title: Prolonged Cerebrospinal Fluid Neurofilament Light Chain Increase in Patients with Post-Traumatic Disorders of Consciousness.
abstract: The mechanisms involved in secondary brain injury after the acute phase of severe traumatic brain injury (TBI) are largely unknown. Ongoing axonal degeneration, consequent to the initial trauma, may lead to secondary brain injury. To test this hypothesis, we evaluated the cerebrospinal fluid (CSF) level of neurofilament light chain (NF-L), a proposed marker of axonal degeneration, in 10 patients who developed a severe disorder of consciousness after a TBI, including 7 in a minimally conscious state and 3 with unresponsive wakefulness syndrome (time since brain injury, 309 ± 169 days). CSF NF-L level was measured with a commercially available NF-L enzyme-linked immunosorbent assay. CSF NF-L level was very high in all 10 patients, ranging from 2.4- to 60.5-fold the upper normal limit (median value, 4458 pg/mL; range, 695-23,000). Moreover, NF-L level was significantly higher after a severe TBI than in a reference group of 9 patients with probable Alzheimer's disease, a population with elevated levels of CSF NF-L attributed to neuronal degeneration (median value, 1173 pg/mL; range, 670-3643; p < 0.01). CSF NF-L level was correlated with time post-TBI (p = 0.04). These results demonstrate prolonged secondary brain injury, suggesting that patients exhibit ongoing axonal degeneration up to 19 months after a severe TBI.
authors.affiliation: 1 Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto Giuseppe Giglio , Cefalù (PA), Italy .
authors.forename: Sergio
authors.initials: S
authors.lastname: Bagnato
authors.affiliation: 2 Neurology Department, Fondazione Istituto Giuseppe Giglio , Cefalù (PA), Italy .
authors.forename: Luigi M E
authors.initials: LME
authors.lastname: Grimaldi
authors.affiliation: 2 Neurology Department, Fondazione Istituto Giuseppe Giglio , Cefalù (PA), Italy .
authors.forename: Giorgio
authors.initials: G
authors.lastname: Di Raimondo
authors.affiliation: 1 Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto Giuseppe Giglio , Cefalù (PA), Italy .
authors.forename: Antonino
authors.initials: A
authors.lastname: Sant'Angelo
authors.affiliation: 1 Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto Giuseppe Giglio , Cefalù (PA), Italy .
authors.forename: Cristina
authors.initials: C
authors.lastname: Boccagni
authors.affiliation: 3 Strategic Direction, Fondazione Istituto Giuseppe Giglio , Cefalù (PA), Italy .
authors.forename: Vittorio
authors.initials: V
authors.lastname: Virgilio
authors.affiliation: 4 Clinical Pathology and Microbiology Laboratory, Fondazione Istituto Giuseppe Giglio , Cefalù (PA), Italy .
authors.forename: Maria
authors.initials: M
authors.lastname: Andriolo
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000134:cerebrospinal fluid; D000070642:Brain Injuries, Traumatic / Q000134:cerebrospinal fluid*; D003244:Consciousness Disorders / Q000134:cerebrospinal fluid*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016900:Neurofilament Proteins / Q000134:cerebrospinal fluid*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D016900:Neurofilament Proteins; C044882:neurofilament protein L
keywords: Alzheimer's disease; axonal injury; neurofilaments; traumatic brain injury; vegetative state