101
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Longitudinal Study of Retinal Nerve Fiber Layer Thickness and Macular Volume in Patients With Neuromyelitis Optica Spectrum Disorder. J Neuroophthalmol 2017; 36:363-368. [PMID: 27416520 DOI: 10.1097/wno.0000000000000404] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuromyelitis spectrum disorder (NMOSD) is a rare autoimmune disorder previously thought to be a subtype of multiple sclerosis (MS). NMOSD is characterized by episodes of inflammation and damage to astrocytes that primarily results in damage to optic nerve and spinal cord. The objective of this exploratory study was to use optical coherence tomography (OCT) to measure axonal and neuronal health in NMOSD eyes over time. METHODS Nine patients with definite NMOSD were assessed at baseline and follow-up visits (time between visits: 35-55 months). OCT assessment involved a macular volume protocol and a retinal nerve fiber layer (RNFL) thickness scan. RESULTS The temporal, inferior, nasal, or superior quadrant and the mean global RNFL thickness, macular thickness, and volume of each NMOSD patient was unchanged compared with baseline for each eye separately and both together. There also was no change between the 2 time points for the OCT measures for eyes affected and unaffected by optic neuritis and all eyes together except for a significant change in the temporal RNFL quadrant when all NMOSD eyes were pooled together (mean = 2.88 μm, SD = 3.7, P = 0.021). CONCLUSIONS Unlike in MS eyes, ongoing RNFL and macular thinning secondary to brain and optic nerve atrophy could not be observed in NMOSD eyes during an observation period of 4 years. This might be an additional marker to distinguish these 2 diseases. However, to confirm this finding, more long-term data are needed to compare these 2 diseases longitudinally.
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102
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Time is vision in recurrent optic neuritis. Brain Res 2017; 1673:95-101. [PMID: 28823952 DOI: 10.1016/j.brainres.2017.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/08/2017] [Accepted: 08/11/2017] [Indexed: 11/22/2022]
Abstract
In optic neuritis (ON) inflammation precedes onset of demyelination and axonal loss. The anti-inflammatory properties of corticosteroids may be most effective in the early inflammatory phase, but rapid patient recruitment remains a logistic challenge. The aim of the study was to review the effect of time to initiation of treatment on visual outcome in recurrent ON. A retrospective case note review of patients known to our centre with recurrent ON. The primary clinical outcome was change of best corrected high contrast visual acuity (BCVA). The secondary outcome was the change of optical coherence tomography (OCT) thickness of the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell layer (mGCL) from baseline and after a minimum of 3months following the episode of recurrent ON. Of 269 patients with a previous episode of ON, 54 experienced recurrent ON. In total 40 OCT documented episodes of relapsing ON were captured in 19 patients. Treatment within <2days led to better recovery of the BCVA (+0.02) and mGCL (-2.4µm) if compared to delayed treatment (BCVA -0.2, p=0.036, mGCL -25.6µm, p=0.019) or no corticosteroids treatment (BCVA -0.2, p=0.045, GCL -5.0µm, p=0.836). These data suggest a beneficial effect of hyperacute corticosteroid treatment. A pragmatic approach for a prospective treatment trial should consider patients with recurrent ON for logistic reasons.
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103
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Andersen MR, Roar M, Sejbaek T, Illes Z, Grauslund J. Long-term structural retinal changes in patients with optic neuritis related to multiple sclerosis. Clin Ophthalmol 2017; 11:1519-1525. [PMID: 28860702 PMCID: PMC5566504 DOI: 10.2147/opth.s142206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose To evaluate the long-term structural and functional outcome in patients with multiple sclerosis (MS) with and without a history of optic neuritis (ON). Methods This was a cross-sectional study of 82 patients diagnosed with MS between 2000 and 2006 from a tertiary hospital center in Denmark. Patients gave a self-reported history of ON, and functional (visual acuity and color vision) and structural (spectra domain optical coherence tomography) markers of vision were tested. Results Median age and MS duration at the time of the clinical examination were 49.9 years (range 30.7–72.6 years) and 13 years (range 9–15 years), respectively. ON was not associated with impairment of visual acuity or color vision. Twenty-three patients had a history of ON in at least one eye. Compared to non-affected patients, these had a lower inferior (109 vs 113 μm, P=0.04) and temporal retinal nerve fiber layer (RNFL) thickness (56 vs 67 μm, P=0.01). In an age- and sex-adjusted logistic regression model, lower inferior and temporal RNFL were associated with a higher risk of ON (odds ratio [OR] 1.56 [95% confidence interval {CI} 1.01–2.41] and OR 1.74 [95% CI 1.10–2.77] per 10 μm decrement in RNFL thickness, respectively). Twenty patients had a history of ON in one eye. Compared to the non-affected eye, this eye had a lower RNFL (109 vs 115 μm, P=0.04) and a higher central retinal thickness/mean RNFL ratio (2.7 vs 2.4, P=0.04). Conclusion Although patients with long-term MS and a previous history of ON did not have any functional loss of vision, structural neurodegeneration could be demonstrated in the affected eye.
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Affiliation(s)
| | - Malte Roar
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tobias Sejbaek
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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104
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Spain RI, Liu L, Zhang X, Jia Y, Tan O, Bourdette D, Huang D. Optical coherence tomography angiography enhances the detection of optic nerve damage in multiple sclerosis. Br J Ophthalmol 2017; 102:520-524. [PMID: 28814415 DOI: 10.1136/bjophthalmol-2017-310477] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/26/2017] [Accepted: 07/02/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Quantitative assessment of optic nerve damage is important in the evaluation of optic neuritis (ON) and multiple sclerosis (MS). OBJECTIVE To detect optic nerve damage using optical coherence tomography (OCT) and OCT angiography in MS. METHODS Peripapillary retinal nerve fibre layer (NFL) thickness, macular ganglion cell complex (GCC) thickness and Optic Nerve Head Flow Index (ONH-FI) were measured. The ONH-FI was defined as flow signal averaged over the optic disc. Diagnostic accuracy was evaluated by the area under the receiver-operating characteristics curve (AROC). RESULTS Sixty-eight eyes of 45 MS participants and 55 eyes of 32 healthy controls (HCs) were analysed. Of MS eyes, 25 had a history of ON (MS+ON) and 43 didn't (MS-ON). MS-ON and MS+ON eyes had reductions in ONH-FI (p=0.031 and p=0.001, respectively), GCC thickness (p=0.245 and p<0.001, respectively), and NFL thickness (p=0.003 and p=0.024, respectively), compared with HCs. The highest AROC (0.940) was achieved by the logistic regression combination of all three variables, which was significantly higher than other variables (p=0.018). CONCLUSION MS produces both retinal structural loss and decreased ONH perfusion in MS eyes with and without history of ON. The combination of perfusion and structural measurements enhances detection of optic nerve damage in MS. OCT angiography may be a useful additional retinal marker in evaluation of ON in MS.
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Affiliation(s)
- Rebecca I Spain
- VA Portland Health Care System, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Liang Liu
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Xinbo Zhang
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Ou Tan
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Dennis Bourdette
- VA Portland Health Care System, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
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105
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Lascano AM, Lalive PH, Hardmeier M, Fuhr P, Seeck M. Clinical evoked potentials in neurology: a review of techniques and indications. J Neurol Neurosurg Psychiatry 2017; 88:688-696. [PMID: 28235778 DOI: 10.1136/jnnp-2016-314791] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/27/2017] [Accepted: 02/01/2017] [Indexed: 01/11/2023]
Abstract
Evoked potentials (EPs) are a powerful and cost-effective tool for evaluating the integrity and function of the central nervous system. Although imaging techniques, such as MRI, have recently become increasingly important in the diagnosis of neurological diseases, over the past 30 years, many neurologists have continued to employ EPs in specific clinical applications. This review presents an overview of the recent evolution of 'classical' clinical applications of EPs in terms of early diagnosis and disease monitoring and is an extension of a previous review published in this journal in 2005 by Walsh and collaborators. We also provide an update on emerging EPs based on gustatory, olfactory and pain stimulation that may be used as clinically relevant markers of neurodegenerative disorders such as Parkinson's disease, Alzheimer's disease and cortical or peripheral impaired pain perception. EPs based on multichannel electroencephalography recordings, known as high-density EPs, help to better differentiate between healthy subjects and patients and, moreover, they provide valuable spatial information regarding the site of the lesion. EPs are reliable disease-progression biomarkers of several neurological diseases, such as multiple sclerosis and other demyelinating disorders. Overall, EPs are excellent neurophysiological tools that will expand standard clinical practice in modern neurology.
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Affiliation(s)
- Agustina M Lascano
- Department of Clinical Neurosciences, Division of Neurology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Patrice H Lalive
- Department of Clinical Neurosciences, Division of Neurology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Hardmeier
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Peter Fuhr
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Margitta Seeck
- Department of Clinical Neurosciences, Division of Neurology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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106
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Kuchling J, Brandt AU, Paul F, Scheel M. Diffusion tensor imaging for multilevel assessment of the visual pathway: possibilities for personalized outcome prediction in autoimmune disorders of the central nervous system. EPMA J 2017; 8:279-294. [PMID: 29021839 DOI: 10.1007/s13167-017-0102-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/07/2017] [Indexed: 02/06/2023]
Abstract
The afferent visual pathway represents the most frequently affected white matter pathway in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Diffusion tensor imaging (DTI) can reveal microstructural or non-overt brain tissue damage and quantify pathological processes. DTI facilitates the reconstruction of major white matter fiber tracts allowing for the assessment of structure-function and damage-dysfunction relationships. In this review, we outline DTI studies investigating the afferent visual pathway in idiopathic optic neuritis (ON), NMOSD, and MS. Since MS damage patterns are believed to depend on multiple factors, i.e., ON (anterior visual pathway damage), inflammatory lesions (posterior visual pathway damage), and global diffuse inflammatory and neurodegenerative processes, comprehensive knowledge on different contributing factors using DTI in vivo may advance our understanding of MS disease pathology. Combination of DTI measures and visual outcome parameters yields the potential to improve routine clinical diagnostic procedures and may further the accuracy of individual prognosis with regard to visual function and personalized disease outcome. However, due to the inherent limitations of DTI acquisition and post-processing techniques and the so far heterogeneous and equivocal data of previous studies, evaluation of the true potential of DTI as a possible biomarker for afferent visual pathway dysfunction is still substantially limited. Further research efforts with larger longitudinal studies and standardized DTI acquisition and post-processing validation criteria are needed to overcome current DTI limitations. DTI evaluation at different levels of the visual pathway has the potential to provide markers for individual damage evaluation in the future. As an imaging biomarker, DTI may support individual outcome prediction during personalized treatment algorithms in MS and other neuroinflammatory diseases, hereby leveraging the concept of predictive, preventive, and personalized medicine in the field of clinical neuroimmunology.
