From the Research
Serum neurofilament light chain (sNfL) levels are a valuable biomarker for predicting visual recovery in children with acute demyelinating optic neuritis, with higher levels at disease onset correlating with poorer visual outcomes. When a child presents with optic neuritis, measuring sNfL levels can help clinicians estimate the likelihood of complete visual recovery and guide treatment decisions. The relationship between sNfL and visual outcomes remains significant even after accounting for other factors like age, sex, and initial visual acuity.
Key Points
- Higher sNfL levels at disease onset are associated with poorer visual outcomes, making this biomarker useful for early prognostication 1.
- Measuring sNfL levels can help clinicians estimate the likelihood of complete visual recovery and guide treatment decisions.
- The predictive value of sNfL stems from the fact that it is released into circulation when axonal damage occurs in the optic nerve, with greater levels indicating more extensive neuronal injury.
- For clinical practice, sNfL testing should be performed within the first week of symptom onset for optimal prognostic value, and results should be interpreted alongside clinical findings and imaging to develop appropriate treatment and rehabilitation plans 2.
Treatment Considerations
- High-dose steroids remain the mainstay of acute treatment for optic neuritis, but evidence is emerging that atypical features may require special consideration, such as early addition of other therapeutic agents or tapering the steroid very slowly 1.
- Disease-modifying therapies should be considered as a treatment option at the time of initial presentation in patients with acute demyelinating optic neuritis and demyelinating lesions on brain MRI 3.