Patients with autoimmune myelopathy present with subacute onset and rapid progression of spinal cord symptoms (e.g., weakness, gait difficulties, loss of sensation, neuropathic pain, and bowel and bladder dysfunction). Autoimmune myelopathy evaluation of serum and spinal fluid can assist in the diagnosis and aid distinction from other causes of myelopathy (e.g., multiple sclerosis, sarcoidosis, vascular disease). Early detection may assist in diagnosis of occult cancer, prompt initiation of immune therapies, or both.
Novel biomarker for a treatable
A novel astrocytic autoantibody, glial fibrillary acidic protein (GFAP), has recently been described by Mayo Clinic as a biomarker of a relapsing autoimmune meningoencephalomyelitis that is responsive to immunotherapies. Seropositivity distinguishes autoimmune GFAP meningoencephalomyelitis from disorders commonly considered in the differential diagnosis.
In a Mayo Clinic study, 40% of patients with
GFAP-IgG were found to have co-existing antibodies.
When to consider testing
Consider autoimmune testing for patients presenting with spinal cord symptoms and one or more of the following:
- Rapid onset and progression
- Fluctuating course
- Autoimmune stigmata (e.g., physical signs or personal/ family history of diabetes, thyroid disorder, vitiligo, prematurely gray hair, myasthenia gravis, rheumatoid arthritis, systemic lupus erythematosus)
- History of cancer
- Smoking history (20+ pack years) or other cancer risk factors
- Inflammatory cerebrospinal fluid
- Neuroimaging atypical for degenerative etiology
- Prior treatment with immune checkpoint inhibitors
Which test should I order?
GFAP: A Novel Test for a Newly Identified Meningoencephalomyelitis
Mayo Clinic Laboratories is the only laboratory in the world to offer testing for a novel form of autoimmune meningoencephalomyelitis. Known as autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy, the condition was identified by Mayo Clinic in 2016. The GFAP antibody test is offered as part of Mayo Clinic Laboratories’ encephalitis and myelopathy evaluations.
Plasma membrane specificities
Nuclear and cytoplasmic specificities
A Test in Focus: Autoimmune myelopathy
Andrew McKeon, M.B., B.Ch., M.D., gives an overview of this test available through Mayo Clinic Laboratories. He discusses when this testing should be ordered, how this testing improves upon previous testing approaches, what clinical action can be taken due to the results of this testing.
Webinar - Autoimmune myelopathy
Andrew McKeon, M.B., B.Ch., M.D., gives an overview of the autoimmune encephalopathy evaluations. He focuses on when the tests should be ordered, how this testing improves upon previous approaches, and what clinical action the results enable.