Serial cerebrospinal fluid neurofilament heavy chain levels in severe Guillain-Barre syndrome

Introduction Proximal axonotmesis results in the release of neurofilament (Nf) proteins into the cerebrospinal fluid (CSF) in patients with Guillain-Barre syndrome (GBS). High CSF levels of the phosphorylated form of Nf-heavy chain (NfHSMI35) at GBS onset have been reported to be a poor prognostic marker, but routine measurement of CSF NfHSMI35 levels has not been done and the longitudinal profile of CSF NfHSMI35 levels in GBS is not known. Methods This prospective case series describes the clinical, neurophysiological, and biomarker characteristics of 3 patients with severe GBS. Results High and increasing levels of CSF NfHSMI35 in serial CSF samples were associated with poor clinical and electrophysiological outcome. Conclusions These data further suggest that CSF NfHSMI35 could be a prognostic biomarker which might indicate the development of retrograde axonal degeneration or additional proximal axonal damage during the course of GBS. Muscle Nerve, 2013