b'uid than serum. Because of the need for a Clinical trials using neurolament lightlumbar puncture to obtain cerebrospinal uid, chains could help break open the barrierspatients requiring routine neurolament light of treatment with MS disease progressionchainmonitoringwoulduseserumlevels. and ecacy of treatment options. In currentThe cerebrospinal uid assays would be practice, patients with minimal activity on anused for initial testing and diagnostic purposes, MRI are often started on lower ecacy DMTs.while the blood test would be used after If their neurolament light chain levels wereobtaining the baseline levels. Serum levels high, treatment could be steered to a morehave been recommended to be taken three aggressive,high-efficacyDMT,possiblyto six months following a relapse event or decreasing the rate of disability. Additionally,following MRI changes or discovery of lesions patientscurrentlyonhigh-ecacyDMTsto help monitor the progression of the disease. could use their neuro-lament light chainInterpreting the results levels to determine if that specic DMT is theAs a patient is screened for neurolament best course of action for their therapy. If thelight chain levels, there are considerations to neurolamentlightchainlevelsdecreaseaccount for in the data interpretation. Patients from baseline, they should be continued onon high-dose biotin must consider the timing the current therapy, while if they increaseof their dose to the subsequent blood draw from baseline, the clinicians will use this as anbecause of biotins eect on the the Simoa indicator to switch therapies before furtherassay. Serum neurolament light chain levels damage or relapse can occur. naturally increase at a gradual rate as a person Even though neurofilament light chainages withasharpincreaseafterage60. monitoring may not be seen in clinics andTherefore, a person should have resampling doctors practices currently, this level ofof cerebrospinal uid at ve-to-10-year intervalsand a repeat serum level after the patient research and data collection could be wherereaches the age of 60. Patients with a higher MS treatments are going. In the future,body mass index could have lower neuro- considerations of neurolament light chainslament light levels while patients with diabetes could inform treatment decisions at thecould have elevated neurolament light levels. individual level creating a more tailoredWhile studies have not shown a dierence in approach to earlier, more aggressive treatmentsex- or race-related variances, the questions options and improving the patients qualitycould not be completely ruled out at this time. of life. Patients with neurologic conditions such Thisimprovementindiagnosisandas dementia, traumatic brain injury, stroke, treatment options could be relevant to MS asParkinsons disease, or amyotrophic lateral well as a multitude of other neurologicalsclerosishaveevidenceofincreasedlight conditions that are associated with neuro-chain neurolament levels while neurological lament light chain elevations. If this avenuedisorders such as epilepsy, Guillain-Barre of therapy and monitoring could be benecialsyndrome, meningitis, or hypoxic brain injurycould have relevance to the neuro-lament to your treatment, discuss the future use oflight levels, but the associations are not currently neurolament light chain monitoring withestablished.your healthcare provider.57 msfocusmagazine.org'