Ganglionic Antibody Level as a Predictor of Severity of Autonomic Failure

Mayo Clinic Proceedings
Jeremy K Cutsforth-GregoryPhillip A Low

Abstract

To assess antibody level as a test of autonomic failure (AF) associated with ganglionic nicotinic acetylcholine receptor antibody (AChR-Ab) autoimmunity. We searched the Mayo Clinic laboratory database of 926 ganglionic AChR-Ab-seropositive patients seen at our institution between October 1, 1997, and April 1, 2015, for initial level of 0.05 nmol/L or higher and contemporaneous autonomic reflex screen (standardized evaluation of adrenergic, cardiovagal, and sudomotor functions) from which Composite Autonomic Scoring Scale (CASS) scores could be calculated. Of 289 patients who met inclusion criteria, 163 (56.4%) were women, median age was 54 years (range, 10-87 years), median antibody level was 0.11 nmol/L (range, 0.05-22.10 nmol/L), and median CASS total score was 2.0 (range, 0-10). Using receiver operating characteristic curve analysis, a level above 0.40 nmol/L predicted severe AF (CASS score, ≥7) with 92% specificity and 56% sensitivity. For at least moderate AF (CASS score ≥4 and anhidrosis ≥25%), a level of at least 0.20 nmol/L had 80% specificity and 59% sensitivity. Levels below 0.20 nmol/L were not predictive of the presence or absence of AF. For predicting orthostatic hypotension, ganglionic AChR-Ab level had excellent...Continue Reading

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Citations

Sep 10, 2020·Seminars in Neurology·William P Cheshire
Jan 31, 2020·Continuum : Lifelong Learning in Neurology·Steven Vernino
Jan 31, 2020·Continuum : Lifelong Learning in Neurology·Elizabeth A Coon, William P Cheshire
Jan 10, 2021·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·William P CheshireWolfgang Singer
Jan 14, 2021·Annals of Neurology·Shiwen KoayValeria Iodice

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