The longer I work in MS the more I realize how unpredictable it is. There are complications in diagnosis, in assessing treatment efficacy, in prognosticating, and in achieving homogeneity in clinical practice. The complications are complicated.
But what if you have a test done, albeit quite randomly and it tells you something bad is going to happen in the near future – would you ignore it?
This is exactly what the Edwards group in New York found. As part of another study to determine the drug activity of dimethyl fumarate (or Tecfidera), 16 PwMS had lumbar punctures performed.
However, one person in the group demonstrated a rise in their neurofilament levels (PwMS No 4 in figure below). This person, subsequently went onto experience a disabling MS relapse.
There are two key findings to consider with this person: 1) the rise in neurofilament preceded the relapse, and 2) the MRI didn’t demonstrate any changes.
And, then there is the niggling point, which is, once you’re faced with such a test result, can you afford to sit and wait?
Mult Scler Relat Disord. 2019 Mar 23;31:59-61. doi: 10.1016/j.msard.2019.03.016. [Epub ahead of print]
Neurofilament light chain as an indicator of exacerbation prior to clinical symptoms in multiple sclerosis.
Edwards KR, Garten L, Button J, O’Connor J, Kamath V, Frazier C.
Background: Biomarkers may be a sensitive measure of disease activity in patients with multiple sclerosis (pwMS).
Objective: A pwMS had a marked increase of neurofilament light chain (NfL) in CSF 9-weeks prior to a clinical exacerbation.
Methods and Results: Brain MRI, CSF, EDSS were measured at baseline, 6 weeks and 28 weeks. The patient had an exacerbation at week 15 of study but the NfL measured at week 6 were found to show a nearly 3-fold increase of CSF NfL levels prior to symptoms when the NfL levels were later measured.
Conclusion: This is an example supporting the usefulness of NfL in monitoring disease activity in pwMS which may predict disease activity prior to a clinical exacerbation.