1Ayesha Ashfaq

1Sheikh Zayed Medical Complex, Lahore, Pakistan


With this study we aim to establish the importance of non radiological biomarkers of MS in establishing Prognostic value of disease activity in CIS. Monitoring disease activity in Relapsing remitting Multiple Sclerosis. Establish the value of quantification of neurofilament light chains in progressive multiple sclerosis in relation to active disease and chronic stable disease

Material(s) and Method(s):

Electronic databases search included the Cochrane and Pudmed library. 12 hits were screened from pubmed out of which 3 were selected for this study and 1 hit from Cochrane which was also selected and included in this study.


Prognostication in CIS: The median baseline level of serum nfl was 22.0 pg/ml (interquartile range [IQR] 11.6–40.4).

  1. CIS patients subsequently developing MS had higher levels (median 30.2, iqr 16.4–48.7 pg/ml) than patients who did not develop MS (median 9.7, iqr 5.5–18.1 pg/ml, p < 0.001).
  2. Median CSF nfl level in CIS patients was 731.3 (iqr 346.9–1,194.6) pg/ml and they were directly related with serum levels particularly in patients with gd-enhancing lesions .
  3. Among 222 patients who were enrolled (mean follow-up 100.6 months), 45 patients (20%) developed CDMS and 141 patients (63.5%) developed 2017 MS at 2 years.

Relapsing remitting type:

Neurofilament light chains in CSF were:-

5 x HIGHER IN REMISSION THAN NINDS. (1896.4 ng/L, vs 365.1 ng/L).

9 x higher in relapse v/s control (3272.2 ng/L vs 364.9 ng/L).

Primary & secondary progressive types:-

Neurofilament light chains in CSF were :-

Twice more than controls (1260.4 ng/L vs 469 ng/L).

Significantly lower than in patients with relapsing remitting type. (2124.8 ng/L vs 1121.4 ng/L).


1. Study proved that serum nfl have a prognostic value for CIS patient conversion to MS.

2. Csf neurofilament light chains correlate with disease activity throughout the course of ms, reflecting the axonal damage .

3 .Relapse is more strongly associated with elevated csf nfl than the development of progression.

4.Nfl could be the most useful marker of disease activity rather than as a marker of disability or disease stage.