In pediatric patients with a first attack of acquired demyelinating syndrome (ADS), there exists a positive association between CSF and serum neurofilament light chain (NfL), a study in Neurology reports.

Pediatric patients (age, <18 years) from a Dutch prospective multicenter study were included in the analysis if they had a first attack of central nervous system demyelination (n=102). Age-matched controls with neurologic symptoms in the absence of objective clinical or paraclinical findings to define a neurologic disease were also included (n=23). Researchers tested CSF NfL and serum NfL (sNfL) in 47 patients. The endpoint of the study was clinically definite multiple sclerosis (CDMS).

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There was a positive correlation between CSF and sNfL in the 47 patients who had these data available (ρ 0.532, P <.001). Researchers also found a significant correlation between CSF and sNfL in a subgroup of 23 patients who were diagnosed with CDMS during follow up (ρ 0.773, P <.001). Values of sNfL were higher in patients with a first attack of central nervous system demyelination vs controls (geometric mean, 36.1 pg/mL vs 6.1 pg/mL, respectively; P <.001).

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Levels of sNfL were also higher in 28 patients with ADS who had encephalopathy (100.4 pg/mL) as well as in 40 patients without encephalopathy (ADS−) with a future diagnosis of CDMS (32.5 pg/mL; 95% CI, 22.3-47.2; P <.001). Levels of sNfL >26.7 pg/mL correlated with a shorter time to second attack and CDMS diagnosis in patients who were ADS- (P =.045).

Limitations of the study include the small sample size as well as the lack of assessment for the correlation between disease-modifying treatment and sNfL levels.

The researchers concluded that the association between CSF and serum NfL “strengthens its reliability as a peripheral marker of neuroaxonal damage in children with ADS.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Wong YYM, Bruijstens AL, Barro C, et al.Serum neurofilament light chain in pediatric MS and other acquired demyelinating syndromes. Neurology. 2019;93(10):e968-e974.