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Affiliation(s)
- Joseph Kuchling
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, NeuroCure Clinical Research Center, Charitéplatz 1, D-10117 Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, D-10117 Berlin, Germany
| | - Alexander U Brandt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, NeuroCure Clinical Research Center, Charitéplatz 1, D-10117 Berlin, Germany
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, NeuroCure Clinical Research Center, Charitéplatz 1, D-10117 Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, D-10117 Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Scheel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, NeuroCure Clinical Research Center, Charitéplatz 1, D-10117 Berlin, Germany
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107
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Huang H, Miao L, Liang F, Liu X, Xu L, Teng X, Wang Q, Ridder WH, Shindler KS, Sun Y, Hu Y. Neuroprotection by eIF2α-CHOP inhibition and XBP-1 activation in EAE/optic neuritiss. Cell Death Dis 2017; 8:e2936. [PMID: 28726788 PMCID: PMC5550873 DOI: 10.1038/cddis.2017.329] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/05/2017] [Accepted: 06/13/2017] [Indexed: 12/22/2022]
Abstract
No therapies exist to prevent neuronal deficits in multiple sclerosis (MS), because the molecular mechanism responsible for the progressive neurodegeneration is unknown. We previously showed that axon injury-induced neuronal endoplasmic reticulum (ER) stress plays an important role in retinal ganglion cell (RGC) death and optic nerve degeneration in traumatic and glaucomatous optic neuropathies. Optic neuritis, one of the most common clinical manifestations of MS, is readily modeled by experimental autoimmune encephalomyelitis (EAE) in mouse. Using this in vivo model, we now show that ER stress is induced early in EAE and that modulation of ER stress by inhibition of eIF2α-CHOP and activation of XBP-1 in RGC specifically, protects RGC somata and axons and preserves visual function. This finding adds to the evidence that ER stress is a general upstream mechanism for neurodegeneration and suggests that targeting ER stress molecules is a promising therapeutic strategy for neuroprotection in MS.
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Affiliation(s)
- Haoliang Huang
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto CA 94304, USA
| | - Linqing Miao
- Shriners Center for Neural Repair and Rehabilitation, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Feisi Liang
- Shriners Center for Neural Repair and Rehabilitation, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Xiaodong Liu
- Shriners Center for Neural Repair and Rehabilitation, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Lin Xu
- Shriners Center for Neural Repair and Rehabilitation, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Xiuyin Teng
- Shriners Center for Neural Repair and Rehabilitation, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Qizhao Wang
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto CA 94304, USA
| | - William H Ridder
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, CA 92831, USA
| | - Kenneth S Shindler
- Scheie Eye Institute and F.M. Kirby Center for Molecular Ophthalmology, Departments of Ophthalmology and Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yang Sun
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto CA 94304, USA
| | - Yang Hu
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto CA 94304, USA
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108
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Sanchez-Dalmau B, Martinez-Lapiscina EH, Torres-Torres R, Ortiz-Perez S, Zubizarreta I, Pulido-Valdeolivas IV, Alba-Arbalat S, Guerrero-Zamora A, Calbet D, Villoslada P. Early retinal atrophy predicts long-term visual impairment after acute optic neuritis. Mult Scler 2017; 24:1196-1204. [PMID: 28669275 DOI: 10.1177/1352458517718628] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Visual recovery after optic neuritis (ON) used to be defined as good, although patients frequently complain of poor vision. METHODS We carried out a prospective study on 38 consecutive patients with acute ON followed monthly for 6 months and evaluated high- and low-contrast visual acuity (HCVA and LCVA, respectively), quality of vision (National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25)), visual fields, and retinal thickness by spectral domain optical coherence tomography (OCT). RESULTS We found significant impaired LCVA and color vision in ON eyes 6 months after acute ON, which impact on quality of life. LCVA and color vision were correlated with the thicknesses of the ganglion cell and inner plexiform layer (GCIPL; 2.5% LCVA r = 0.65 and p = 0.0001; color vision r = 0.75 and p < 0.0001) and that of the peripapillary retinal nerve fiber layer (pRNFL; LCVA r = 0.43 and p = 0.0098; color vision r = 0.62 and p < 0.0001). Linear regression models that included the change in the GCIPL and pRNFL thicknesses from baseline to month 1 after onset explained 47% of the change in 2.5% LCVA and 67% of the change of color vision acuity. When adjusting for the value of visual acuity at baseline, predictors of the change in vision from baseline to month 6 achieved similar performance for all three types of vision (HCVA, LCVA, and color vision). CONCLUSION Monitoring retinal atrophy by OCT within the first month after ON onset allows individuals at a high risk of residual visual impairment to be identified.
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Affiliation(s)
- Bernardo Sanchez-Dalmau
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain/Department of Ophthalmology, Hospital Clinic, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ruben Torres-Torres
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain/Department of Ophthalmology, Hospital Clinic, Barcelona, Spain
| | - Santiago Ortiz-Perez
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain/Department of Ophthalmology, Hospital Clinic, Barcelona, Spain
| | - Irati Zubizarreta
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irene V Pulido-Valdeolivas
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Salut Alba-Arbalat
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ana Guerrero-Zamora
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Pablo Villoslada
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain/University of California San Francisco, San Francisco, CA, USA
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109
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Hahn S, Trendelenburg G, Scharf M, Denno Y, Brakopp S, Teegen B, Probst C, Wandinger KP, Buttmann M, Haarmann A, Szabados F, vom Dahl M, Kümpfel T, Eichhorn P, Gold H, Paul F, Jarius S, Melzer N, Stöcker W, Komorowski L. Identification of the flotillin-1/2 heterocomplex as a target of autoantibodies in bona fide multiple sclerosis. J Neuroinflammation 2017; 14:123. [PMID: 28645295 PMCID: PMC5481867 DOI: 10.1186/s12974-017-0900-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/13/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Autoantibodies, in particular those against aquaporin-4 and myelin-oligodendrocyte glycoprotein (MOG), aid as biomarkers in the differential diagnosis of demyelination. Here, we report on discovery of autoantibodies against flotillin in patients with multiple sclerosis (MS). METHODS The target antigen was identified by histo-immunoprecipitation using the patients' sera and cryosections of rat or pig cerebellum combined with mass spectrometrical analysis. Correct identification was ascertained by indirect immunofluorescence and neutralization tests using the target antigens recombinantly expressed in HEK293 cells. RESULTS Serum and CSF of the index patient produced a fine-granular IgG indirect immunofluorescence staining of the hippocampal and cerebellar molecular layers. Flotillin-1 and flotillin-2 were identified as target autoantigens. They also reacted with recombinant human flotillin-1/2 co-expressed in HEK293 cells, but not with the individual flotillins in fixed- and live-cell assays. Moreover, neutralization using flotillin-1/2, but not the single flotillins, abolished the tissue reactivity of patient serum. Screening of 521 patients, for whom anti-aquaporin-4 testing was requested and negative, revealed 8 additional patients with anti-flotillin-1/2 autoantibodies. All eight were negative for anti-MOG. Six patients ex post fulfilled the revised McDonald criteria for MS. Vice versa, screening of 538 MS sera revealed anti-flotillin-1/2 autoantibodies in eight patients. The autoantibodies were not found in a cohort of 67 patients with other neural autoantibody-associated syndromes and in 444 healthy blood donors. CONCLUSIONS Autoantibodies against the flotillin-1/2 heterocomplex, a peripheral membrane protein that is involved in axon outgrowth and regeneration of the optic nerve, are present in 1-2% of patients with bona fide MS.
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Affiliation(s)
- S. Hahn
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - G. Trendelenburg
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - M. Scharf
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Y. Denno
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - S. Brakopp
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - B. Teegen
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
- Clinical Immunological Laboratory Prof. Dr. med Stöcker, Lübeck, Germany
| | - C. Probst
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - K. P. Wandinger
- Department of Neurology, University Medical Center Schleswig Holstein (UKSH), Lübeck, Germany
| | - M. Buttmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
- Department of Neurology, Caritas Hospital, Bad Mergentheim, Germany
| | - A. Haarmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - F. Szabados
- Medical Laboratory Osnabrück, Georgsmarienhütte, Germany
| | - M. vom Dahl
- Department of Neurology, Ammerland Klinik, Westerstede, Germany
| | - T. Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany
| | - P. Eichhorn
- Institute of Clinical Chemistry, Ludwig Maximilian University, Munich, Germany
| | - H. Gold
- Department of Neurology, Klinikum am Gesundbrunnen, Heilbronn, Germany
| | - F. Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitätsmedizin, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité Universitätsmedizin, Berlin, Germany
| | - S. Jarius
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - N. Melzer
- Department of Neurology, University of Münster, Münster, Germany
| | - W. Stöcker
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
- Clinical Immunological Laboratory Prof. Dr. med Stöcker, Lübeck, Germany
| | - L. Komorowski
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
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110
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Sattarnezhad N, Farrow S, Kimbrough D, Glanz B, Healy B, Chitnis T. Agreement analysis comparing iPad LCVA and Sloan testing in multiple sclerosis patients. Mult Scler 2017; 24:1126-1130. [PMID: 28585909 DOI: 10.1177/1352458517713667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Visual symptoms are common in multiple sclerosis (MS). Low-contrast visual acuity (LCVA) testing using Sloan charts has demonstrated increased sensitivity for visual deficits compared to high-contrast acuity testing. Computerized testing of visual acuity may facilitate use in the clinic setting. OBJECTIVES To evaluate the agreement between an iPad-based and Sloan testing of LCVA in a cohort of MS patients. METHODS A total of 38 patients with relapsing-remitting MS were enrolled after providing informed written consent at Partners MS Center, Brigham and Women's hospital. Monocular LCVA was measured using retroilluminated Sloan chart and iPad-based LogMAR chart. Number of correct letters and agreement between two measurements were assessed for each eye using Bland-Altman analysis and paired t-test. RESULTS For both eyes, there was no significant difference in number correct between the two measurements using a paired t-test, and there was high correlation between two measurements (oculus dextrus (OD) r = 0.89, p < 0.001; oculus sinister (OS) r = 0.78, p < 0.001). The limits of agreement were -7.9 to +8.5 letters for the right eye and -10.9 to +11.2 letters for the left eye. CONCLUSION An iPad-based LCVA test shows good agreement with Sloan testing in MS patients.
