It is no secret that one of the major unmet needs for Parkinson's research is the development of biomarkers that allow us to measure change in the underlying disease process. As clinicians, we are frequently confronted with a patient that has some features of Parkinson's, but the diagnosis cannot be made definitively and they may in fact have a Parkinson's mimic. Neurofilament light chain (NFL) in spinal fluid has been studied in a variety of neurological diseases and when raised is a marker of nerve cell damage... in this meta-analysis NFL is shown to differentiate between Parkinson's and more aggressive Parkinson's mimics. It may aid accurate diagnosis of Parkinson's in the clinical setting.
Of course we are interested in identifying who might be at risk of Parkinson's and predicting who might go on to get a diagnosis in years to come. NFL could yet be an important marker of nerve cell damage in such people and build confidence in the prediction process...
Neurosci Lett. 2018 Jul 20;685:35-41. doi: 10.1016/j.neulet.2018.07.030. [Epub ahead of print]
Ge F, Ding J, Liu Y, Lin H, Chang T.
https://www.sciencedirect.com/science/article/abs/pii/S0304394018305032
Abstract
Neurofilament light chain (NFL) in cerebrospinal fluid (CSF) is a promising biomarker candidate which may discriminate atypical parkinsonian disorders (APD), mainly including multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), from Parkinson's disease (PD). We aim to evaluate the diagnostic accuracy of CSF NFL level as a differentiating biomarker between APD and PD. Databases of PubMed, OVID and Web of Science were searched for studies (published until May 31, 2017) that reported on CSF NFL as a diagnostic biomarker between APD and PD. Eight studies were pooled in this meta-analysis, including 341 PD and 396 APD patients and 388 healthy controls. The pooled sensitivity was 82% (95% CI, 68%-91%) and specificity was 85% (95% CI, 79%-89%) in differentiating APD from PD. The pooled positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were 5.4 (95% CI, 3.6%-8.1%), 0.21 (95% CI, 0.11%-0.40%), and 25 (95% CI, 9%-69%) respectively; and the area under the curve (AUC) was 0.89 (95% CI, 0.86%-0.91%). Subgroup analysis revealed sensitivity and specificity were significantly influenced by study design. The APD subtypes, disease duration and severity were the main heterogeneity sources in specificity. The results of Deeks' test revealed a low risk of publication bias. The CSF NFL level may be used as a biomarker in discriminating APD from PD with high diagnostic accuracy at an early stage of disease. Large and longitudinal studies are still needed on individuals who are suspected to have APD.
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