RT Journal Article
SR Electronic
T1 Serum neurofilament light chain in pediatric MS and other acquired demyelinating syndromes
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e968
OP e974
DO 10.1212/WNL.0000000000008057
VO 93
IS 10
A1 Yu Yi M. Wong
A1 Arlette L. Bruijstens
A1 Christian Barro
A1 Zuzanna Michalak
A1 Marie-José Melief
A1 Annet F. Wierenga
A1 E. Daniëlle van Pelt
A1 Rinze F. Neuteboom
A1 Jens Kuhle
A1 Rogier Q. Hintzen
YR 2019
UL http://n.neurology.org/content/93/10/e968.abstract
AB Objective To explore the correlation between serum and CSF neurofilament light chain (NfL) and the association of NfL levels and future disease activity in pediatric patients with a first attack of acquired demyelinating syndromes (ADS).Methods In total, 102 children <18 years with a first attack of CNS demyelination and 23 age-matched controls were included. Clinically definite multiple sclerosis (CDMS) was set as an endpoint for analysis. CSF NfL was tested by the commercially available ELISA (UmanDiagnostics); serum NfL (sNfL) was tested with a Simoa assay. Hazard ratios (HR) were calculated with Cox regression analysis.Results Of the 102 patients, 47 (46%) were tested for CSF NfL. CSF and serum NfL correlated significantly in the total group (ρ 0.532, p < 0.001) and even more significantly in the subgroup of patients with future CDMS diagnosis (ρ 0.773, p < 0.001). sNfL was higher in patients than in controls (geometric mean 6.1 pg/mL, p < 0.001), and was highest in ADS presenting with encephalopathy (acute disseminated encephalomyelitis, n = 28, 100.4 pg/mL), followed by patients without encephalopathy (ADS−) with future CDMS diagnosis (n = 40, 32.5 pg/mL), and ADS− who remained monophasic (n = 34, 17.6 pg/mL). sNfL levels higher than a median of 26.7 pg/mL at baseline are associated with a shorter time to CDMS diagnosis in ADS− (p = 0.045). HR for CDMS diagnosis was 1.09 for each 10 pg/mL increase of sNfL, after correction for age, oligoclonal bands, and MRI measures (p = 0.012).Conclusion The significant correlation between CSF and serum NfL strengthens its reliability as a peripheral marker of neuroaxonal damage. Higher sNfL levels at baseline were associated with higher probability of future CDMS diagnosis in ADS−.ADEM=acute disseminated encephalomyelitis; ADS=acquired demyelinating syndromes; CDMS=clinically definite multiple sclerosis; CI=confidence interval; DMT=disease-modifying treatment; EDSS=Expanded Disability Status Scale; FU=follow-up; HR=hazard ratio; IgG=immunoglobulin G; IQR=interquartile range; IVMP=IV methylprednisolone; mAB=monoclonal antibody; MS=multiple sclerosis; NfL=neurofilament light chain; OCB=oligoclonal bands; ON=optic neuritis; SC=symptomatic control; sNfL=serum neurofilament light chain; TM=transverse myelitis