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Affiliation(s)
- Neda Sattarnezhad
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Samantha Farrow
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Dorlan Kimbrough
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Bonnie Glanz
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian Healy
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA/Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
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111
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Biousse V, Newman NJ. Diagnosis and clinical features of common optic neuropathies. Lancet Neurol 2017; 15:1355-1367. [PMID: 27839652 DOI: 10.1016/s1474-4422(16)30237-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 12/25/2022]
Abstract
Disorders of the optic nerves (optic neuropathies) are some of the most common causes of visual loss, and can present in isolation or with associated neurological or systemic symptoms and signs. Several optic neuropathies-especially inflammatory optic neuropathies-are associated with neurological disorders and thus are often diagnosed and treated by neurologists. The mechanisms underlying optic neuropathies are diverse and typically manifest with decreased visual acuity, altered colour vision, and abnormal visual field in the affected eye. Diagnosis is made on the basis of clinical history and clinical examination, of which several aspects are particularly important, including the mode of onset of visual loss, the presence of pain with eye movements, the visual acuity, and the retention of colour vision. Advances in optic nerve imaging-particularly retinal digital photography, optical coherence tomography, and MRI techniques-have revolutionised the diagnosis and follow-up of patients with an optic neuropathy. Furthermore, improvement and generalisation of some ancillary tests, such as diagnostic antibodies for neuromyelitis optica, allows better phenotyping of the heterogeneous inflammatory optic neuropathies.
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Affiliation(s)
- Valérie Biousse
- Neuro-Ophthalmology Unit, Emory Eye Center, Emory University, Atlanta, GA, USA.
| | - Nancy J Newman
- Neuro-Ophthalmology Unit, Emory Eye Center, Emory University, Atlanta, GA, USA
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112
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Balk LJ, Coric D, Nij Bijvank JA, Killestein J, Uitdehaag BM, Petzold A. Retinal atrophy in relation to visual functioning and vision-related quality of life in patients with multiple sclerosis. Mult Scler 2017; 24:767-776. [PMID: 28511578 PMCID: PMC5971367 DOI: 10.1177/1352458517708463] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Inner retinal layer atrophy in patients with multiple sclerosis (MS) has been validated as a structural imaging biomarker for neurodegeneration. Objective: To determine how retinal layer thickness relates to high-contrast visual acuity (HCVA), low-contrast visual acuity (LCVA) and vision-related quality of life (QoL) and to investigate the effect of previous episodes on MS-associated optic neuritis (MSON). Methods: Spectral-domain optical coherence tomography (SD-OCT) was performed in 267 patients with MS. Images were segmented for the peripapillary retinal nerve fiber layer (pRNFL) and the macular ganglion cell inner plexiform layer (GCIPL). Ophthalmological evaluations included history of MSON, HCVA, LCVA, and vision-related QoL. Results: Independent of MSON, HCVA and LCVA were significantly associated with pRNFL and GCIPL thicknesses. Vision-related QoL was positively associated with pRNFL (β = 0.92, p = 0.06) and GCIPL (β = 0.93, p = 0.02) thicknesses. These associations were independent of MSON. Not only binocular but also monocular atrophy of the inner retinal layers was associated with lower vision-related QoL. Conclusion: This study showed that retinal atrophy has a significant impact on visual functioning in patients with MS. OCT may therefore provide useful insight to patients with visual dysfunction, and our findings support including OCT and vision-related QoL measures into optic neuritis treatment trials.
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Affiliation(s)
- Lisanne J Balk
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Danko Coric
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jenny A Nij Bijvank
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Ophthalmology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Axel Petzold
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Ophthalmology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/UCL Institute of Neurology, University College London (UCL), London, UK/Moorfields Eye Hospital, London, UK
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113
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Functional connectivity alterations in a murine model of optic neuritis. Exp Neurol 2017; 295:18-22. [PMID: 28502610 DOI: 10.1016/j.expneurol.2017.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/14/2017] [Accepted: 05/11/2017] [Indexed: 12/17/2022]
Abstract
The basis for neuronal dysfunction following inflammatory demyelination of the central nervous system (CNS) remains poorly understood. We characterized the network response to white matter injury in the anterior visual pathway using an experimental model of optic neuritis (ON), as ON is often an early manifestation of immune-mediated CNS demyelination in multiple sclerosis (MS). Optical intrinsic signal imaging was performed before and after the induction of ON in mice to measure changes in cortical network functional connectivity. We observed a greater loss of connectivity between homotopic visual cortices in ON mice compared to controls. Further, decreases in homotopic visual cortex connectivity were associated with visual acuity loss in ON mice. These results demonstrate that network connectivity changes resulting from ON can be modeled in an experimental murine system. Future studies will identify the mechanisms that cause neuronal dysfunction due to white matter injury seen in MS.
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114
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Using endogenous saccades to characterize fatigue in multiple sclerosis. Mult Scler Relat Disord 2017; 14:16-22. [DOI: 10.1016/j.msard.2017.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/21/2017] [Accepted: 01/27/2017] [Indexed: 11/20/2022]
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115
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Lateral thinking - Interocular symmetry and asymmetry in neurovascular patterning, in health and disease. Prog Retin Eye Res 2017; 59:131-157. [PMID: 28457789 DOI: 10.1016/j.preteyeres.2017.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/24/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023]
Abstract
No biological system or structure is likely to be perfectly symmetrical, or have identical right and left forms. This review explores the evidence for eye and visual pathway asymmetry, in health and in disease, and attempts to provide guidance for those studying the structure and function of the visual system, where recognition of symmetry or asymmetry may be essential. The principal question with regards to asymmetry is not 'are the eyes the same?', for some degree of asymmetry is pervasive, but 'when are they importantly different?'. Knowing if right and left eyes are 'importantly different' could have significant consequences for deciding whether right or left eyes are included in an analysis or for examining the association between a phenotype and ocular parameter. The presence of significant asymmetry would also have important implications for the design of normative databases of retinal and optic nerve metrics. In this review, we highlight not only the universal presence of asymmetry, but provide evidence that some elements of the visual system are inherently more asymmetric than others, pointing to the need for improved normative data to explain sources of asymmetry and their impact on determining associations with genetic, environmental or health-related factors and ultimately in clinical practice.
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116
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Lin TH, Chiang CW, Perez-Torres CJ, Sun P, Wallendorf M, Schmidt RE, Cross AH, Song SK. Diffusion MRI quantifies early axonal loss in the presence of nerve swelling. J Neuroinflammation 2017; 14:78. [PMID: 28388913 PMCID: PMC5384143 DOI: 10.1186/s12974-017-0852-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background Magnetic resonance imaging markers have been widely used to detect and quantify white matter pathologies in multiple sclerosis. We have recently developed a diffusion basis spectrum imaging (DBSI) to distinguish and quantify co-existing axonal injury, demyelination, and inflammation in multiple sclerosis patients and animal models. It could serve as a longitudinal marker for axonal loss, a primary cause of permanent neurological impairments and disease progression. Methods Eight 10-week-old female C57BL/6 mice underwent optic nerve DBSI, followed by a week-long recuperation prior to active immunization for experimental autoimmune encephalomyelitis (EAE). Visual acuity of all mice was assessed daily. Longitudinal DBSI was performed in mouse optic nerves at baseline (naïve, before immunization), before, during, and after the onset of optic neuritis. Tissues were perfusion fixed after final in vivo scans. The correlation between DBSI detected pathologies and corresponding immunohistochemistry markers was quantitatively assessed. Results In this cohort of EAE mice, monocular vision impairment occurred in all animals. In vivo DBSI detected, differentiated, and quantified optic nerve inflammation, demyelination, and axonal injury/loss, correlating nerve pathologies with visual acuity at different time points of acute optic neuritis. DBSI quantified, in the presence of optic nerve swelling, ~15% axonal loss at the onset of optic neuritis in EAE mice. Conclusions Our findings support the notion that axonal loss could occur early in EAE mice. DBSI detected pathologies in the posterior visual pathway unreachable by optical coherence tomography and without confounding inflammation induced optic nerve swelling. DBSI could thus decipher the interrelationship among various pathological components and the role each plays in disease progression. Quantification of the rate of axonal loss could potentially serve as the biomarker to predict treatment outcome and to determine when progressive disease starts.
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Affiliation(s)
- Tsen-Hsuan Lin
- Radiology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Chia-Wen Chiang
- Radiology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.,Current Address: Institute of Biomedical Engineering and Nanomedicine, National Health Research Institute, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
| | - Carlos J Perez-Torres
- Radiology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.,Current Address: School of Health Sciences, Purdue University, 550 W Stadium Ave, West Lafayette, IN, 47907, USA
| | - Peng Sun
- Radiology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Michael Wallendorf
- Biostatistics, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Robert E Schmidt
- Pathology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Anne H Cross
- Neurology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.,Hope Center for Neurological Disorders, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Sheng-Kwei Song
- Radiology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA. .,Hope Center for Neurological Disorders, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA. .,Biomedical Engineering, Washington University, 1 Brookings Dr, St. Louis, MO, 63130, USA. .,Biomedical MR Laboratory, Washington University School of Medicine, Campus Box 8227, Room 2313, 4525 Scott Ave, St Louis, MO, 63110, USA.
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Balcer LJ, Raynowska J, Nolan R, Galetta SL, Kapoor R, Benedict R, Phillips G, LaRocca N, Hudson L, Rudick R. Validity of low-contrast letter acuity as a visual performance outcome measure for multiple sclerosis. Mult Scler 2017; 23:734-747. [PMID: 28206829 PMCID: PMC5407511 DOI: 10.1177/1352458517690822] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Low-contrast letter acuity (LCLA) has emerged as the leading outcome measure to assess visual disability in multiple sclerosis (MS) research. As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Low-contrast acuity captures visual loss not seen in high-contrast visual acuity (HCVA) measurements. These issues are addressed by the MS Outcome Assessments Consortium (MSOAC), including representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are clinically meaningful. This review shows that MS and disease-free controls have similar median HCVA, while MS patients have significantly lower LCLA. Deficits in LCLA and vision-specific quality of life are found many years after an episode of acute optic neuritis, even when HCVA has recovered. Studies reveal correlations between LCLA and the Expanded Disability Status Score (EDSS), Multiple Sclerosis Functional Composite (MSFC), retinal nerve fiber layer (RNFL) and ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness on optical coherence tomography (OCT), brain magnetic resonance imaging (MRI), visual evoked potential (VEP), electroretinogram (ERG), pupillary function, and King-Devick testing. This review also concludes that a 7-point change in LCLA is clinically meaningful. The overall goal of this review is to describe and characterize the LCLA metric for research and clinical use among persons with MS.
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Affiliation(s)
- Laura J Balcer
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Jenelle Raynowska
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Rachel Nolan
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Raju Kapoor
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Ralph Benedict
- Department of Neurology, University at Buffalo, Buffalo, NY, USA
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- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
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118
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Nguyen CTO, Hui F, Charng J, Velaedan S, van Koeverden AK, Lim JKH, He Z, Wong VHY, Vingrys AJ, Bui BV, Ivarsson M. Retinal biomarkers provide "insight" into cortical pharmacology and disease. Pharmacol Ther 2017; 175:151-177. [PMID: 28174096 DOI: 10.1016/j.pharmthera.2017.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The retina is an easily accessible out-pouching of the central nervous system (CNS) and thus lends itself to being a biomarker of the brain. More specifically, the presence of neuronal, vascular and blood-neural barrier parallels in the eye and brain coupled with fast and inexpensive methods to quantify retinal changes make ocular biomarkers an attractive option. This includes its utility as a biomarker for a number of cerebrovascular diseases as well as a drug pharmacology and safety biomarker for the CNS. It is a rapidly emerging field, with some areas well established, such as stroke risk and multiple sclerosis, whereas others are still in development (Alzheimer's, Parkinson's, psychological disease and cortical diabetic dysfunction). The current applications and future potential of retinal biomarkers, including potential ways to improve their sensitivity and specificity are discussed. This review summarises the existing literature and provides a perspective on the strength of current retinal biomarkers and their future potential.
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Affiliation(s)
- Christine T O Nguyen
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia.
| | - Flora Hui
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Jason Charng
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Shajan Velaedan
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Anna K van Koeverden
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Jeremiah K H Lim
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Zheng He
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Vickie H Y Wong
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Algis J Vingrys
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Bang V Bui
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Magnus Ivarsson
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
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119
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Stellmann JP, Cetin H, Young KL, Hodecker S, Pöttgen J, Bittersohl D, Hassenstein A, Oberwahrenbrock T, Heesen C, Siemonsen S. Pattern of gray matter volumes related to retinal thickness and its association with cognitive function in relapsing-remitting MS. Brain Behav 2017; 7:e00614. [PMID: 28239524 PMCID: PMC5318367 DOI: 10.1002/brb3.614] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/02/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Neurodegeneration in multiple sclerosis (MS) may be investigated in the visual system as optical coherence tomography (OCT) and magnetic resonance imaging (MRI) allows examining structural integrity in detail. The association between thickness of retinal layers and focal cortical volumes beyond the primary visual system has not been thoroughly investigated. OBJECTIVE To investigate the association between focal cortical volume and thickness of retinal layers. METHODS Fifty-four patients (relapsing-remitting MS, mean age 40.5 years, mean disease duration 7.6 years, median EDSS 2) underwent OCT and MRI. The association between focal cortical volume and OCT measurements was investigated with voxel-based morphometry (VBM). Patterns of association were determined with Yeo's functional network atlas and the Harvard-Oxford cortical atlas. We used GEE models with cortical volumes from the FreeSurfer parcellation to confirm VBM results. Post hoc, we analyzed the association between OCT, focal cortical volumes, and an extended neuropsychological assessment in a subgroup of 14 patients. RESULTS Macular retinal nerve fiber layer (mRNFL) and ganglion cell /inner plexiform layer (GCIPL) showed a robust association with mainly the insular cortex and the cingulate cortex. VBM findings were confirmed with FreeSurfer volumes. The post hoc analysis detected significant correlations between both OCT outcomes and cognition. CONCLUSION Besides the primary visual system, OCT outcomes show a correlation pattern with cortical regions that are known to be important for cognitive performance, predominantly the insula in both hemispheres. Thus, OCT should be further investigated as a marker for neurodegeneration in MS.
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Affiliation(s)
- Jan-Patrick Stellmann
- Institut für Neuroimmunologie und Multiple Sklerose Universitätsklinikum Hamburg-Eppendorf Germany; Klinik und Poliklinik für Neurologie Universitätsklinikum Hamburg-Eppendorf Germany
| | - Hanife Cetin
- Institut für Neuroimmunologie und Multiple Sklerose Universitätsklinikum Hamburg-Eppendorf Germany; Klinik und Poliklinik für Neurologie Universitätsklinikum Hamburg-Eppendorf Germany
| | - Kim Lea Young
- Institut für Neuroimmunologie und Multiple Sklerose Universitätsklinikum Hamburg-Eppendorf Germany; Klinik und Poliklinik für Neurologie Universitätsklinikum Hamburg-Eppendorf Germany
| | - Sibylle Hodecker
- Institut für Neuroimmunologie und Multiple Sklerose Universitätsklinikum Hamburg-Eppendorf Germany; Klinik und Poliklinik für Neurologie Universitätsklinikum Hamburg-Eppendorf Germany
| | - Jana Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose Universitätsklinikum Hamburg-Eppendorf Germany; Klinik und Poliklinik für Neurologie Universitätsklinikum Hamburg-Eppendorf Germany
| | - Diana Bittersohl
- Klinik für Augenheilkunde Universitätsklinikum Hamburg-Eppendorf Germany
| | - Andrea Hassenstein
- Klinik für Augenheilkunde Universitätsklinikum Hamburg-Eppendorf Germany
| | - Timm Oberwahrenbrock
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine Berlin Germany
| | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose Universitätsklinikum Hamburg-Eppendorf Germany; Klinik und Poliklinik für Neurologie Universitätsklinikum Hamburg-Eppendorf Germany
| | - Susanne Siemonsen
- Institut für Neuroimmunologie und Multiple Sklerose Universitätsklinikum Hamburg-Eppendorf Germany; Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention Universitätsklinikum Hamburg-Eppendorf Germany
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120
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Khan RS, Dine K, Bauman B, Lorentsen M, Lin L, Brown H, Hanson LR, Svitak AL, Wessel H, Brown L, Shindler KS. Intranasal Delivery of A Novel Amnion Cell Secretome Prevents Neuronal Damage and Preserves Function In A Mouse Multiple Sclerosis Model. Sci Rep 2017; 7:41768. [PMID: 28139754 PMCID: PMC5282572 DOI: 10.1038/srep41768] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/28/2016] [Indexed: 01/07/2023] Open
Abstract
The ability of a novel intranasally delivered amnion cell derived biologic to suppress inflammation, prevent neuronal damage and preserve neurologic function in the experimental autoimmune encephalomyelitis animal model of multiple sclerosis was assessed. Currently, there are no existing optic nerve treatment methods for disease or trauma that result in permanent vision loss. Demyelinating optic nerve inflammation, termed optic neuritis, induces permanent visual dysfunction due to retinal ganglion cell damage in multiple sclerosis and experimental autoimmune encephalomyelitis. ST266, the biological secretome of Amnion-derived Multipotent Progenitor cells, contains multiple anti-inflammatory cytokines and growth factors. Intranasally administered ST266 accumulated in rodent eyes and optic nerves, attenuated visual dysfunction, and prevented retinal ganglion cell loss in experimental optic neuritis, with reduced inflammation and demyelination. Additionally, ST266 reduced retinal ganglion cell death in vitro. Neuroprotective effects involved oxidative stress reduction, SIRT1-mediated mitochondrial function promotion, and pAKT signaling. Intranasal delivery of neuroprotective ST266 is a potential novel, noninvasive therapeutic modality for the eyes, optic nerves and brain. The unique combination of biologic molecules in ST266 provides an innovative approach with broad implications for suppressing inflammation in autoimmune diseases, and for preventing neuronal damage in acute neuronal injury and chronic neurodegenerative diseases such as multiple sclerosis.
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Affiliation(s)
- Reas S Khan
- Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kimberly Dine
- Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bailey Bauman
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Lorentsen
- Drexel University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisa Lin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Helayna Brown
- Drexel University School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Howard Wessel
- Noveome Biotherapeutics, Inc., Pittsburgh, Pennsylvania, USA
| | - Larry Brown
- Noveome Biotherapeutics, Inc., Pittsburgh, Pennsylvania, USA
| | - Kenneth S Shindler
- Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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121
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Al-Khersan H, Hain T, Grassi MA. Vision Loss in a Teenage Girl With Postconcussion Syndrome. JAMA Ophthalmol 2017; 135:75-76. [PMID: 27892982 DOI: 10.1001/jamaophthalmol.2016.2830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hasenin Al-Khersan
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Tim Hain
- Northwestern University, Chicago, Illinois
| | - Michael A Grassi
- Grassi Retina, Naperville, Illinois4Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
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122
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Dodick D, Starling AJ, Wethe J, Pang Y, Messner LV, Smith C, Master CL, Halker-Singh RB, Vargas BB, Bogle JM, Mandrekar J, Talaber A, Leong D. The Effect of In-School Saccadic Training on Reading Fluency and Comprehension in First and Second Grade Students. J Child Neurol 2017; 32:104-111. [PMID: 28257277 DOI: 10.1177/0883073816668704] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Efficient eye movements provide a physical foundation for proficient reading skills. We investigated the effect of in-school saccadic training on reading performance. In this cross-over design, study participants (n = 327, 165 males; mean age [SD]: 7 y 6 mo [1y 1 mo]) were randomized into treatment and control groups, who then underwent eighteen 20-minute training sessions over 5 weeks using King-Devick Reading Acceleration Program Software. Pre- and posttreatment reading assessments included fluency, comprehension, and rapid number naming performance. The treatment group had significantly greater improvement than the control group in fluency (6.2% vs 3.6%, P = .0277) and comprehension (7.5% vs 1.5%, P = .0002). The high-needs student group significantly improved in fluency ( P < .001) and comprehension ( P < .001). We hypothesize these improvements to be attributed to the repetitive practice of reading-related eye movements, shifting visuospatial attention, and visual processing. Consideration should be given to teaching the physical act of reading within the early education curriculum.
