Clinical Short Communication| Volume 378, P85-90, July 15, 2017

Detection of LGI1 and CASPR2 antibodies with a commercial cell-based assay in patients with very high VGKC-complex antibody levels

Published:April 27, 2017DOI:


      • In this study, a commercial assay was used to detect LGI1/CASPR2 antibodies.
      • Seven of 8 patients with very high VGKC-complex antibody levels (median 2663.5 pM) had LGI1/CASPR2 antibodies.
      • The patient without LGI1/CASPR2 antibodies remained negative on re-testing with a live cell assay.
      • There was high inter-rater reliability between the 2 test readers.
      • We discuss the performance characteristics of the commercial assay and the patients' clinico-serological associations.



      The presence of VGKC-complex antibodies, without LGI1/CASPR2 antibodies, as a standalone marker for neurological autoimmunity remains controversial. Additionally, the lack of an unequivocal VGKC-complex antibody cut-off level defining neurological autoimmunity makes it important to test for monospecific antibodies. We aim to determine the performance characteristics of a commercial assay (Euroimmun, Lübeck, Germany) for LGI1/CASPR2 antibody detection in patients with very high VGKC-complex antibody levels and report their clinico-serological associations.


      We identified 8 patients in our cohort with the highest VGKC-complex antibody levels (median 2663.5 pM, range 933–6730 pM) with VGKC-complex antibody related syndromes (Group A). Two other groups were identified; 1 group with suspected neuronal surface antibody syndromes and negative for VGKC-complex antibodies (Group B, n = 8), and another group with cerebellar ataxia and negative for onconeuronal antibodies (Group C, n = 8).


      Seven out of 8 patients (87.5%) in Group A had LGI1 and/or CASPR2 antibodies. One Group B patient had LGI1 antibodies but was negative on re-testing with a live cell assay. No Group C patients had monospecific antibodies. Inter-rater reliability was high; combining Groups A and B patients, the kappa statistic was 0.87 and 1.0 for LGI1 and CASPR2 antibodies respectively.


      We demonstrated that a high proportion of patients with very high VGKC-complex antibody levels and relevant clinical syndromes have LGI1 and/or CASPR2 antibodies detected by the commercial assay. Our findings lend support to the use of the assay for rapid and reliable detection of LGI1 and CASPR2 antibodies.


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