What if a Blood Test Could Predict MS Worsening? New research indicates that symptom progression can be detected a year before it occurs. I remember my first appointment with a multiple sclerosis (MS)–specializing neurologist perhaps better than most. It was three months after my official diagnosis by a general neurologist, so I had had some time to process the whole thing before seeing him. During that appointment, I remember asking what my MS would be like, going forward. His answer — reflecting the best science at the time — was that the next page of my disease was not yet written, let alone the next chapter. Well, it appears that mightn’t have been the reality it was understood to be at the time. Elevated NfL Levels Predict Disease Worsening Elevated NfL Levels Predict Disease Worsening New research published in JAMA Neurology shows that a specific blood test can predict disease worsening about 12 months in advance of clinical evidence of the same (and up to two years in some people). The blood test measures neurofilament light chain (NfL) level, which is a marker of axon damage in the central nervous system. Axons are the fiber-like portions of nerve cells that conduct electrical impulses away from the cells. The study looked at 1899 patients (in two cohorts: those in the EPIC study in the United States, and those in the SMSC database in Switzerland) over nearly 13,000 clinic visits. The researchers were looking for confirmed disability worsening (CDW), defined as worse scores on the Expanded Disability Status Scale (EDSS), a widely used method of quantifying disability in MS. They categorized CDW as either worsening with clinical relapse (CDW-R) or without clinical relapse (CDW-NR). In the case of CDW-R, researchers saw correlation between elevated NfL levels and symptomatic worsening within approximately one year. With CDW-NR, about one to two years. This indicates that a window of opportunity might exist during which acute therapy might be used to address damage before it gets to the level where clinical worsening is observed. Wow! It’s been suggested that having these blood tests every three months might best track damage that was, to this point, undetectable. Do We Really Want to Know About Future Disability? Do We Really Want to Know About Future Disability? I suppose this discovery also prompts the old question about whether or not one would want to know of an impending illness or death. Would knowing that we’re 12 to 24 months out from experiencing disability progression be helpful? Without an acute treatment to stop this damage as it’s happening, would it just cause anxiety knowing that it was coming? Perhaps it would allow for time to prepare and get some things done in advance. Move a vacation forward a few months, go see those people we’ve been meaning to see, do that physical activity now rather than put it off. Fingers crossed that this new evidence of damage as it’s happening will spur on research into medical interventions that might stop it before symptoms emerge and disability progresses. This is not only big news for researchers and clinicians, but also for those of us living under the swinging weight of multiple sclerosis progression. Wishing you and your family the best of health. Cheers, Trevis My new book, Living Well with Multiple Sclerosis, is available for preorder on Amazon. Follow me on the Life With MS Facebook page, and read more on Life With Multiple Sclerosis. Important: The views and opinions expressed in this article are those of the author and not Everyday Health.
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