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Affiliation(s)
- David Dodick
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Amaal J Starling
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jennifer Wethe
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Yi Pang
- 2 Illinois Eye Institute, Chicago, IL, USA
| | | | - Craig Smith
- 3 Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Christina L Master
- 4 Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bert B Vargas
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jamie M Bogle
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jay Mandrekar
- 5 Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Danielle Leong
- 2 Illinois Eye Institute, Chicago, IL, USA.,6 King-Devick Test, Inc, Oakbrook Terrace, IL, USA
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123
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Abstract
Due to the heterogeneous nature of the disease, it is a challenge to capture disease activity of multiple sclerosis (MS) in a reliable and valid way. Therefore, it can be difficult to assess the true efficacy of interventions in clinical trials. In phase III trials in MS, the traditionally used primary clinical outcome measures are the Expanded Disability Status Scale and the relapse rate. Secondary outcome measures in these trials are the number or volume of T2 hyperintense lesions and gadolinium-enhancing T1 lesions on magnetic resonance imaging (MRI) of the brain. These secondary outcome measures are often primary outcome measures in phase II trials in MS. Despite several limitations, the traditional clinical measures are still the mainstay for assessing treatment efficacy. Newer and potentially valuable outcome measures increasingly used or explored in MS trials are, clinically, the MS Functional Composite and patient-reported outcome measures, and on MRI, brain atrophy and the formation of persisting black holes. Several limitations of these measures have been addressed and further improvements will probably be proposed. Major improvements are the coverage of additional functional domains such as cognitive functioning and assessment of the ability to carry out activities of daily living. The development of multidimensional measures is promising because these measures have the potential to cover the full extent of MS activity and progression. In this review, we provide an overview of the historical background and recent developments of outcome measures in MS trials. We discuss the advantages and limitations of various measures, including newer assessments such as optical coherence tomography, biomarkers in body fluids and the concept of 'no evidence of disease activity'.
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Affiliation(s)
- Caspar E. P. van Munster
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 Amsterdam, The Netherlands
| | - Bernard M. J. Uitdehaag
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 Amsterdam, The Netherlands
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Optical Coherence Tomography and Magnetic Resonance Imaging in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder. Int J Mol Sci 2016; 17:ijms17111894. [PMID: 27854301 PMCID: PMC5133893 DOI: 10.3390/ijms17111894] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/04/2016] [Accepted: 11/06/2016] [Indexed: 01/01/2023] Open
Abstract
Irreversible disability in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) is largely attributed to neuronal and axonal degeneration, which, along with inflammation, is one of the major pathological hallmarks of these diseases. Optical coherence tomography (OCT) is a non-invasive imaging tool that has been used in MS, NMOSD, and other diseases to quantify damage to the retina, including the ganglion cells and their axons. The fact that these are the only unmyelinated axons within the central nervous system (CNS) renders the afferent visual pathway an ideal model for studying axonal and neuronal degeneration in neurodegenerative diseases. Structural magnetic resonance imaging (MRI) can be used to obtain anatomical information about the CNS and to quantify evolving pathology in MS and NMOSD, both globally and in specific regions of the visual pathway including the optic nerve, optic radiations and visual cortex. Therefore, correlations between brain or optic nerve abnormalities on MRI, and retinal pathology using OCT, may shed light on how damage to one part of the CNS can affect others. In addition, these imaging techniques can help identify important differences between MS and NMOSD such as disease-specific damage to the visual pathway, trans-synaptic degeneration, or pathological changes independent of the underlying disease process. This review focuses on the current knowledge of the role of the visual pathway using OCT and MRI in patients with MS and NMOSD. Emphasis is placed on studies that employ both MRI and OCT to investigate damage to the visual system in these diseases.
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Myelin-oligodendrocyte-glycoprotein (MOG) autoantibodies as potential markers of severe optic neuritis and subclinical retinal axonal degeneration. J Neurol 2016; 264:139-151. [PMID: 27844165 DOI: 10.1007/s00415-016-8333-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 12/11/2022]
Abstract
Antibodies against conformation-dependent epitopes of myelin-oligodendrocyte-glycoprotein (MOG-abs) are present in subgroups of neuromyelitis optica spectrum disorder (NMOSD), recurrent optic neuritis (rON), multiple sclerosis (MS), and anti-NMDAR encephalitis. Using optical coherence tomography (OCT) we assessed whether MOG-abs might serve as potential marker of retinal axonal degeneration. We investigated a clinically heterogeneous cohort of 13 MOG-abs-positive patients (4 MOG-abs-positive rON, 4 MOG-abs-positive adult MS, 3 MOG-abs-positive relapsing encephalomyelitis, 2 MOG-abs-positive aquaporin-4-abs-negative NMOSD). As controls, we studied 13 age, sex and ON episode(s)-matched MOG-abs and aquaporin-4-abs-negative (AQP4-abs-negative) MS patients and 13 healthy controls (HC). In addition, we investigated 19 unmatched AQP4-abs-positive MOG-abs-negative NMOSD subjects. Considering all eyes, global pRNFL [in µm, mean (SD)] was significantly reduced in MOG-abs-positive patients [72.56 (22.71)] compared to MOG-abs-negative MS [80.81 (13.55), p = 0.0128], HCs [103.54 (8.529), p = 0.0014] and NMOSD [88.32 (18.43), p = 0.0353]. Non ON eyes from MOG-abs-positive subjects showed significant subclinical atrophy of temporal pRNFL quadrants. Microcystic macular edema (MME) was observed only in eyes of MOG-abs-positive (24%) and AQP4-abs-positive NMOSD (5.6%), but not in MOG-abs-negative MS or HC (p < 0.01). MOG-abs may serve as potential marker of retinal degeneration. Specifically, MOG-abs-related OCT features predominate in temporal pRNFL quadrants (resembling the MS retinal pattern), might be more severe than AQP4-abs-positive NMOSD, indicate subclinical pathology, and may be associated with MME.
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Longbrake EE, Lancia S, Tutlam N, Trinkaus K, Naismith RT. Quantitative visual tests after poorly recovered optic neuritis due to multiple sclerosis. Mult Scler Relat Disord 2016; 10:198-203. [PMID: 27919490 DOI: 10.1016/j.msard.2016.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/11/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Visual dysfunction in MS can be quantified using a variety of tests. Many vision tests have not been formally evaluated among MS patients with existing visual dysfunction. OBJECTIVE Evaluate several versions of visual acuity and contrast sensitivity tests, measures of central and peripheral vision, retina structure, electrophysiologic function, and quality of life among MS patients with moderate/severe visual dysfunction. METHODS Cross-sectional study of 46 patients with stable, incompletely recovered optic neuritis. Testing included Snellen eye charts, several Sloan low contrast charts, Pelli Robson (PR) contrast sensitivity charts, optical coherence tomography, visual fields, Farnsworth Munsell 100-hue test, visual evoked potentials (VEP), and visual function quality of life (VFQ-25) testing. RESULTS 98% of eyes could read two lines of the PR chart, while only 43% read the 2.5% contrast chart. Low contrast tests correlated strongly with each other and with retinal nerve fiber layer (RNFL) thickness, visual fields, and color vision but not with VEPs. For patients with RNFL <75µm, VFQ-25 scores dropped by approximately 2 points for every 1µm decrease in RNFL. CONCLUSION Among MS patients with visual impairment due to optic neuritis, PR contrast sensitivity could be utilized as a single chart. Visual quality of life was associated with RNFL thinning below 75µm.
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Affiliation(s)
- Erin E Longbrake
- Department of Neurology, Washington University in St. Louis, St Louis, MO, United States.
| | - Samantha Lancia
- Department of Neurology, Washington University in St. Louis, St Louis, MO, United States
| | - Nhial Tutlam
- Department of Neurology, Washington University in St. Louis, St Louis, MO, United States
| | - Kathryn Trinkaus
- Division of Biostatistics, Washington University in St. Louis, St Louis, MO, United States
| | - Robert T Naismith
- Department of Neurology, Washington University in St. Louis, St Louis, MO, United States
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Mikolajczak J, Zimmermann H, Kheirkhah A, Kadas EM, Oberwahrenbrock T, Muller R, Ren A, Kuchling J, Dietze H, Prüss H, Paul F, Hamrah P, Brandt AU. Patients with multiple sclerosis demonstrate reduced subbasal corneal nerve fibre density. Mult Scler 2016; 23:1847-1853. [PMID: 27811337 DOI: 10.1177/1352458516677590] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Many studies in multiple sclerosis (MS) have investigated the retina. Little, however, is known about the effect of MS on the cornea, which is innervated by the trigeminal nerve. It is the site of neural-immune interaction with local dendritic cells reacting in response to environmental stimuli. OBJECTIVE This study aims to investigate the effect of MS on corneal nerve fibres and dendritic cells in the subbasal nerve plexus using in vivo confocal microscopy (IVCM). METHODS We measured the corneal nerve fibre and dendritic cell density in 26 MS patients and matched healthy controls using a Heidelberg Retina Tomograph with cornea module. Disease severity was assessed with the Multiple Sclerosis Functional Composite, Expanded Disability Status Scale, visual acuity and retinal optical coherence tomography. RESULTS We observed significant reduction in total corneal nerve fibre density in MS patients compared to controls. Dendritic cell density was similar in both groups. Reduced total nerve fibre density was associated with worse clinical severity but not with previous clinical trigeminal symptoms, retinal neuro-axonal damage, visual acuity or disease duration. CONCLUSION Corneal nerve fibre density is a promising new imaging marker for the assessment of disease severity in MS and should be investigated further.
