Providing care to patients with autoimmune neurologic diseases: from lab to clinic

Dr Budhram standing in lab

April 18, 2024

The tenth floor of London Health Sciences Centre’s Victoria Hospital is home to a series of specialty diagnostic laboratories in the department of Pathology and Laboratory Medicine (PaLM), where experts are exploring neuroimmunology, a field of study focusing on nervous system diseases that are caused by a person’s own immune system.

In the neuroimmunology lab, tests are conducted to identify the presence of diseases that occur when a person’s immune system mistakenly attacks their brain, spinal cord or nerves. Examples of these conditions include autoimmune encephalitis, neuromyelitis optica spectrum disorders, and myasthenia gravis.

Dr. Adrian Budhram is a neurologist who runs the Autoimmune Neurology Clinic and works in the Clinical Immunology Laboratory at London Health Sciences Centre, where he oversees the clinical side of neuroimmunology testing. This relatively new and rapidly advancing area of laboratory medicine is enabling care providers to accurately diagnose some of the most complex or rarest autoimmune neurologic conditions, which helps inform best treatment options for patients.

Dr. Budhram uses his skills in the laboratory and clinical settings to help his colleagues diagnose and care for patients with autoimmune neurologic diseases. An example of a disease that the neuroimmunology lab tests for is autoimmune encephalitis, a potentially devastating yet treatable condition where inflammation of the brain caused by a person’s own immune system can lead to symptoms such as memory issues and seizures.


The discovery of numerous antibodies to help diagnose autoimmune encephalitis over the last two decades has dramatically impacted this field. “It really led a revolution, and the discovery of these antibodies, these markers for diagnosis of neuro-inflammatory diseases, has enabled us to better treat them,” explains Dr. Budhram.

How does the testing work?

Testing is focused on the detection of neural antibodies, which are proteins that act as valuable biomarkers, or indicators, of autoimmune neurologic diseases. “By detecting these antibodies here in this lab, we can provide the clinician with the confirmation of a diagnosis, help them figure out what's wrong with their patient and ensure that an appropriate treatment plan is started as quickly as possible,” explains Dr. Budhram.

Patient samples that have been ordered by a clinician are sent to the LHSC Clinical Immunology laboratory from across the city of London, as well as other parts of Ontario and Canada. Those samples are received by lab professionals, who then run them using different instruments to detect neural antibodies.

LHSC tests for many neural antibodies, which are often detected by a test method called indirect immunofluorescence.

“When a patient has a positive result to a test, you can see it using fluorescence under the microscope,” says Dr. Budhram, who spends a large part of his time in the lab reviewing these slides. “It requires expertise to review those slides, interpret a positive result, and then report those out with appropriate commentary for the clinician.”

Dr. Budhram works closely with laboratory professionals to review the tests that are run weekly. Processing thousands of patient samples a year, the lab has grown significantly over the last few years as new tests have been developed and introduced.

“These are conditions that can be quite serious, but also quite treatable,” Dr. Budhram says. “This is just one of many ways that our laboratory teams are helping to make a direct contribution to improving the lives of patients receiving care at LHSC, St. Joseph’s and beyond.”

About Pathology and Laboratory Medicine (PaLM)

PaLM provides a comprehensive range of routine and specialized testing and clinical consultation for patient care within southwestern Ontario and beyond. As a joint venture of London Health Sciences Centre and St. Joseph’s Health Care London, PaLM consists of 28 labs and more than 560 highly skilled professionals who help to support critical medical decisions through the delivery of accurate and timely test results.