title: Clinical experience of seropositive ganglionic acetylcholine receptor antibody in a tertiary neurology referral center.
abstract: BACKGROUND
  Antibody against the acetylcholine receptor of autonomic ganglia (gAChR-Ab) is implicated in the pathogenesis of autoimmune autonomic ganglionopathy (AAG) and several other disorders.
  
  
  METHODS
  This study was a retrospective evaluation of 95 patients positive for gAChR-Ab.
  
  
  RESULTS
  Twenty-one (22%) patients had AAG, with a greater median gAChR-Ab level (0.21 nmol/L) and higher percentage (57%) of antibody levels >0.20 nmol/L when compared with the remaining 74 patients without autonomic manifestations (non-AAG group, 0.10 nmol/L and 15%, respectively). Only 2 new cases of malignancy were diagnosed after gAChR-Ab detection. The non-AAG group was associated with high frequencies of neurological and non-neurological autoimmunity, but also included 23 (31%) patients with mostly degenerative disorders.
  
  
  CONCLUSIONS
  Detection of gAChR-Ab, especially at a higher level, is helpful for the diagnosis of AAG in patients with corresponding autonomic symptoms. However, its value is limited for predicting cancer risk and for diagnosis and management of patients without autonomic symptoms.
authors.affiliation: Department of Neurology, Desk S90, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, 44195, USA.
authors.forename: Yuebing
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Neurology, Desk S90, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, 44195, USA.
authors.forename: Adham
authors.initials: A
authors.lastname: Jammoul
authors.affiliation: Department of Neurology, Desk S90, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, 44195, USA.
authors.forename: Karin
authors.initials: K
authors.lastname: Mente
authors.affiliation: Department of Quantitative Health Sciences, Learner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Neurology, Desk S90, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, 44195, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Shields
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Vernino
authors.affiliation: Department of Neurology, Desk S90, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, 44195, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rae-Grant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000276:immunology*; D001342:Autonomic Nervous System Diseases / Q000276:immunology*; D015331:Cohort Studies; D005260:Female; D005725:Ganglia, Autonomic / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020361:Paraneoplastic Syndromes, Nervous System / Q000276:immunology*; D011950:Receptors, Cholinergic / Q000276:immunology; D011978:Receptors, Nicotinic / Q000276:immunology*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D011950:Receptors, Cholinergic; D011978:Receptors, Nicotinic
keywords: autoimmune autonomic ganglionopathy; autoimmunity; diagnostic testing; ganglionic autonomic acetylcholine receptor; malignancy