Autoantibodies in autoimmune neurological disease and myasthenia gravis
How to order and read neural antibody results (AChR, MuSK, LRP4, VGCC and SOX1, AQP4 and MOG, NMDA and other glutamate receptors, LGI1 and CASPR2 in place of VGKC, gangliosides, MAG and GAD65), which assay to trust, serum versus CSF, and the false positives that mislead.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Neural antibodies support a diagnosis that the clinical picture proposes. A positive result in the wrong syndrome is more often a false positive than a revelation.
- The antigen's location predicts behaviour. Cell-surface or synaptic antigens (AChR, MuSK, NMDA receptor, LGI1, AQP4) are pathogenic and treatment-responsive. Intracellular antigens (Hu, Yo, GAD65) mark a T-cell process and, for most, a cancer.
- Choose the assay: cell-based assays for surface antibodies, radioimmunoassay for AChR binding, line blots for intracellular antigens confirmed on tissue.
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Sources
- Therapeutic Guidelines: NeurologyAU/NZTherapeutic Guidelines Limited
- RCPA Manual (neural autoantibodies, acetylcholine receptor antibodies)AU/NZRoyal College of Pathologists of Australasia
- International consensus guidance for management of myasthenia gravis: 2020 update (Narayanaswami P et al. Neurology 2021;96(3):114-122)Neurology, 2020 (published 2021); no newer international diagnostic consensus found November 2026
- A clinical approach to diagnosis of autoimmune encephalitis (Graus F et al. Lancet Neurol 2016;15(4):391-404)Lancet Neurology, 2016 (still the current consensus criteria, November 2026)
- Updated diagnostic criteria for paraneoplastic neurologic syndromes (Graus F et al. Neurol Neuroimmunol Neuroinflamm 2021;8(4):e1014)Neurology Neuroimmunology and Neuroinflammation, 2021
- International consensus diagnostic criteria for neuromyelitis optica spectrum disorders (Wingerchuk DM et al. Neurology 2015;85(2):177-189)Neurology, 2015
- Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: international MOGAD Panel proposed criteria (Banwell B et al. Lancet Neurol 2023;22(3):268-282)Lancet Neurology, 2023
- Electrophysiological diagnostic criteria of Lambert-Eaton myasthenic syndrome (Oh SJ et al. Muscle Nerve 2005;32(4):515-520)Muscle & Nerve, 2005
- A comprehensive analysis of the epidemiology and clinical characteristics of anti-LRP4 in myasthenia gravis (Zisimopoulou P et al. J Autoimmun 2014;52:139-145)Journal of Autoimmunity, 2014
- Looking beyond syndrome-based criteria for autoimmune encephalitis: the need for complementary neural antibody-based diagnostic criteria (Budhram A, Irani SR, Flanagan EP. JAMA Neurol 2024;81(3):227)JAMA Neurology, 2024
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback