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juvenileonset huntingtons disease johd rare particularly devastating form huntingtons disease hd clinical diagnosis challenging robust outcome measures lacking neurofilament light protein nfl plasma emerged prognostic biomarker adultonset hd performed retrospective analysis samples data collected 2009 2020 kidshd kidsjhd studies plasma samples children young adults johd premanifest hd prehd mutation carriers agematched controls used quantify plasma nfl concentrations using ultrasensitive immunoassay report elevated plasma nfl concentrations johd premanifest hd mutationcarrying children pediatric hd mutation carriers within 20 years predicted onset patients johd plasma nfl level associated caudate putamen volumes quantifying plasma nfl concentration may assist clinical diagnosis therapeutic trial design pediatric population 2022 authors movement disorders published wiley periodicals llc behalf international parkinson movement disorder society