1
|
Küchlin S, Ihorst G, Heinrich SP, Márquez Neila P, Albrecht P, Hug MJ, Diem R, Lagrèze WA. Disease Course of Clinically Isolated Optic Neuritis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200223. [PMID: 38588480 PMCID: PMC11010245 DOI: 10.1212/nxi.0000000000200223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/06/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND OBJECTIVES Optic neuritis is the most common optic neuropathy in young adults and a frequent manifestation of multiple sclerosis. Its clinical course is pertinent to the design of visual pathway neuroprotection trials. METHODS This is a secondary analysis of longitudinal data from the TONE trial, which included 103 patients from 12 German academic tertiary centers with acute unilateral optic neuritis as a clinically isolated syndrome and baseline high-contrast visual acuity <0.5 decimal. Patients were randomized to 1,000 mg methylprednisolone i.v./d plus either erythropoietin (33,000 IU/d) or placebo (saline solution) for 3 days. They were followed up at standardized intervals with a battery of tests including high-contrast visual acuity, low-contrast letter acuity, contrast sensitivity, visual fields, visual evoked potentials, and retinal optical coherence tomography. At 6 months, participants answered a standardized questionnaire on vision-related quality of life (NEI-VFQ 25). We describe the disease course with mixed-effects piecewise linear models and calculate structure-function correlations using Pearson r. Because erythropoietin had no effect on the visual system, we use pooled (treatment-agnostic) data. RESULTS Patients experienced initial rapid and then decelerating improvements of visual function with thinning of inner and thickening of outer retinal layers. At 6 months, visual parameters were positively correlated with inner and negatively correlated with outer retinal thickness changes. Peripapillary retinal nerve fiber layer thinning predominantly occurred in sectors without previous swelling. At 6 months, macular ganglion cell and inner plexiform layer thinning was weakly correlated with the P100 peak time (r = -0.11) and moderately correlated with the amplitude of visual evoked potentials (r = 0.35). Only functional outcomes were at least moderately correlated with vision-related quality of life. DISCUSSION The longitudinal data from this large study cohort may serve as a reference for the clinical course of acute optic neuritis. The pattern of correlation between visual evoked potentials and inner retinal thinning may argue that the latter is mostly due to ganglion cell loss, rather than dysfunction. Visual pathway neuroprotection trials with functional outcomes are needed to confirm that candidate drugs will benefit patients' vision-related quality of life. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov, NCT01962571.
Collapse
Affiliation(s)
- Sebastian Küchlin
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Gabriele Ihorst
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Sven P Heinrich
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Pablo Márquez Neila
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Philipp Albrecht
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Martin J Hug
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Ricarda Diem
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Wolf A Lagrèze
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| |
Collapse
|
2
|
Chaudhary P, Lockwood H, Stowell C, Bushong E, Reynaud J, Yang H, Gardiner SK, Wiliams G, Williams I, Ellisman M, Marsh-Armstrong N, Burgoyne C. Retrolaminar Demyelination of Structurally Intact Axons in Nonhuman Primate Experimental Glaucoma. Invest Ophthalmol Vis Sci 2024; 65:36. [PMID: 38407858 PMCID: PMC10902877 DOI: 10.1167/iovs.65.2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/28/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose To determine if structurally intact, retrolaminar optic nerve (RON) axons are demyelinated in nonhuman primate (NHP) experimental glaucoma (EG). Methods Unilateral EG NHPs (n = 3) were perfusion fixed, EG and control eyes were enucleated, and foveal Bruch's membrane opening (FoBMO) 30° sectoral axon counts were estimated. Optic nerve heads were trephined; serial vibratome sections (VSs) were imaged and colocalized to a fundus photograph establishing their FoBMO location. The peripheral neural canal region within n = 5 EG versus control eye VS comparisons was targeted for scanning block-face electron microscopic reconstruction (SBEMR) using micro-computed tomographic reconstructions (µCTRs) of each VS. Posterior laminar beams within each µCTR were segmented, allowing a best-fit posterior laminar surface (PLS) to be colocalized into its respective SBEMR. Within each SBEMR, up to 300 axons were randomly traced until they ended (nonintact) or left the block (intact). For each intact axon, myelin onset was identified and myelin onset distance (MOD) was measured relative to the PLS. For each EG versus control SBEMR comparison, survival analyses compared EG and control MOD. Results MOD calculations were successful in three EG and five control eye SBEMRs. Within each SBEMR comparison, EG versus control eye axon loss was -32.9%, -8.3%, and -15.2% (respectively), and MOD was increased in the EG versus control SBEMR (P < 0.0001 for each EG versus control SBEMR comparison). When data from all three EG eye SBEMRs were compared to all five control eye SBEMRs, MOD was increased within the EG eyes. Conclusions Structurally intact, RON axons are demyelinated in NHP early to moderate EG. Studies to determine their functional status are indicated.
