Diagnosis of neuromyelitis spectrum disorders: Comparative sensitivities and specificities of immunohistochemical and immunoprecipitation assays

Andrew McKeon, James P. Fryer, Metha Apiwattanakul, Vanda A. Lennon, Shannon R. Hinson, Thomas J. Kryzer, Claudia F. Lucchinetti, Brian G. Weinshenker, Dean M. Wingerchuk, Elizabeth A. Shuster, Sean J. Pittock

Research output: Contribution to journalArticlepeer-review

89 Scopus citations

Abstract

Objective: To compare the sensitivity and specificity of immunofluorescence (IF) and immunoprecipitation (IP) assays using green fluorescent protein-tagged aquaporin-4 (AQP4) in 6335 patients for whom serological evaluation was requested on a service basis. Design: Case-control study. Setting: Mayo Clinic Neuroimmunology Laboratory (Rochester, Minnesota) and Departments of Neurology (Rochester, Minnesota; Scottsdale, Arizona; and Jacksonville, Florida). Patients: Group 1, 835 Mayo Clinic patients, 100 with a neuromyelitis optica (NMO) spectrum disorder diagnosis and 735 without NMO spectrum disorder; group 2, 5500 non-Mayo Clinic patients. Main Outcome Measure: Sensitivity and specificity of each assay for NMO or NMO spectrum disorder, individually and combined. Results: In group 1, the sensitivity rates for NMO were IF, 58%; IP, 33%; and combined assays, 63%. The sensitivity rates for relapsing longitudinally extensive transverse myelitis were IF, 29%; IP, 6%; and combined assays, 29%. The specificity rates for NMO and relapsing longitudinally extensive transverse myelitis were IF, 99.6%; IP, 99.3%; and combined assays, 99.2%. In group 2, NMO-IgG was detected by IF in 498 of 5500 patients (9.1%) and by IP in 331 patients (6.0%); 76 of the 331 patients seropositive by IP (23%) were negative by IF. Clinical information was available for 124 patients (including 16 of those seropositive by IP only); 123 had a definite NMO spectrum disorder and 1 was at risk for NMO (monophasic optic neuritis). Conclusions: In this large, clinical practice-based study, NMO-IgG detected by IF or IP was highly specific for NMO spectrum disorders. The IP assay was significantly less sensitive than IF. Combined testing improved sensitivity by 5%.

Original languageEnglish (US)
Pages (from-to)1134-1138
Number of pages5
JournalArchives of neurology
Volume66
Issue number9
DOIs
StatePublished - Sep 1 2009

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

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