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Anti-ganglioside antibody tests for possible immune-mediated neuropathy have become widely available in recent years. They have become popular because of their potential to identify subsets of patients within the large group of idiopathic neuropathies that have lacked specific clinical definition. Anti-GM1 antibodies may play a pathogenic role in multifocal motor neuropathy1 and Guillain-Barré syndrome,2 and GM1 ganglioside is found in the nodal regions3 of peripheral nerves. In this issue of Neurology, Carpo et al. compare the sensitivity, specificity, and positive predictive value of anti-GM1 testing by Covalink ELISA and by standard ELISA techniques in a cohort of 76 patients with definite motor neuron or neuropathy syndromes, including 26 patients with multifocal motor neuropathy.4 They found high titers of anti-GM1 immunoglobulin (Ig)M antibodies (≥1/2000) by Covalink ELISA in 35% of patients with multifocal mononeuropathy (i.e., a sensitivity of 35%) and in 12% of those with other motor neuron or neuropathy syndromes (i.e., a specificity of 88%) compared with 31% and 8% by standard ELISA methods.
These data differ from earlier data where the Covalink technique detected high titers of IgM antibodies in 85% (≥1/1800) of multifocal motor neuropathy patients.5 The usefulness of the anti-GM1 Covalink technology is not confirmed by Carpo et al.4 Should the clinician start to use this new Covalink ELISA test in patients with a progressive, unexplained motor neuropathy?
This question is one that must be asked for many new diagnostic tests. The initial report of a diagnostic test demonstrates relatively high indices of accuracy (i.e., sensitivity …
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