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Affiliation(s)
- Janine Mikolajczak
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ahmad Kheirkhah
- Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Ella Maria Kadas
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timm Oberwahrenbrock
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rodrigo Muller
- Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Aiai Ren
- Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Joseph Kuchling
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Holger Dietze
- Department of Optometry, Beuth University of Applied Sciences, Berlin, Germany
| | - Harald Prüss
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany/German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany/Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pedram Hamrah
- Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA/Boston Image Reading Center and Cornea Service, New England Eye Center, Boston, MA, USA/Tufts Medical Center, Department of Ophthalmology, School of Medicine, Tufts University, Boston, MA, USA
| | - Alexander U Brandt
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Teixeira LBC, Hoeve JNV, Mayer JA, Dubielzig RR, Smith CM, Radcliff AB, Duncan ID. Modeling the Chronic Loss of Optic Nerve Axons and the Effects on the Retinal Nerve Fiber Layer Structure in Primary Disorder of Myelin. Invest Ophthalmol Vis Sci 2016; 57:4859-4868. [PMID: 27654412 PMCID: PMC5032912 DOI: 10.1167/iovs.16-19871] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose We determined whether the chronic lack of optic nerve myelination and subsequent axon loss is associated with optical coherence tomography (OCT) changes in the retinal nerve fiber layer (RNFL), and whether this models what occurs in multiple sclerosis (MS) and confers its use as a surrogate marker for axon degeneration. Methods Using an animal model of Pelizaeus-Merzbacher disease (shp) bilateral longitudinal measurements of the peripapillary RNFL (spectral-domain OCT), electroretinograms (ERG), and visual evoked potentials (VEP) were performed in affected and control animals from 5 months to 2 years and in individual animals at single time points. Light and electron microscopy of the optic nerve and retina and histomorphometric measurements of the RNFL were compared to OCT data. Results Of the shp animals, 17% had an average reduction of OCT RNFL thickness on the superior retinal quadrant compared to controls (P < 0.05). Electroretinograms showed normal photopic A- and B-waves but flash VEPs were disorganized in shp animals. Morphologically, the shp retinas and optic nerves revealed significant RNFL thinning (P < 0.001) without retinal ganglion cell (RGC) loss, decrease total and relative retinal axonal area, and loss of optic nerve axons. There was strong positive correlation between OCT and morphometric RNFL thickness measurements (r = 0.878, P = 0.004). Conclusion The loss of optic nerve axons demonstrated in the shp model resulted in moderate thinning of the RNFL confirmed by OCT and histology. These results indicate that OCT-derived RNFL measurement can be a useful surrogate biomarker of optic nerve axon loss and potentially disease progression in demyelinating diseases.
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Affiliation(s)
- Leandro B C Teixeira
- Department of Pathobiological Sciences School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - James N Ver Hoeve
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Joshua A Mayer
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Richard R Dubielzig
- Department of Pathobiological Sciences School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Chelsey M Smith
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Abigail B Radcliff
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Ian D Duncan
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
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129
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Verden D, Macklin WB. Neuroprotection by central nervous system remyelination: Molecular, cellular, and functional considerations. J Neurosci Res 2016; 94:1411-1420. [PMID: 27618492 DOI: 10.1002/jnr.23923] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/09/2016] [Accepted: 08/24/2016] [Indexed: 12/27/2022]
Abstract
Oligodendrocytes and their myelin sheaths play an intricate role in axonal health and function. The prevalence of white matter pathology in a wide variety of central nervous system disorders has gained attention in recent years. Remyelination has therefore become a major target of therapeutic research, with the aim of protecting axons from further damage. The axon-myelin unit is elaborate, and demyelination causes profound changes in axonal molecular domains, signal transmission, and metabolism. Remyelination is known to restore some of these changes, but many of its outcomes remain unknown. Understanding how different aspects of the axon-myelin unit are restored by remyelination is important for making effective, targeted therapeutics for white matter dysfunction. Additionally, understanding how subtle deficits relate to axonal function during demyelination and remyelination may provide clues into the impact of myelin on neuronal circuits. In this review, we discuss the current knowledge of the neuroprotective effects of remyelination, as well as gaps in our knowledge. Finally, we propose systems with unique myelin profiles that may serve as useful models for investigating remyelination efficacy. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Dylan Verden
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado
| | - Wendy B Macklin
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado.
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Cameron JR, Tatham AJ. A window to beyond the orbit: the value of optical coherence tomography in non-ocular disease. Acta Ophthalmol 2016; 94:533-9. [PMID: 26803923 DOI: 10.1111/aos.12978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/29/2015] [Indexed: 12/12/2022]
Abstract
Optical coherence tomography (OCT) imaging of the eye has become an essential tool for the ophthalmologist, aiding diagnosis and assisting with treatment decisions, in many ocular diseases. However, there is an evolving role for OCT in informing on non-ocular diseases, which ophthalmologists should be aware of. The purpose of this review was to examine recent evidence for the role of ocular OCT imaging to evaluate disease beyond the orbit and to discuss possible opportunities and challenges arising from this, from the perspective of the ophthalmologist.
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Affiliation(s)
- James R. Cameron
- Anne Rowling Regenerative Neurology Clinic; University of Edinburgh; Edinburgh UK
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131
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Kapoor R, Raftopoulos R, Altmann DR, Miller DH, Hickman SJ. Phenytoin for neuroprotection – Authors' reply. Lancet Neurol 2016; 15:902-903. [DOI: 10.1016/s1474-4422(16)30094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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132
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Quantifying visual pathway axonal and myelin loss in multiple sclerosis and neuromyelitis optica. NEUROIMAGE-CLINICAL 2016; 11:743-750. [PMID: 27330974 PMCID: PMC4908282 DOI: 10.1016/j.nicl.2016.05.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/14/2016] [Accepted: 05/25/2016] [Indexed: 12/28/2022]
Abstract
Background The optic nerve is frequently injured in multiple sclerosis and neuromyelitis optica, resulting in visual dysfunction, which may be reflected by measures distant from the site of injury. Objective To determine how retinal nerve fiber layer as a measure of axonal health, and macular volume as a measure of neuronal health are related to changes in myelin water fraction in the optic radiations of multiple sclerosis and neuromyelitis optica participants with and without optic neuritis and compared to healthy controls. Methods 12 healthy controls, 42 multiple sclerosis (16 with optic neuritis), and 10 neuromyelitis optica participants (8 with optic neuritis) were included in this study. Optical coherence tomography assessment involved measurements of the segmented macular layers (total macular, ganglion cell layer, inner plexiform layer, and inner nuclear layer volume) and paripapillary retinal nerve fiber layer thickness. The MRI protocol included a 32-echo T2-relaxation GRASE sequence. Average myelin water fraction values were calculated within the optic radiations as a measure of myelin density. Results Multiple sclerosis and neuromyelitis optica eyes with optic neuritis history had lower retinal nerve fiber layer thickness, total macular, ganglion cell and inner plexiform layer volumes compared to eyes without optic neuritis history and controls. Inner nuclear layer volume increased in multiple sclerosis with optic neuritis history (mean = 0.99 mm3, SD = 0.06) compared to those without (mean = 0.97 mm3, SD = 0.06; p = 0.003). Mean myelin water fraction in the optic radiations was significantly lower in demyelinating diseases (neuromyelitis optica: mean = 0.098, SD = 0.01, multiple sclerosis with optic neuritis history: mean = 0.096, SD = 0.01, multiple sclerosis without optic neuritis history: mean = 0.098, SD = 0.02; F3,55 = 3.35, p = 0.03) compared to controls. Positive correlations between MRI and optical coherence tomography measures were also apparent (retinal nerve fiber layer thickness and ganglion cell layer thickness: r = 0.25, p = 0.05, total macular volume and inner plexiform layer volume: r = 0.27, p = 0.04). Conclusions The relationship between reductions in OCT measures of neuro-axonal health in the anterior visual pathway and MRI-based measures of myelin health in the posterior visual pathway suggests that these measures may be linked through bidirectional axonal degeneration. First study to assess relationship between segmented retinal layers and MRI in NMO First study to use optic radiation myelin water imaging in demyelinating diseases Inner nuclear layer thickening in MS with ON may occur independently of microcystic macular edema. Myelin density reduction in the optic radiation observed in demyelinating diseases Myelin loss may be due to subclinical MS disease activity in subjects without ON. ON may lead to retinal and optic radiation pathology via bidirectional degeneration.
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133
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Beran RG, Stepanova D, Beran ME. Justification for conducting neurological clinical trials as part of patient care within private practice. Int J Clin Pract 2016; 70:365-71. [PMID: 27040457 DOI: 10.1111/ijcp.12800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this review was to assess the benefits and drawbacks of conducting neurological clinical trials and research in private practice for the patients, clinician, Practice Manager, sponsors/Clinical Research Organisations (CROs) and Clinical Trial Coordinator (CTC) to determine if this is justified for all involved. A combination of literature reviews, original research articles and books were selected from 2005 to 2015. Provided that the practice has sufficient number of active trials to prevent financial loss, support staff, adequate facilities and equipment and time, the benefits outweigh the drawbacks. Clinical trials provide patients with more thorough monitoring, re-imbursement of trial-related expenses and the opportunity to try an innovative treatment at no charge when other options have failed. For the clinician, clinical trials provide more information to ensure better care for their patients and improved treatment methods, technical experience and global recognition. Trials collect detailed and up-to-date information on the benefits and risks of drugs, improving society's confidence in clinical research and pharmaceuticals, allow trial sponsors to explore new scientific questions and accelerate innovation. For the CTC, industry-sponsored clinical trials allow potential entry for a career in clinical research giving CTCs the opportunity to become Clinical Research Associates (CRAs), Study Start-Up Managers or Drug Safety Associates.
