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Oncological, Neurological, and Serological Accompaniments

Andrew McKeon, MB, MRCPI; Vanda A. Lennon, MD, PhD; Daniel H. Lachance, MD; Robert D. Fealey, MD; Sean J. Pittock, MD

Arch Neurol. 2009;66(6):735-741.

Objective  To describe the clinical utility of the nicotinic ganglionic acetylcholine receptor (3-AChR) autoantibody as a marker of neurological autoimmunity and cancer.

Design  Case-control study.

Setting  Mayo Clinic, Rochester, Minnesota.

Patients  A total of 15 000 patients seen at Mayo Clinic (2005-2007) and evaluated on a service basis for paraneoplastic neurological autoimmunity for whom clinical information was obtained retrospectively by medical record review as well as 457 neurologically asymptomatic patients or control subjects of whom 173 were healthy, 245 had lung cancer, and 39 had systemic lupus erythematosus or Sjögren syndrome.

Outcome Measures  Neurological, oncological, and serological associations of 3-AChR autoantibody seropositivity.

Results  Of 15 000 patients tested on a service basis, 1% were seropositive (median, 0.12 nmol/L; range, 0.03-18.8 nmol/L; normal, 0.02 nmol/L), 55% were male, and the median age was 65 years. Cancer was found (new or by history) in 24 of 78 patients evaluated for cancer while at Mayo Clinic (30%); 43% had adenocarcinoma (more patients had breast cancer than prostate, lung, and gastrointestinal cancers; each of the latter groups had about the same number of patients). Of 12 patients with high antibody values (1.00 nmol/L), 83% had pandysautonomia. Of 85 patients with medium antibody values (0.10-0.99 nmol/L), neurological presentations were more diverse and included peripheral neuropathies (36%), dysautonomia (20%, usually limited), and encephalopathy (13%). Of 58 patients with low antibody values (0.03-0.09 nmol/L), 54% had a nonautoimmune neurological disorder or no neurological disorder. Of 245 control patients with lung cancer, 7.8% were seropositive. Only 1 of 212 control patients without cancer (0.5%) was seropositive (P < .001).

Conclusion  The detection of 3-AChR autoantibody aids the diagnosis of neurological autoimmunity and cancer.

Author Affiliations: Departments of Neurology (Drs McKeon, Lennon, Lachance, Fealey, and Pittock), Laboratory Medicine and Pathology (Drs Lennon, Lachance, and Pittock), and Immunology (Dr Lennon), Mayo Clinic, Rochester, Minnesota.

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