May 18, 2026

Summary: Choose Warde tests ANAPS or ENCS instead of PNPAB (which will be discontinued by Mayo), or use the following resource to select a panel specific to patient presentation:

Antibody Prevalence in Epilepsy and Encephalopathy (APE2 ) score – Insights

For CSF, use Warde test EAPSF instead of PNCSF (which will be discontinued by Mayo).

Detailed explanation: Autoimmune markers for neurologic evaluation, including markers for paraneoplastic etiology, are sent from Warde to Mayo Clinic Laboratories for testing. Mayo is shifting away from the PAVAL reflexive panel (Warde code PNPAB), towards panels directed towards presenting clinical signs and symptoms. Mayo makes no specific recommendation regarding a one-to-one replacement for PAVAL.

Serum panels are tailored to focused entities (see examples below in bold), and the resource link provided above guides users through questions that clarify which panel may be best.

There is a comprehensive panel containing nearly all antibodies that were included in PAVAL: this is called ENS2 at Mayo and has Warde code ENCS (Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Serum). The cost to patient/payor, for Mayo ENS2 (Warde ENCS) is about double the cost of Mayo PAVAL (Warde PNPAB). Mayo’s laboratory neurology team recommends consideration of the Mayo test AIAES instead of PAVAL, as it contains most of the antibodies and leaves out ones that are no longer in favor due to non-specificity (considered more indicative of general inflammation than paraneoplastic autoimmunity). The test name is Axonal Neuropathy, Autoimmune/Paraneoplastic Evaluation, Serum. The cost for AIAES is similar to PAVAL, and the Warde code is ANAPS.

Mayo provides a number of resources for providers to use when selecting a neurologic autoimmune panel, including this hub:

Autoimmune Neurology Testing – Mayo Clinic Laboratories

All of the variations are available through Warde through miscellaneous ordering (WMISC). However, Warde only codes those in high-volume use, because the presence of so many options on the Warde compendium leads to significant confusion among users (due to too many overlapping panels). We monitor WMISC usage and will code additional Mayo neurology options that are selected most frequently. This also applies to the CSF version of the panels. PNCSF, which maps to Mayo code PAC1, is slated for discontinuation, and no one-to-one replacement will be provided. We have coded Mayo ENC2 as Warde EAPSF, as this panel already shows use from Warde clients. Additional CSF panels at Mayo are targeted at presentation (e.g. encephalopathy, dementia, epilepsy, movement disorders, pediatrics, demyelination, autonomic dysfinction, peripheral neuropathy, and more), and these can be ordered as WMISC with Mayo panel specified in comments.