Blood Test Predicts Multiple Sclerosis Disability Worsening in Advance


Researchers at UC San Francisco have conducted a study that indicates multiple sclerosis (MS) patients whose blood tests reveal elevated levels of NfL, a biomarker of nerve damage, could experience worsening disability one to two years later. This study is the first to quantify the timeframe preceding disability worsening in which injury to the central nervous system occurs. MS affects almost 1 million Americans, and in advanced cases, patients may suffer from limited mobility, spasticity, weakness, poor coordination, and incontinence. However, recent advancements suggest that more severe symptoms can be delayed or even prevented.

The study, co-led by University Hospital and University of Basel, Switzerland, and published in JAMA Neurology on November 6, 2023, examined the incidence of disability worsening in MS patients. Disability worsening was defined as six months or more of increased impairment indicated by a higher score on the Expanded Disability Status Scale. The researchers distinguished between disability worsening with relapse, which involves residual symptoms or the return of previous symptoms following a relapse, and gradual progression of symptoms without relapse.

Data spanning a 10-year period from approximately 4,000 patient visits to UCSF and 9,000 patient visits to multiple sites in Switzerland were analyzed. The studies included almost 1,900 patients, of which 570 patients exhibited worsening disability, predominantly independent of relapses.

The findings revealed that elevated NfL levels were associated with up to a 91% higher risk of worsening disability with relapse approximately a year later, and up to a 49% higher risk of worsening disability without relapse nearly two years later.

The researchers believe that the elevation of NfL occurs earlier in disability worsening without relapse, indicating a more prolonged process. This aligns with the recognition that the death of nerve cells is a slow process that leads to permanent disability. Therefore, interventions aimed at protecting nerve cells may have the opportunity to halt disability progression.

Additionally, the study highlights the important role of NfL as an early marker of nerve damage. It suggests that monitoring NfL levels may be more effective in detecting disease activity than clinical exams or conventional imaging.

Future investigations will focus on identifying therapies that can impede progression during the period of elevated NfL.


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