Collapse
Affiliation(s)
- Priya Chaudhary
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Howard Lockwood
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Cheri Stowell
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Eric Bushong
- National Center for Microscopy & Imaging Research, UCSD, La Jolla, California, United States
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Stuart K Gardiner
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Galen Wiliams
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Imee Williams
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Mark Ellisman
- National Center for Microscopy & Imaging Research, UCSD, La Jolla, California, United States
| | - Nick Marsh-Armstrong
- Department of Ophthalmology, University of California, Davis, California, United States
| | - Claude Burgoyne
- Optic Nerve Head Research Laboratory, Legacy Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| |
Collapse
|
3
|
Habek M, Blazekovic A, Gotovac Jercic K, Pivac N, Outero TF, Borovecki F, Brinar V. Genome-Wide Expression Profile in People with Optic Neuritis Associated with Multiple Sclerosis. Biomedicines 2023; 11:2209. [PMID: 37626706 PMCID: PMC10452153 DOI: 10.3390/biomedicines11082209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of this study was to perform a genome-wide expression analysis of whole-blood samples from people with optic neuritis (ON) and to determine differentially expressed mRNAs compared to healthy control subjects. The study included eight people with acute ON and six healthy control subjects. Gene expression was analyzed using DNA microarrays for whole-human-genome analysis, which contain 54,675 25-base pairs. The additional biostatistical analysis included gene ontology analysis and gene set enrichment analysis (GSEA). Quantitative RT-PCR (qPCR) was used to confirm selected differentially expressed genes. In total, 722 differently expressed genes were identified, with 377 exhibiting increased, and 345 decreased, expression. Gene ontology analysis and GSEA revealed that protein phosphorylation and intracellular compartment, apoptosis inhibition, pathways involved in cell cycles, T and B cell functions, and anti-inflammatory central nervous system (CNS) pathways are implicated in ON pathology. qPCR confirmed the differential expression of eight selected genes, with SLPI, CR3, and ITGA4 exhibiting statistically significant results. In conclusion, whole-blood gene expression analysis showed significant differences in the expression profiles of people with ON compared to healthy control subjects. Additionally, pathways involved in T cell regulation and anti-inflammatory pathways within CNS were identified as important in the early phases of MS.
