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Myasthenia Gravis

What does ganglionic mean in the ACHR test?

06/29/2006

Question:

After 3yrs neuro saying dont know whats wrong probably MS I ended up in hospital with double vision, facial paralysis, weakness in arms and legs. Usual neuro was on vacation so had different neuro, he asked if he could run different blood tests. I said "Sure". Then I get a call from an Onocologist saying I need to come see him because one of the blood tests ACHR Ganglionic Neuronal AR came back with high levels. He said "That gives you a high risk for cancer of the lungs." Everything I have found about the ACHR blood test doesnt talk about cancer, but is the ganglionic test different? The onocologist did CT but found lungs and thynoma to be ok. Symptoms of double vision,weakness in arms and legs, and fatigue continue. What type of doctor would you suggest I see next?

Answer:

The ganglionic ACHR (acetylcholine receptor) is different than the muscle acetylcholine receptor. The ganglionic antibody is a marker used in autoimmune and paraneoplastic (associated with cancer) diseases, particularly those that affect the autonomic system (sympathetic and parasympathetic). In fact, the only instance where I use the test is in the context of autoimmune dysfunction, such as autoimmune neuropathy. Symptoms that might suggest this: erectile dysfunction, dry mouth, dry eyes, pupillary dysfunction, orthostatic hypotension, gastrointestinal dysfunction (diarrhea, constipation), heart arrhythmias, and/or sweating dysfunction. The nicotinic acetylcholine receptor antibody is different in the skeletal muscle as opposed to the autonomic ganglia. The nicotinic skeletal muscle ACHR antibody is used when we suspect that there is myasthenia gravis. The nicotinic ganglionic ACHR antibody is used in the context of autonomic neuropathies. I would suggest that you return to your regular neurologist with this information. A neurologist seems to me the most appropriate doctor to see, especially with your symptoms.

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati