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Serum Neurofilament Light Chain is a Biomarker of Cubital Tunnel Syndrome
Amanda M Faust, BS
1, Christopher J. Dy, MD, MPH
2, Ryan P. Calfee, MD
3, Marie T. Morris, MD
4, Martin I Boyer, MD
1, Charles A. Goldfarb, MD
5, Lindley B Wall, MD
4; David M. Brogan, MD MSc
4(1)Washington University in St. Louis, St. Louis, MO, (2)Washington University School of Medicine, St. Louis, St. Louis, MO, (3)Washington University in St. Louis School of Medicine, St. Louis, MO, (4)Washington University School of Medicine, St. Louis, MO, (5)Washington University School of Medicine, St Louis, MO
Hypothesis: Neurofilament light chain (NfL) is a structural component of axons which becomes elevated in various central and peripheral nervous system injuries, such as spinal cord and traumatic brain injuries. We hypothesize that serum NfL levels will be a sensitive biomarker of axonal injury in cubital tunnel syndrome, as demonstrated by correlation with electrodiagnostic measures of nerve dysfunction.
Methods: Adult patients diagnosed with cubital tunnel syndrome and indicated for surgery were enrolled; those with evidence of radiculopathy, kidney disease or concomitant peripheral neuropathy (other than carpal tunnel syndrome) were excluded. Twenty-five healthy controls were enrolled. Peripheral blood draws were obtained pre-operatively and at 6 months postoperatively. Participants underwent EMG/NCS and US of the ulnar nerve pre and post-operatively, along with recording of numeric pain scales, PRUNE and PROMIS questionnaires. Linear regression analysis was performed to assess correlations between log-transformed NfL levels and clinical/electrodiagnostic measures. Longitudinal changes in NfL and patient-reported outcomes were evaluated using visualized histograms.
Results: Pre-operative serum log NfL significantly correlated with 1 of 6 nerve conduction study (NCS) parameters, with pain scores and demonstrated near-significant trends with 4 additional NCS measures. No significant correlations were observed with US or patient-reported outcomes (
Figure 1). Covariance analysis did not demonstrate any correlation of serum NfL with age, sex or concomitant carpal tunnel syndrome. At 6-month follow-up, PRUNE total and subscale scores as well as PROMIS Upper Extremity (UE) and Anxiety domains improved significantly
(Figure 2). Neither motor amplitudes nor NfL levels showed a significant change from preoperative values at follow-up.
Conclusions: - Serum neurofilament light chain (NfL) levels demonstrate strong trends toward correlation with electrodiagnostic markers and pain but not with patient-reported outcomes in cubital tunnel syndrome.
- Demographic variables and coexisting carpal tunnel syndrome appeared to have no influence on NfL levels.
- Change in NfL levels over time appear to mirror axonal changes as measured by NCS.
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