Collapse
Affiliation(s)
- Mario Habek
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Antonela Blazekovic
- Department for Functional Genomics, Center for Translational and Clinical Research, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- Department for Anatomy and Clinical Anatomy, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Kristina Gotovac Jercic
- Department for Functional Genomics, Center for Translational and Clinical Research, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Nela Pivac
- Division of Molecular Medicine, Rudjer Bošković Institute, 10002 Zagreb, Croatia
| | - Tiago Fleming Outero
- Department of Experimental Neurodegeneration, Centre for Biostructural Imaging of Neurodegeneration, University Medical Centre Göttingen, 37075 Göttingen, Germany
- Max Planck Institute for Experimental Medicine, 37075 Göttingen, Germany
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE1 7RU, UK
- German Centre for Neurodegenerative Diseases (DZNE), 17475 Göttingen, Germany
| | - Fran Borovecki
- Department for Functional Genomics, Center for Translational and Clinical Research, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Vesna Brinar
- Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| |
Collapse
|
4
|
Gandhi F, Jhaveri S, Avanthika C, Singh A, Jain N, Gulraiz A, Shah P, Nasir F. Impact of Vitamin D Supplementation on Multiple Sclerosis. Cureus 2021; 13:e18487. [PMID: 34754649 PMCID: PMC8567111 DOI: 10.7759/cureus.18487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease affecting a large number of people every year. The exact causal factor for this disease is unclear, but it commonly affects middle-aged women, with known triggers like stress, childbirth, infections, poor diet, lack of sleep, etc. Many epidemiological studies have indicated that various genetic abnormalities are also critical drivers of the onset of MS. The major risk factors of MS identified include hypovitaminosis D while environmental protective factors include allele HLA DRB1 1501, obesity, Epstein-Barr virus infection, sexual hormones, and smoking. Our article explores the correlation between the deficiency of vitamin D and the onset and progression of MS. The study uses a systematic review methodology by researching and reviewing scholarly articles exploring the topic. We conducted online searches of literature on Google Scholar and PubMed using the keywords "vitamin D deficiency" and "multiple sclerosis" and accessed the relevant secondary literature sources for review. The variables under study included vitamin D insufficiency as the dependent variable while MS was the independent variable. Causal variables included environmental, genetic, and protective factors. We hypothesized that there is indeed a correlation between vitamin D deficiency and MS. The findings from our review indicate a strong correlation between the insufficiency of vitamin D and the onset and progression of MS. These results are essential in devising interventions to accomplish primary and secondary prevention of MS, as well as integrating vitamin D supplementation in current treatment protocols for MS.
Collapse
Affiliation(s)
- Fenil Gandhi
- Internal Medicine, Shree Krishna Hospital, Anand, IND
| | - Sharan Jhaveri
- Internal Medicine, Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Chaithanya Avanthika
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND.,Pediatrics, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Abhishek Singh
- Internal Medicine, Mount Sinai Morningside, New York City, USA
| | - Nidhi Jain
- Internal Medicine, Sir Ganga Ram Hospital, New Delhi, IND
| | - Azouba Gulraiz
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | - Fareeha Nasir
- Internal Medicine, Harlem Hospital Center, New York City, USA
| |
Collapse
|
5
|
Liao L, Fang R, Fang F, Zhu XH. Clinical observations of acute onset of myopic optic neuropathy in a real-world setting. Int J Ophthalmol 2021; 14:461-467. [PMID: 33747826 DOI: 10.18240/ijo.2021.03.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/24/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To describe the clinical features of acute myopic onset of optic neuropathy and observe the effects of retrobulbar and systemic glucocorticoid therapy in a real-world setting. METHODS A retrospective observational case series included 18 patients with a clinical diagnosis of acute onset of myopic optic neuropathy in a real-world setting. While the patients were using retrobulbar and systemic glucocorticoid therapy, various imaging examination data were analysed, and the clinical features of myopic optic neuropathy were summarized for 6mo to 2y. RESULTS The included group of patients with acute onset of myopic optic neuropathy consisted mostly of females (n=11). The visual field (VF) showed abnormalities in bilateral eyes, including the spread of physiological blind spots, central and paracentral dark spots, and centripetal peripheral VF reduction; but central vision with no subjective changes. The visual evoked potential (VEP) was abnormal in all eyes with vision loss. The best corrected visual acuity (BCVA) was improved from 1.04±0.63 to 0.47±0.57 (logMAR) after glucocorticoid treatment (P<0.05). In patients with a short course (within 1wk), recovery was fast and achieved the same BCVA as recorded before the onset within 6d. However, in patients with the long course (1 to 2wk), recovery was slow and did not achieve the BCVA recorded before the onset within 10d. The changes of intraocular pressure (IOP) were not obvious before and after treatment (18.68±5.30 vs 19.55±5.34 mm Hg, P>0.05). There was no recurrence during long-term follow-up observation. CONCLUSION The acute onset of myopic optic neuropathy is characterized by BCVA and VF abnormalities in bilateral eyes. Retrobulbar and systemic glucocorticoid therapy is effective.
