Guide to autoantibody testing in peripheral neuropathies

BACKGROUND - Many autoantibodies with reactivity to glycoconjugate components of peripheral nerve have been described in the last two decades. Serum autoantibodies to gangliosides and glycoproteins have received the most attention and have been implicated in a variety of sensory and motor neuropathy syndromes. Detection of these autoantibodies raises the possibility that the peripheral nerve disturbance is immune-mediated and that immunosuppressive therapy may be of benefit. REVIEW SUMMARY - This review summarizes the peripheral nerve syndromes associated with autoantibodies to glycoconjugates. The potential role for these autoantibodies in diagnosing peripheral nerve syndromes as well as predicting treatment response and immunopathogenesis is discussed. Autoantibody panels promoted by commercial laboratories for the evaluation of peripheral neuropathies are analyzed. CONCLUSIONS - Despite the fact that a pathogenic role for many peripheral nerve autoantibodies remains in question, several have evolved into helpful serologic markers for certain neuropathy syndromes. A rational approach to autoantibody testing in routine practice is presented, with an argument that testing should be individualized and tailored to the clinical setting, avoiding the use of larger screening panels.