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Neurofilament and glial fibrillary acidic protein in multiple sclerosis

From the Department of Immunology (Dr. Stigbrand, N. Norgren), University of Umeå; Department of Neurology (Drs. Sundström, Svenningsson, and Gunnarsson), Umeå University Hospital; and Institute of Clinical Neuroscience (Dr. Rosengren), Department of Neurology, University of Göteborg, Sahlgrenska Hospital, Sweden.

Address correspondence and reprint requests to Dr. Torgny Stigbrand, Department of Immunology, University of Umeå, S-901 87 Umeå, Sweden; e-mail: torgny.stigbrand{at}climi.umu.se

Objective: To evaluate levels of neurofilament light (NFL) and glial fibrillary acidic protein (GFAP) in CSF from patients with multiple sclerosis (MS) in relation to clinical progress of the disease.

Methods: CSF levels of NFL and GFAP were determined by sensitive ELISAs in 99 patients with different subtypes of MS, classified in terms of "ongoing relapse" or "clinically stable disease," and 25 control subjects. Levels were compared with paraclinical data such as immunoglobulin G index and inflammatory cell count in the CSF, and the levels were related to Expanded Disability Status Scale score and progression index at clinical follow-up evaluations later in the disease course.

Results: NFL and GFAP levels were elevated in MS patients as compared with control subjects (p < 0.001). The NFL levels were higher at relapses, whereas GFAP levels were unaffected. High NFL levels correlated with progression in patients with an active relapse (r = 0.49; p < 0.01) and in clinically stable patients (r = 0.29; p < 0.05). GFAP correlated to progression in the total patient cohort (r = 0.24; p < 0.05). Moreover, a strong correlation between NFL levels and inflammatory cell counts was evident in the group of patients with an ongoing relapse (r = 0.52; p = 0.001).

Conclusions: CSF levels of neurofilament light and glial fibrillary acidic protein may have prognostic value in multiple sclerosis.

Received December 3, 2003. Accepted in final form June 24, 2004.

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