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Neurology. 2019 Sep 3;93(10):e968-e974. doi: 10.1212/WNL.0000000000008057. Epub 2019 Aug 5.

Serum neurofilament light chain in pediatric MS and other acquired demyelinating syndromes.

Author information

1
From the Department of Neurology, MS Centre ErasMS (Y.Y.M.W., A.L.B., D.v.P., R.Q.H.), Department of Immunology (M.-J.M., A.F.W., R.Q.H.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC, Rotterdam, the Netherlands; and Neurologic Clinic and Policlinic (C.B., Z.M., J.K.), University Hospital Basel, Switzerland.
2
From the Department of Neurology, MS Centre ErasMS (Y.Y.M.W., A.L.B., D.v.P., R.Q.H.), Department of Immunology (M.-J.M., A.F.W., R.Q.H.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC, Rotterdam, the Netherlands; and Neurologic Clinic and Policlinic (C.B., Z.M., J.K.), University Hospital Basel, Switzerland. y.wong@erasmusmc.nl.

Abstract

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-.

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