain.

Commonly Ordered Panels

Neuromyelitis Optica (NMO) Panel

For suspected NMO:

Aquaporin-4 (AQP4/NMO-IgG) antibodies

• Highly specific for NMO
• Positive in ~75% of NMO patients
• Can be positive before clinical criteria met

MOG antibodies

• Associated with MOGAD
• Different treatment implications than AQP4+

Myasthenia Gravis Panel

For suspected myasthenia gravis:

• Acetylcholine receptor (AChR) antibodies
• Anti-MuSK antibodies
• Anti-LRP4 antibodies (less available)

Paraneoplastic Panel

For suspected cancer-associated visual syndromes:

Common antibodies:

• Anti-recoverin (CAR)
• Anti-enolase
• Anti-CRMP-5 (CV2)
• Anti-Hu
• Anti-Yo
• Anti-amphiphysin

Vasculitis/Inflammatory Panel

For systemic inflammation:

• ANA (antinuclear antibody)
• ANCA (anti-neutrophil cytoplasmic antibodies)
• Anti-dsDNA
• Complement levels (C3, C4)

For specific conditions:

• Anti-SSA/SSB (Sjögren syndrome)
• ACE level (sarcoidosis)

When Panels Are Ordered

Optic Neuritis

• NMO/MOG panel if atypical features
• ANA if lupus suspected
• MRI findings guide testing

Unexplained Vision Loss

• Paraneoplastic panel
• NMO panel
• Inflammatory markers

Muscle Weakness with Eye Findings

• Myasthenia panel
• Thyroid antibodies

Orbital Inflammation

• Thyroid antibodies (Graves' disease)
• ANA, ANCA
• IgG4 levels

Understanding Results

Positive Results

• Support but don't prove diagnosis
• Must correlate with clinical picture
• Some antibodies highly specific (AQP4, AChR)
• Others less specific (ANA)

Negative Results

• Don't always rule out disease
• Sensitivity varies by antibody
• Test at specialized labs when possible
• May need to repeat if clinical suspicion high

False Positives

• Can occur, especially with less specific tests
• Low-titer ANA common in healthy people
• Clinical correlation essential

Test Considerations

Sample Handling

• Some antibodies require specific handling
• Cell-based assays more sensitive than ELISA for some
• Specialized laboratories may be needed

Cost

• Panels can be expensive
• Insurance coverage varies
• Order targeted tests when diagnosis likely

Timing

• Results may take 1-3 weeks
• Rush testing sometimes available
• Don't delay treatment while waiting if urgent

Common Scenarios

Atypical Optic Neuritis

Order:

• AQP4 antibody
• MOG antibody
• Consider ANA, B12, other tests

Ptosis and Diplopia

Order:

• AChR antibody
• Anti-MuSK antibody
• Thyroid panel

Unexplained Retinopathy

Order:

• Paraneoplastic panel
• Consider cancer workup if positive