Serial cerebrospinal fluid neurofilament heavy chain levels in severe Guillain‐Barré syndrome

Abstract

Proximal axonotmesis results in the release of neurofilament (Nf) proteins into the cerebrospinal fluid (CSF) in patients with Guillain-Barré syndrome (GBS). High CSF levels of the phosphorylated form of Nf-heavy chain (NfH(SMI35) ) at GBS onset have been reported to be a poor prognostic marker, but routine measurement of CSF NfH(SMI35) levels has not been done and the longitudinal profile of CSF NfH(SMI35) levels in GBS is not known. This prospective case series describes the clinical, neurophysiological, and biomarker characteristics of 3 patients with severe GBS. High and increasing levels of CSF NfH(SMI35) in serial CSF samples were associated with poor clinical and electrophysiological outcome. These data further suggest that CSF NfH(SMI35) could be a prognostic biomarker which might indicate the development of retrograde axonal degeneration or additional proximal axonal damage during the course of GBS.