Collapse
Affiliation(s)
- Li Liao
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China.,Changsha Aier Eye Hospital, Changsha 410015, Hunan Province, China
| | - Rui Fang
- Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Fang Fang
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Xiao-Hua Zhu
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China.,Changsha Aier Eye Hospital, Changsha 410015, Hunan Province, China
| |
Collapse
|
6
|
Svrčinová T, Hok P, Šínová I, Dorňák T, Král M, Hübnerová P, Mareš J, Kaňovský P, Šín M. Changes in oxygen saturation and the retinal nerve fibre layer in patients with optic neuritis associated with multiple sclerosis in a 6-month follow-up. Acta Ophthalmol 2020; 98:841-847. [PMID: 32395882 PMCID: PMC7754403 DOI: 10.1111/aos.14463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/19/2020] [Accepted: 04/18/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Optic neuritis (ON) is an inflammatory demyelinating disorder of the optic nerve, which can be the first manifestation of multiple sclerosis (MS). The main goal was to assess changes in the retinal nerve fibre layer (RNFL) and in retinal oxygen saturation [arterial (AS), venous (VS) and arterio-venous (A-V) difference] in the affected and unaffected eye. METHODS Fifty patients with ON due to MS within 3 months of onset of symptoms were enrolled (17 males, mean age 35.3). All patients were examined at baseline (V1) and after 6 months (V2) using optical coherence tomography (OCT) to get RNFL values; automatic retinal oximetry to obtain saturation values; and ultrasound to exclude arterial stenosis, and orbital colour Doppler imaging was performed in the ophthalmic artery. RESULTS At V1, AS was significantly increased in affected eye compared to unaffected eye (99.5% versus 98.0%, p = 0.03). Significant decrease in A-V difference from baseline was detected in both eyes for ON eye: 32.0% versus 29.0%, p = 0.004; for fellow eye: 31.4% versus 30.0%, p = 0.04. We did not observe any changes in retinal vessel diameter. There were no changes observed in blood flow in ophthalmic artery. At V1, there were no significant differences in RNFL, and significant loss of RNFL was confirmed in the affected eye at V2 (95 μm versus 86 μm, p = 0.0002) and in comparison with the fellow eye (86 μm versus 94 μm, p = 0.0002). There were no correlations between RNFL and saturation values at V1, although at V2, there was a negative correlation between the RNFL and AS (Spearman's rho = -0.480, p = 0.003) and between the RNFL and VS (rho = -0.620, p = 0.00007). CONCLUSION Retinal oximetry is altered in both eyes in MS patients with unilateral ON. During the course of the disease, the retinal oxygen consumption decreases to a different degree in each eye and this change is not completely followed by changes in the RNFL thickness, suggesting either sub-clinical ON or systemic effects in the clinically unaffected eye. Since this is the first and initial longitudinal evaluation of the saturation changes in MS patients, the clinical value of these findings needs to be deeper evaluated in the future studies.
Collapse
Affiliation(s)
- Tereza Svrčinová
- Department of NeurologyFaculty of Medicine and DentistryUniversity HospitalPalacký University OlomoucOlomoucCzech Republic
| | - Pavel Hok
- Department of NeurologyFaculty of Medicine and DentistryUniversity HospitalPalacký University OlomoucOlomoucCzech Republic
| | - Irena Šínová
- Department of OphthalmologyFaculty of Medicine and DentistryUniversity HospitalPalacký University OlomoucOlomoucCzech Republic
| | - Tomáš Dorňák
- Department of NeurologyFaculty of Medicine and DentistryUniversity HospitalPalacký University OlomoucOlomoucCzech Republic
| | - Michal Král
- Department of NeurologyFaculty of Medicine and DentistryUniversity HospitalPalacký University OlomoucOlomoucCzech Republic
| | - Petra Hübnerová
- Department of OphthalmologyFaculty of Medicine and DentistryUniversity HospitalPalacký University OlomoucOlomoucCzech Republic
| | - Jan Mareš
