Overview
Progressive multiple sclerosis (MS) represents an unmet need for treatments to halt progressive disability 2. Severe, progressive MS is characterized by complex physical and psychosocial needs, typically over several years, with few options to prevent or delay clinical worsening 1. Severe MS is defined as requiring constant bilateral support to walk 20 meters (Expanded Disability Status Scale score > 6.0) or higher disability 1.Diagnosis
Serum neurofilament light chain (sNfL) is a plausible biomarker of neurodegeneration in progressive MS 2.
sNfL concentrations correlate with imaging and disability measures, predict future disease course, and can predict treatment response 2.
Standard procedures for sNfL sample processing and analysis should be established 2.
Distinguishing sNfL contributions from active inflammation versus insidious disability progression in progressive MS remains challenging 2.Management
Palliative care is a key component of management for people with severe, progressive MS, addressing complex physical and psychosocial needs 1.
Palliative care encompasses general and specialist services, advance care planning, discussion of end-of-life wishes, symptom management, and multidisciplinary rehabilitation 1.
Interventions for caregivers and healthcare professionals are also part of comprehensive palliative care 1.
sNfL can predict response to treatment, potentially accelerating treatment development 2.Special Populations
More data are required on the effects of age and comorbidities on serum neurofilament light chain levels 2.References
1 Solari A, Giordano A, Sastre-Garriga J, Köpke S, Rahn AC, Kleiter I et al.. EAN guideline on palliative care of people with severe, progressive multiple sclerosis. European journal of neurology 2020. link
2 Kapoor R, Smith KE, Allegretta M, Arnold DL, Carroll W, Comabella M et al.. Serum neurofilament light as a biomarker in progressive multiple sclerosis. Neurology 2020. link