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For the 13th consecutive time, this year’s World Congress on Controversies in Neurology (CONy 2019, held in Madrid, Spain on April 4–7, 2019) covered a range of current, intriguing topics in the field of Multiple Sclerosis (MS).

Friday’s MS sessions opened with a thorough examination of neurofilaments as viable biomarkers of MS progression, as well as their potential to replace magnetic resonance imagining (MRI) as a monitoring tool. Due to her opponent not being present for the debate, Dr. Georgina Arrambide from the Center of Multiple Sclerosis of Catalonia (Cemcat) had the daunting task of representing both sides of the argument as a pro-NfL advocate herself.

Neurofilament light chain (NfL) is released in the cerebrospinal fluid (CSF) after axonal injury leading to higher blood and CSF levels in patients with MS—and other neurological diseases—than in healthy subjects. Increased levels have been shown to correlate with MRI lesions and other measures of disease activity. Measurement of NfL serum levels, however, is fraught with reproducibility and validation challenges that render its widespread adoption difficult at this point in time. The audience in attendance was in strong agreement with this observation and overwhelmingly voted that they did not see NfL serum levels as replacing MRI anytime soon as the gold standard for monitoring MS progr