- Department of NeurologyFaculty of Medicine and DentistryUniversity HospitalPalacký University OlomoucOlomoucCzech Republic
| | - Petr Kaňovský
- Department of NeurologyFaculty of Medicine and DentistryUniversity HospitalPalacký University OlomoucOlomoucCzech Republic
| | - Martin Šín
- Department of OphthalmologyFaculty of Medicine and DentistryUniversity HospitalPalacký University OlomoucOlomoucCzech Republic
| |
Collapse
|
7
|
Herrero-Morant A, Álvarez-Reguera C, Martín-Varillas JL, Calvo-Río V, Casado A, Prieto-Peña D, Atienza-Mateo B, Maiz-Alonso O, Blanco A, Vicente E, Rúa-Figueroa Í, Cáceres-Martin L, García-Serrano JL, Callejas-Rubio JL, Ortego-Centeno N, Narváez J, Romero-Yuste S, Sánchez J, Estrada P, Demetrio-Pablo R, Martínez-López D, Castañeda S, Hernández JL, González-Gay MÁ, Blanco R. Biologic Therapy in Refractory Non-Multiple Sclerosis Optic Neuritis Isolated or Associated to Immune-Mediated Inflammatory Diseases. A Multicenter Study. J Clin Med 2020; 9:E2608. [PMID: 32796717 PMCID: PMC7464396 DOI: 10.3390/jcm9082608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 01/24/2023] Open
Abstract
We aimed to assess the efficacy of biologic therapy in refractory non-Multiple Sclerosis (MS) Optic Neuritis (ON), a condition more infrequent, chronic and severe than MS ON. This was an open-label multicenter study of patients with non-MS ON refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were Best Corrected Visual Acuity (BCVA) and both Macular Thickness (MT) and Retinal Nerve Fiber Layer (RNFL) using Optical Coherence Tomography (OCT). These outcome variables were assessed at baseline, 1 week, and 1, 3, 6 and 12 months after biologic therapy initiation. Remission was defined as the absence of ON symptoms and signs that lasted longer than 24 h, with or without an associated new lesion on magnetic resonance imaging with gadolinium contrast agents for at least 3 months. We studied 19 patients (11 women/8 men; mean age, 34.8 ± 13.9 years). The underlying diseases were Bechet's disease (n = 5), neuromyelitis optica (n = 3), systemic lupus erythematosus (n = 2), sarcoidosis (n = 1), relapsing polychondritis (n = 1) and anti-neutrophil cytoplasmic antibody -associated vasculitis (n = 1). It was idiopathic in 6 patients. The first biologic agent used in each patient was: adalimumab (n = 6), rituximab (n = 6), infliximab (n = 5) and tocilizumab (n = 2). A second immunosuppressive drug was simultaneously used in 11 patients: methotrexate (n = 11), azathioprine (n = 2), mycophenolate mofetil (n = 1) and hydroxychloroquine (n = 1). Improvement of the main outcomes was observed after 1 year of therapy when compared with baseline data: mean ± SD BCVA (0.8 ± 0.3 LogMAR vs. 0.6 ± 0.3 LogMAR; p = 0.03), mean ± SD RNFL (190.5 ± 175.4 μm vs. 183.4 ± 139.5 μm; p = 0.02), mean ± SD MT (270.7 ± 23.2 μm vs. 369.6 ± 137.4 μm; p = 0.03). Besides, the median (IQR) prednisone-dose was also reduced from 40 (10-61.5) mg/day at baseline to. 2.5 (0-5) mg/day after one year of follow-up; p = 0.001. After a mean ± SD follow-up of 35 months, 15 patients (78.9%) achieved ocular remission, and 2 (10.5%) experienced severe adverse events. Biologic therapy is effective in patients with refractory non-MS ON.
Collapse
Affiliation(s)
- Alba Herrero-Morant
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Carmen Álvarez-Reguera
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | | | - Vanesa Calvo-Río
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Alfonso Casado
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Diana Prieto-Peña
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Belén Atienza-Mateo
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Olga Maiz-Alonso
- Rheumatology and Ophtalmology, Hospital de Donostia, Paseo Dr. Begiristain, 117, 20080 Donostia, Spain; (O.M.-A.); (A.B.)
| | - Ana Blanco
- Rheumatology and Ophtalmology, Hospital de Donostia, Paseo Dr. Begiristain, 117, 20080 Donostia, Spain; (O.M.-A.); (A.B.)
| | - Esther Vicente
- Rheumatology, Hospital Universitario de La Princesa, C/Diego de León, 62, 28006 Madrid, Spain; (E.V.); (S.C.)