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Affiliation(s)
- R G Beran
- Liverpool Hospital, Sydney, NSW, Australia
- Griffith University, Gold Coast and Brisbane, Qld, Australia
- Strategic Health Evaluators, Sydney, NSW, Australia
| | - D Stepanova
- Strategic Health Evaluators, Sydney, NSW, Australia
| | - M E Beran
- Strategic Health Evaluators, Sydney, NSW, Australia
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Gresle MM, Liu Y, Kilpatrick TJ, Kemper D, Wu QZ, Hu B, Fu QL, So KF, Sheng G, Huang G, Pepinsky B, Butzkueven H, Mi S. Blocking LINGO-1 in vivo reduces degeneration and enhances regeneration of the optic nerve. Mult Scler J Exp Transl Clin 2016; 2:2055217316641704. [PMID: 28607723 PMCID: PMC5433342 DOI: 10.1177/2055217316641704] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/07/2016] [Indexed: 12/31/2022] Open
Abstract
Background Two ongoing phase II clinical trials (RENEW and SYNERGY) have been developed to test the efficacy of anti-LINGO-1 antibodies in acute optic neuritis and relapsing forms of multiple sclerosis, respectively. Across a range of experimental models, LINGO-1 has been found to inhibit neuron and oligodendrocyte survival, axon regeneration, and (re)myelination. The therapeutic effects of anti-LINGO-1 antibodies on optic nerve axonal loss and regeneration have not yet been investigated. Objective In this series of studies we investigate if LINGO-1 antibodies can prevent acute inflammatory axonal loss, and promote axonal regeneration after injury in rodent optic nerves. Methods The effects of anti-LINGO-1 antibody on optic nerve axonal damage were assessed using rodent myelin oligodendrocyte glycoprotein experimental autoimmune encephalomyelitis (EAE), and its effects on axonal regeneration were assessed in optic nerve crush injury models. Results In the optic nerve, anti-LINGO-1 antibody therapy was associated with improved optic nerve parallel diffusivity measures on MRI in mice with EAE and reduced axonal loss in rat EAE. Both anti-LINGO-1 antibody therapy and the genetic deletion of LINGO-1 reduced nerve crush-induced axonal degeneration and enhanced axonal regeneration. Conclusion These data demonstrate that LINGO-1 blockade is associated with axonal protection and regeneration in the injured optic nerve.
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Affiliation(s)
- Melissa M Gresle
- Department of Medicine (RMH), University of Melbourne, Australia
| | - Yaou Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, China
| | - Trevor J Kilpatrick
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Dennis Kemper
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Qi-Zhu Wu
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Bing Hu
- CAS Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, China
| | - Qing-Ling Fu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, China
| | - Kwok-Fai So
- Department of Ophthalmology, University of Hong Kong, China
| | | | | | | | | | - Sha Mi
- Department of Discovery Neurobiology, Biogen, USA
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135
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Raftopoulos R, Hickman SJ, Toosy A, Sharrack B, Mallik S, Paling D, Altmann DR, Yiannakas MC, Malladi P, Sheridan R, Sarrigiannis PG, Hoggard N, Koltzenburg M, Gandini Wheeler-Kingshott CAM, Schmierer K, Giovannoni G, Miller DH, Kapoor R. Phenytoin for neuroprotection in patients with acute optic neuritis: a randomised, placebo-controlled, phase 2 trial. Lancet Neurol 2016; 15:259-69. [DOI: 10.1016/s1474-4422(16)00004-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/10/2015] [Accepted: 01/04/2016] [Indexed: 01/04/2023]
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Kiiski HSM, Ní Riada S, Lalor EC, Gonçalves NR, Nolan H, Whelan R, Lonergan R, Kelly S, O'Brien MC, Kinsella K, Bramham J, Burke T, Ó Donnchadha S, Hutchinson M, Tubridy N, Reilly RB. Delayed P100-Like Latencies in Multiple Sclerosis: A Preliminary Investigation Using Visual Evoked Spread Spectrum Analysis. PLoS One 2016; 11:e0146084. [PMID: 26726800 PMCID: PMC4699709 DOI: 10.1371/journal.pone.0146084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/11/2015] [Indexed: 01/21/2023] Open
Abstract
Conduction along the optic nerve is often slowed in multiple sclerosis (MS). This is typically assessed by measuring the latency of the P100 component of the Visual Evoked Potential (VEP) using electroencephalography. The Visual Evoked Spread Spectrum Analysis (VESPA) method, which involves modulating the contrast of a continuous visual stimulus over time, can produce a visually evoked response analogous to the P100 but with a higher signal-to-noise ratio and potentially higher sensitivity to individual differences in comparison to the VEP. The main objective of the study was to conduct a preliminary investigation into the utility of the VESPA method for probing and monitoring visual dysfunction in multiple sclerosis. The latencies and amplitudes of the P100-like VESPA component were compared between healthy controls and multiple sclerosis patients, and multiple sclerosis subgroups. The P100-like VESPA component activations were examined at baseline and over a 3-year period. The study included 43 multiple sclerosis patients (23 relapsing-remitting MS, 20 secondary-progressive MS) and 42 healthy controls who completed the VESPA at baseline. The follow-up sessions were conducted 12 months after baseline with 24 MS patients (15 relapsing-remitting MS, 9 secondary-progressive MS) and 23 controls, and again at 24 months post-baseline with 19 MS patients (13 relapsing-remitting MS, 6 secondary-progressive MS) and 14 controls. The results showed P100-like VESPA latencies to be delayed in multiple sclerosis compared to healthy controls over the 24-month period. Secondary-progressive MS patients had most pronounced delay in P100-like VESPA latency relative to relapsing-remitting MS and controls. There were no longitudinal P100-like VESPA response differences. These findings suggest that the VESPA method is a reproducible electrophysiological method that may have potential utility in the assessment of visual dysfunction in multiple sclerosis.
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Affiliation(s)
- Hanni S. M. Kiiski
- Neural Engineering Group, Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
- School of Engineering, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Sinéad Ní Riada
- Neural Engineering Group, Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
- School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Edmund C. Lalor
- Neural Engineering Group, Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
- School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Nuno R. Gonçalves
- Neural Engineering Group, Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
- School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Hugh Nolan
- Neural Engineering Group, Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
- School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Robert Whelan
- Neural Engineering Group, Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
- Cognitive and Behavioural Neuroscience Research Group, School of Psychology, UCD College of Human Sciences, University College Dublin, Dublin, Ireland
| | - Róisín Lonergan
- Department of Neurology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Siobhán Kelly
- Department of Neurology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Marie Claire O'Brien
- Cognitive and Behavioural Neuroscience Research Group, School of Psychology, UCD College of Human Sciences, University College Dublin, Dublin, Ireland
| | - Katie Kinsella
- Department of Neurology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Jessica Bramham
- Cognitive and Behavioural Neuroscience Research Group, School of Psychology, UCD College of Human Sciences, University College Dublin, Dublin, Ireland
| | - Teresa Burke
- Cognitive and Behavioural Neuroscience Research Group, School of Psychology, UCD College of Human Sciences, University College Dublin, Dublin, Ireland
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Seán Ó Donnchadha
- Cognitive and Behavioural Neuroscience Research Group, School of Psychology, UCD College of Human Sciences, University College Dublin, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Niall Tubridy
- Department of Neurology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Richard B. Reilly
- Neural Engineering Group, Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
- School of Engineering, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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137
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Roberts PS, Rizzo JR, Hreha K, Wertheimer J, Kaldenberg J, Hironaka D, Riggs R, Colenbrander A. A conceptual model for vision rehabilitation. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2016; 53:693-704. [PMID: 27997671 PMCID: PMC5444332 DOI: 10.1682/jrrd.2015.06.0113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/15/2015] [Indexed: 01/15/2023]
Abstract
Vision impairments are highly prevalent after acquired brain injury (ABI). Conceptual models that focus on constructing intellectual frameworks greatly facilitate comprehension and implementation of practice guidelines in an interprofessional setting. The purpose of this article is to provide a review of the vision literature in ABI, describe a conceptual model for vision rehabilitation, explain its potential clinical inferences, and discuss its translation into rehabilitation across multiple practice settings and disciplines.
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Affiliation(s)
- Pamela S. Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
| | - John-Ross Rizzo
- Rehabilitation Medicine, New York University Langone Medical Center, New York, NY
| | - Kimberly Hreha
- Kessler Institute for Rehabilitation and Kessler Foundation, West Orange, NJ, and Teachers College, Columbia University, New York, NY
| | - Jeffrey Wertheimer
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
| | - Jennifer Kaldenberg
- College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Dawn Hironaka
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
| | - Richard Riggs
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
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138
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Qureshi SS, Frohman EM. Acute optic neuritis: a clinical paradigm for evaluation of neuroprotective and restorative strategies? Neural Regen Res 2015; 10:1599-601. [PMID: 26692855 PMCID: PMC4660751 DOI: 10.4103/1673-5374.165286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sara S Qureshi
- Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
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139
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Abstract
Acute visual symptom emergencies occur commonly and present a challenge to both clinical and radiologic facets. Although most patients with visual complaints routinely require clinical evaluation with direct ophthalmologic evaluation, imaging is rarely necessary. However, there are highly morbid conditions where the prompt recognition and management of an acute visual syndrome (AVS) requires an astute physician to probe further. Suspicious symptomatology including abrupt visual loss, diplopia, ophthalmoplegia, and proptosis/exophthalmos require further investigation with advanced imaging modalities such as magnetic resonance imaging and magnetic resonance angiography. This review will discuss a variety of AVSs including orbital apex syndrome, cavernous sinus thrombosis, cavernous carotid fistula, acute hypertensive encephalopathy (posterior reversible encephalopathy syndrome), optic neuritis, pituitary apoplexy including hemorrhage into an existing adenoma, and idiopathic intracranial hypertension. A discussion of each entity will focus on the clinical presentation, management and prognosis when necessary and finally, neuroimaging with emphasis on magnetic resonance imaging. The primary purpose of this review is to provide an organized approach to the differential diagnosis and typical imaging patterns for AVSs. We have provided a template for radiologists and specialists to assist in early intervention in order to decrease morbidity and provide value-based patient care through imaging.
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Affiliation(s)
- Shalini V Mukhi
- Michael E. DeBakey VA Medical Center Houston and Baylor College of Medicine, Houston, TX
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140
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Sun L, Weng H, Li Z. Elevation of AQP4 and selective cytokines in experimental autoimmune encephalitis mice provides some potential biomarkers in optic neuritis and demyelinating diseases. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:15749-15758. [PMID: 26884844 PMCID: PMC4730057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
Idiopathic optic neuritis (ION) is an inflammation of the optic nerve that may result in a complete or partial loss of vision. ION is usually due to the immune attack of the myelin sheath covering the optic nerve. ION acts frequently as the first symptoms of multiple sclerosis (MS) and neuromyelitis optica (NMO), or other inflammatory demyelinating disorders. The pathogenic progression of ION remains unclear. Experimental autoimmune encephalitis (EAE) is a commonly used model of idiopathic inflammatory demyelinating disorders (IIDDs); the optic nerve is affected in EAE as well. The specific mediators of demyelination in optic neuritis are unknown. Recent studies have indicated what T-cell activation in peripheral blood is associated with optic neuritis pathogenesis. The object of the present study was to determine whether certain cytokines (IL-6, IL-17A, and IL-23) and AQP4 contribute to the demyelinating process using EAE model. We have found that IL-6R, AQP4 and IL-23R are significantly increased in mRNA and protein levels in optic nerves in EAE mice compared to control mice; serum AQP4, IL-6, IL-17A, IL-23 are increased whereas transforming growth factor beta (TGF-β) is decreased in EAE mice. These results suggest that AQP4 and selective cytokines in serum are associated with ION pathogenesis in the animal model, and these results shine light for future clinical diagnosis as potential biomarkers in ION patients.
