Blood Test Shows Worsening Disability in MS Patients 1 to 2 Years before Occurrence

Globally, multiple sclerosis (MS) affects millions of individuals. In its more severe stages, it can significantly impair movement and cause muscle stiffness, diminished strength, coordination issues, and loss of bladder control. However recent developments indicate that these intense symptoms can be significantly postponed or possibly prevented. Now, a new study has revealed that MS patients with higher levels of NfL, a marker indicating nerve cell damage in the blood, could face worsening disability within the following one to two years.

The study led by researchers at University of California San Francisco (San Francisco, CA, USA) is the first to measure the period before there is a notable decline in ability, during which damage to the brain and spinal cord occurs in MS patients. The researchers examined the incidence of increased disability, defined as six months or more of rising impairment reflected in a higher score on the Expanded Disability Status Scale. They distinguished between the worsening of disability associated with a relapse—characterized by lingering symptoms or the resurgence of previous ones—and the steady advancement of symptoms without a relapse.

Image: MS patients whose blood tests reveal elevated NfL could see worsening disability one to two years later (Photo courtesy of 123RF)

In their analysis, the team examined data spanning more than a decade from around 4,000 visits by patients to UCSF, part of the EPIC study, and roughly 9,000 visits from multiple locations in Switzerland, as part of the SMSC study. These studies encompassed close to 1,900 individuals. Out of these, 570 patients were identified as having progressively worsening disability, with the larger number experiencing this independent of relapses. The findings linked high NfL levels with an up to 91% increased likelihood of disability that intensified with a relapse about a year later, and an up to 49% increased likelihood of disability progression without a relapse nearly two years later. The researchers are now focusing on future research to identify treatments that can halt this progression during the time when NfL levels are elevated.

“In addition to the groundbreaking findings on the temporal relationship between NfL increases and gradual disease progression in MS, the study supports the important role of NfL as an early marker of nerve damage,” said Jens Kuhle, MD, PhD. “Monitoring NfL levels might be able to detect disease activity with higher sensitivity than clinical exam or conventional imaging.”

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