| | - Íñigo Rúa-Figueroa
- Rheumatology, Hospital Universitario de Gran Canaria Doctor Negrín, C/Plaza Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Spain; (Í.R.-F.); (L.C.-M.)
| | - Laura Cáceres-Martin
- Rheumatology, Hospital Universitario de Gran Canaria Doctor Negrín, C/Plaza Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Spain; (Í.R.-F.); (L.C.-M.)
| | - José L. García-Serrano
- Internal Medicine and Ophtalmology, Hospital San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain; (J.L.G.-S.); (J.L.C.-R.); (N.O.-C.)
| | - José Luis Callejas-Rubio
- Internal Medicine and Ophtalmology, Hospital San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain; (J.L.G.-S.); (J.L.C.-R.); (N.O.-C.)
| | - Norberto Ortego-Centeno
- Internal Medicine and Ophtalmology, Hospital San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain; (J.L.G.-S.); (J.L.C.-R.); (N.O.-C.)
| | - Javier Narváez
- Rheumatology, Hospital de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain;
| | - Susana Romero-Yuste
- Rheumatology, Complejo Hospitalario Universitario de Pontevedra, Loureiro Crespo, 2, 36002 Pontevedra, Spain;
| | - Julio Sánchez
- Rheumatology, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain;
| | - Paula Estrada
- Rheumatology, Hospital de Sant Joan Despí Moisès Broggi, Carrer de Jacint Verdaguer, 90, 08970 Sant Joan Despí, Spain;
| | - Rosalía Demetrio-Pablo
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - David Martínez-López
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Santos Castañeda
- Rheumatology, Hospital Universitario de La Princesa, C/Diego de León, 62, 28006 Madrid, Spain; (E.V.); (S.C.)
| | - José L. Hernández
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Miguel Á. González-Gay
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Ricardo Blanco
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| |
Collapse
|
8
|
Altered hypothalamic metabolism in early multiple sclerosis – MR spectroscopy study. J Neurol Sci 2019; 407:116458. [DOI: 10.1016/j.jns.2019.116458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 08/19/2019] [Accepted: 09/10/2019] [Indexed: 12/31/2022]
|
9
|
Mercury in the retina and optic nerve following prenatal exposure to mercury vapor. PLoS One 2019; 14:e0220859. [PMID: 31390377 PMCID: PMC6685637 DOI: 10.1371/journal.pone.0220859] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023] Open
Abstract
Damage to the retina and optic nerve is found in some neurodegenerative disorders, but it is unclear whether the optic pathway and central nervous system (CNS) are affected by the same injurious agent, or whether optic pathway damage is due to retrograde degeneration following the CNS damage. Finding an environmental agent that could be responsible for the optic pathway damage would support the hypothesis that this environmental toxicant also triggers the CNS lesions. Toxic metals have been implicated in neurodegenerative disorders, and mercury has been found in the retina and optic nerve of experimentally-exposed animals. Therefore, to see if mercury exposure in the prenatal period could be one link between optic pathway damage and human CNS disorders of later life, we examined the retina and optic nerve of neonatal mice that had been exposed prenatally to mercury vapor, using a technique, autometallography, that detects the presence of mercury within cells. Pregnant mice were exposed to a non-toxic dose of mercury vapor for four hours a day for five days in late gestation, when the mouse placenta most closely resembles the human placenta. The neonatal offspring were sacrificed one day after birth and gapless serial sections of formalin-fixed paraffin-embedded blocks containing the eyes were stained with silver nitrate autometallography to detect inorganic mercury. Mercury was seen in the nuclear membranes of retinal ganglion cells and endothelial cells. A smaller amount of mercury was present in the retinal inner plexiform and inner nuclear layers. Mercury was conspicuous in the peripapillary retinal pigment epithelium. In the optic nerve, mercury was seen in the nuclear membranes and processes of glia and in endothelial cells. Optic pathway and CNS endothelial cells contained mercury. In conclusion, mercury is taken up preferentially by fetal retinal ganglion cells, optic nerve glial cells, the retinal pigment epithelium, and endothelial cells. Mercury induces free radical formation, autoimmunity, and genetic and epigenetic changes, so these findings raise the possibility that mercury plays a part in the pathogenesis of degenerative CNS disorders that also affect the retina and optic nerve.
