Utility of Neurofilament Light Chain in Assessment of Neurocysticercosis in Lusaka, Zambia
Kristen Sportiello1, Claudia Gambrah-Lyles2, Mashina Chomba3, Melody Asukile3, Caroline Kabwe3, Deanna Saylor4, David Bearden1
1University of Rochester School of Medicine and Dentistry, 2Children's Hospital of Philadelphia, 3University Teaching Hospital, 4Johns Hopkins Hospital
Objective:
1. Determine whether neurofilament light chain (NFL) serum concentration is higher in people with neurocysticercosis (NCC) than in those with other causes of focal epilepsy.
2. Determine whether NFL concentration is higher in people with neurocysticercosis with an abnormal EEG than in people with neurocysticercosis with a normal EEG.
Background:
Neurocysticercosis is one of the most common causes of epilepsy in low- and middle-income countries. However, little is known regarding optimal diagnostic tests for this condition, especially in resource-limited settings where access to neuroimaging is often limited. NFL is a marker of central neuronal damage. Studies have suggested that it may have clinical utility in diagnosing other neurological conditions marked by this damage, but its relationship with NCC is unknown.
Design/Methods:
A prospective case-control study with cross-sectional evaluation of diagnostic testing was conducted among consenting adults seen at the main referral center in Lusaka, Zambia from January 2022 to October 2023. Cases were defined as those participants with untreated NCC with active lesions on head CT or MRI, regardless of clinical presentation. Controls were adults with new-onset focal epilepsy within the previous six months and no evidence of NCC on neuroimaging. Demographic and clinical details were captured, and participants underwent routine EEG and blood collection for serum NFL concentrations using ELISA assays. Wilcoxon rank sum tests were used to compare means between groups.
Results:
34 cases and 32 controls had NFL data available. Mean NFL concentration was significantly higher in controls than in cases (361.3 vs. 54.1 pg/mL, p=0.0031). Among those with NCC, NFL concentration was significantly higher in those with an abnormal EEG (114.6 vs. 36.3 pg/mL, p=0.0029).
Conclusions:
Among those with NCC, NFL concentration is significantly higher in those with an abnormal EEG, suggesting it may be a promising biomarker of seizure propensity amongst people with NCC.