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MESH Headings
- Animals
- Aquaporin 4/blood
- Aquaporin 4/genetics
- Aquaporin 4/metabolism
- Biomarkers/metabolism
- Cytokines/blood
- Cytokines/metabolism
- Demyelinating Diseases/blood
- Demyelinating Diseases/diagnosis
- Demyelinating Diseases/metabolism
- Demyelinating Diseases/physiopathology
- Encephalomyelitis, Autoimmune, Experimental/blood
- Encephalomyelitis, Autoimmune, Experimental/diagnosis
- Encephalomyelitis, Autoimmune, Experimental/metabolism
- Encephalomyelitis, Autoimmune, Experimental/physiopathology
- Evoked Potentials, Visual
- Female
- Interleukin-17/metabolism
- Interleukin-23/metabolism
- Interleukin-6/metabolism
- Mice, Inbred C57BL
- Optic Nerve/metabolism
- Optic Nerve/pathology
- Optic Nerve/physiopathology
- Optic Neuritis/blood
- Optic Neuritis/diagnosis
- Optic Neuritis/metabolism
- Optic Neuritis/physiopathology
- Predictive Value of Tests
- Prognosis
- Transforming Growth Factor beta/metabolism
- Up-Regulation
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Affiliation(s)
- Li Sun
- Department of Ophthalmology, Huashan Hospital, Fudan UniversityShanghai, China
| | - Huan Weng
- Department of Ophthalmology, Huashan Hospital, Fudan UniversityShanghai, China
| | - Zhenxin Li
- Department of Neurology, Huashan Hospital, Fudan UniversityShanghai, China
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141
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Varga BE, Gao W, Laurik KL, Tátrai E, Simó M, Somfai GM, Cabrera DeBuc D. Investigating Tissue Optical Properties and Texture Descriptors of the Retina in Patients with Multiple Sclerosis. PLoS One 2015; 10:e0143711. [PMID: 26619298 PMCID: PMC4664388 DOI: 10.1371/journal.pone.0143711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 11/09/2015] [Indexed: 01/30/2023] Open
Abstract
Purpose To assess the differences in texture descriptors and optical properties of retinal tissue layers in patients with multiple sclerosis (MS) and to evaluate their usefulness in the detection of neurodegenerative changes using optical coherence tomography (OCT) image segmentation. Patients and Methods 38 patients with MS were examined using Stratus OCT. The raw macular OCT data were exported and processed using OCTRIMA software. The enrolled eyes were divided into two groups, based on the presence of optic neuritis (ON) in the history (MSON+ group, n = 36 and MSON- group, n = 31). Data of 29 eyes of 24 healthy subjects (H) were used as controls. A total of seven intraretinal layers were segmented and thickness as well as optical parameters such as contrast, fractal dimension, layer index and total reflectance were measured. Mixed-model ANOVA analysis was used for statistical comparisons. Results Significant thinning of the retinal nerve fiber layer (RNFL), ganglion cell/inner plexiform layer complex (GCL+IPL) and ganglion cell complex (GCC, RNFL+GCL+IPL) was observed between study groups in all comparisons. Significant difference was found in contrast in the RNFL, GCL+IPL, GCC, inner nuclear layer (INL) and outer plexiform layer when comparing MSON+ to the other groups. Higher fractal dimension values were observed in GCL+IPL and INL layers when comparing H vs. MSON+ groups. A significant difference was found in layer index in the RNFL, GCL+IPL and GCC layers in all comparisons. A significant difference was observed in total reflectance in the RNFL, GCL+IPL and GCC layers between the three examination groups. Conclusion Texture and optical properties of the retinal tissue undergo pronounced changes in MS even without optic neuritis. Our results may help to further improve the diagnostic efficacy of OCT in MS and neurodegeneration.
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Affiliation(s)
- Boglárka Enikő Varga
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Wei Gao
- Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Kornélia Lenke Laurik
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Erika Tátrai
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Magdolna Simó
- Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gábor Márk Somfai
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Delia Cabrera DeBuc
- Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
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142
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Shah P. Symptomatic management in multiple sclerosis. Ann Indian Acad Neurol 2015; 18:S35-42. [PMID: 26538847 PMCID: PMC4604696 DOI: 10.4103/0972-2327.164827] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 06/26/2015] [Accepted: 06/15/2015] [Indexed: 02/02/2023] Open
Abstract
Multiple sclerosis (MS) is the commonest cause of disability in young adults. While there is increasing choice and better treatments available for delaying disease progression, there are still, very few, effective symptomatic treatments. For many patients such as those with primary progressive MS (PPMS) and those that inevitably become secondary progressive, symptom management is the only treatment available. MS related symptoms are complex, interrelated, and can be interdependent. It requires good understanding of the condition, a holistic multidisciplinary approach, and above all, patient education and empowerment.
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Affiliation(s)
- Pushkar Shah
- Department of Neurology, Institute of Neurosciences, South Glasgow University Hospital NHS Trust, Glasgow, G51 4TF, United Kingdom
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143
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Hadhoum N, Hodel J, Defoort-Dhellemmes S, Duhamel A, Drumez E, Zéphir H, Pruvo JP, Leclerc X, Vermersch P, Outteryck O. Length of optic nerve double inversion recovery hypersignal is associated with retinal axonal loss. Mult Scler 2015; 22:649-58. [PMID: 26227005 DOI: 10.1177/1352458515598021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/07/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the association between optic nerve double inversion recovery (DIR) hypersignal length and retinal axonal loss in neuroinflammatory diseases affecting optic nerves. METHODS We recruited patients previously affected (> 6 months) by a clinical episode of optic neuritis (ON). We had 25 multiple sclerosis (MS) patients, eight neuromyelitis optica spectrum disorder (NMOSD) patients and two patients suffering from idiopathic caused ON undergo brain magnetic resonance imaging (MRI); including a 3-dimensional (3D) DIR sequence, optical coherence tomography (OCT) examination and visual disability evaluation. Evaluation criteria were retinal thickness/volume, optic nerve DIR hypersignal length and high/low contrast vision acuity. RESULTS In the whole cohort, we found good associations (< 0.0001) between optic nerve DIR hypersignal length, peripapillary retinal nerve fiber layer thickness, inner macular layers volumes, and visual disability. We found subclinical radiological optic nerve involvement in 38.5% of non-ON MS eyes. CONCLUSIONS Optic nerve DIR hypersignal length may be a biomarker for retinal axonal loss, easily applicable in routine and research on new anti-inflammatory or neuroprotective drug evaluation. Detection of subclinical ON with 3D-DIR in a non-negligible proportion of MS patients argues in favor of optic nerve imaging in future OCT MS studies, in order to achieve a better understanding of retinal axonal loss in non-ON eyes.
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Affiliation(s)
- N Hadhoum
- Roger Salengro Hospital, University of Lille, Lille, France
| | - J Hodel
- Roger Salengro Hospital, University of Lille, Lille, France
| | | | - A Duhamel
- Department of Biostatistics, Centre d'Etudes et de Recherche en Informatique Médicale, Lille, France
| | - E Drumez
- Department of Biostatistics, Centre d'Etudes et de Recherche en Informatique Médicale, Lille, France
| | - H Zéphir
- Roger Salengro Hospital, University of Lille, Lille, France
| | - J P Pruvo
- Roger Salengro Hospital, University of Lille, Lille, France
| | - X Leclerc
- Roger Salengro Hospital, University of Lille, Lille, France
| | - P Vermersch
- Roger Salengro Hospital, University of Lille, Lille, France
| | - O Outteryck
- Roger Salengro Hospital, University of Lille, Lille, France
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144
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Stellmann JP, Young KL, Pöttgen J, Dorr M, Heesen C. Introducing a new method to assess vision: Computer-adaptive contrast-sensitivity testing predicts visual functioning better than charts in multiple sclerosis patients. Mult Scler J Exp Transl Clin 2015; 1:2055217315596184. [PMID: 28607699 PMCID: PMC5433336 DOI: 10.1177/2055217315596184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Impaired low-contrast visual acuity (LCVA) is common in multiple sclerosis (MS) and other neurological diseases. Its assessment is often limited to selected contrasts, for example, 2.5% or 1.25%. Computerized adaptive testing with the quick contrast-sensitivity function (qCSF) method allows assessment across expanded contrast and spatial frequency ranges. Objective The objective of this article is to compare qCSF with high- and low-contrast charts and patient-reported visual function. Methods We enrolled 131 consecutive MS patients (mean age 39.6 years) to assess high-contrast visual acuity (HCVA) at 30 cm and 5 m, low-contrast vision with Sloan charts at 2.5% and 1.25%, qCSF and the National Eye Institute Visual Functioning Questionnaire (NEIVFQ). Associations between the different measures were estimated with linear regression models corrected for age, gender and multiple testing. Results The association between qCSF and Sloan charts (R2 = 0.68) was higher than with HCVA (5 m: R2 = 0.5; 30 cm: R2 = 0.41). The highest association with NEIVFQ subscales was observed for qCSF (R2 0.20–0.57), while Sloan charts were not associated with any NEIVFQ subscale after correction for multiple testing. Conclusion The qCSF is a promising new outcome for low-contrast vision in MS and other neurological diseases. Here we show a closer link to patient-reported visual function than standard low- and high-contrast charts.
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Affiliation(s)
- J P Stellmann
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany
| | - K L Young
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany
| | - J Pöttgen
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany
| | - M Dorr
- Adaptive Sensory Technology, Lübeck, Germany
| | - C Heesen
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany
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