Collapse
|
10
|
Santandrea E, Sani I, Morbioli G, Multari D, Marchini G, Chelazzi L. Optic Nerve Degeneration and Reduced Contrast Sensitivity Due to Folic Acid Deficiency: A Behavioral and Electrophysiological Study in Rhesus Monkeys. Invest Ophthalmol Vis Sci 2018; 59:6045-6056. [PMID: 30574659 DOI: 10.1167/iovs.18-24822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of the research was to elucidate the role of folic acid (B9) deficiency in the development of nutritional optic neuritis and to characterize the neurophysiological consequences of optic nerve degeneration in the cortical visual system. Methods A combined behavioral and electrophysiological approach was applied to study luminance contrast sensitivity in two macaque monkeys affected by nutritional optic neuritis and in two healthy monkeys for comparison. For one monkey, a follow-up approach was applied to compare visual performance before onset of optic neuropathy, during the disease, and after treatment. Results Optic nerve degeneration developed as a consequence of insufficient dietary intake of folic acid in two exemplars of macaque monkeys. The degeneration resulted in markedly reduced luminance contrast sensitivity as assessed behaviorally. In one monkey, we also measured visual activity in response to varying contrast at the level of single neurons in the cortical visual system and found a striking reduction in contrast sensitivity, as well as a marked increase in the latency of neuronal responses. Prolonged daily folate supplementation resulted in a significant recovery of function. Conclusions Folic acid deficiency per se can lead to the development of optic nerve degeneration in otherwise healthy adult animals. The optic nerve degeneration strongly affects contrast sensitivity and leads to a distinct reduction in the strength and velocity of the incoming signal to cortical visual areas of the macaque brain, without directly affecting excitability and functional properties of cortical neurons.
Collapse
Affiliation(s)
- Elisa Santandrea
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ilaria Sani
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,The Rockefeller University, New York, New York, United States
| | - Gianpaolo Morbioli
- Interdepartmental Centre of Experimental Research Service, University of Verona, Verona, Italy
| | - Domenico Multari
- CVO Fontane, Centro Veterinario Oculistico, Fontane di Villorba, Treviso, Italy
| | - Giorgio Marchini
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Leonardo Chelazzi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,National Institute of Neuroscience, Verona, Italy
| |
Collapse
|
11
|
Al-Louzi O, Prasad S, Mallery RM. Utility of optical coherence tomography in the evaluation of sellar and parasellar mass lesions. Curr Opin Endocrinol Diabetes Obes 2018; 25:274-284. [PMID: 29771751 DOI: 10.1097/med.0000000000000415] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Anterior visual pathway compression is a common feature of sellar region masses. We review the visual pathway neuroanatomy pertaining to sellar and parasellar lesions and describe recent advances in optical coherence tomography (OCT) imaging that have provided a novel quantitative perspective in the evaluation and management of such patients. RECENT FINDINGS Ultrastructural measurements of optic nerve integrity using OCT, namely peripapillary retinal nerve fiber layer (pRNFL) and the ganglion cell and inner plexiform layer (GCIPL) thicknesses, have been shown to correlate with visual acuity and visual field deficits on perimetry in patients with compressive sellar region masses. In some cases, OCT can visualize early signs of anterior visual pathway involvement in the absence of clinically evident visual field loss or optic disc pallor. OCT is particularly useful when assessing patients who demonstrate less reliable visual field testing. Furthermore, there is growing awareness that pRNFL and GCIPL thinning preoperatively correlate with worse visual recovery following chiasmal decompression, highlighting the prognostic utility of OCT in this patient population. SUMMARY OCT provides a complimentary, yet critical, role in quantitatively assessing ultrastructural retinal injury in patients with sellar and parasellar lesions compressing the anterior visual pathway and should be incorporated into routine evaluation.
Collapse
Affiliation(s)
- Omar Al-Louzi
- Department of Neurology, Brigham and Women's Hospital
- Department of Neurology, Massachusetts General Hospital
| | | | - Robert M Mallery
- Department of Neurology, Brigham and Women's Hospital
- Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O. Multiple sclerosis. Lancet 2018; 391:1622-1636. [PMID: 29576504 DOI: 10.1016/s0140-6736(18)30481-1] [Citation(s) in RCA: 1084] [Impact Index Per Article: 180.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 12/13/2022]
Abstract
Multiple sclerosis continues to be a challenging and disabling condition but there is now greater understanding of the underlying genetic and environmental factors that drive the condition, including low vitamin D levels, cigarette smoking, and obesity. Early and accurate diagnosis is crucial and is supported by diagnostic criteria, incorporating imaging and spinal fluid abnormalities for those presenting with a clinically isolated syndrome. Importantly, there is an extensive therapeutic armamentarium, both oral and by infusion, for those with the relapsing remitting form of the disease. Careful consideration is required when choosing the correct treatment, balancing the side-effect profile with efficacy and escalating as clinically appropriate. This move towards more personalised medicine is supported by a clinical guideline published in 2018. Finally, a comprehensive management programme is strongly recommended for all patients with multiple sclerosis, enhancing health-related quality of life through advocating wellness, addressing aggravating factors, and managing comorbidities. The greatest remaining challenge for multiple sclerosis is the development of treatments incorporating neuroprotection and remyelination to treat and ultimately prevent the disabling, progressive forms of the condition.
Collapse
Affiliation(s)
- Alan J Thompson
- Queen Square MS Centre, UCL Institute of Neurology, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Sergio E Baranzini
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Jeroen Geurts
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, Netherlands
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Olga Ciccarelli
- Queen Square MS Centre, UCL Institute of Neurology, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK
| |
Collapse
|
13
|
Yoo YJ, Hwang JM, Yang HK. Differences in pupillary light reflex between optic neuritis and ischemic optic neuropathy. PLoS One 2017; 12:e0186741. [PMID: 29049405 PMCID: PMC5648212 DOI: 10.1371/journal.pone.0186741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 10/08/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives To determine the differences in pupillary light reflex (PLR) between the acute and chronic phases of optic neuritis (ON) and nonarteritic anterior ischemic optic neuropathy (NAION). Methods The study included 30 patients with ON and 22 patients with NAION whose PLR were measured by a dynamic pupillometer (PLR-200; NeurOptics Inc., Irvine, USA). Age-matched controls included 58 healthy individuals with normal vision and optic nerve function. Pupil diameters, latency, constriction ratio, constriction velocity and dilation velocity were noted. The differences in PLR measurements were compared among the acute and chronic phases of ON and NAION, and in age-matched controls. Regression analysis determined factors associated with PLR measurements, including visual acuity, color vision defect, visual field defects and retinal nerve fiber layer thickness measurements on optical coherence tomography. Results Pupillary constriction velocity, constriction ratio and latency were all significantly decreased in the acute phase of ON and NAION. ON showed significantly delayed constriction latency compared to NAION (P = 0.047). Pupillary constriction velocity, constriction ratio and latency were recovered in the chronic phase of ON (P = 0.038, 0.018, and 0.045), however, these parameters were not recovered in NAION (P = 0.693, 0.173 and 0.994). Conclusions Pupillary constriction velocity, constriction ratio, and latency were significantly decreased in the acute phase of ON and NAION compared to normal controls. ON showed delayed constriction latency compared to NAION. Decreased PLR were recovered in the chronic phase of ON, but not in NAION.
Collapse
Affiliation(s)
- Yung Ju Yoo
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| |
Collapse
|
14
|
Dichoptic Metacontrast Masking Functions to Infer Transmission Delay in Optic Neuritis. PLoS One 2016; 11:e0163375. [PMID: 27711139 PMCID: PMC5053444 DOI: 10.1371/journal.pone.0163375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 09/06/2016] [Indexed: 11/19/2022] Open
Abstract
Optic neuritis (ON) has detrimental effects on the transmission of neuronal signals generated at the earliest stages of visual information processing. The amount, as well as the speed of transmitted visual signals is impaired. Measurements of visual evoked potentials (VEP) are often implemented in clinical routine. However, the specificity of VEPs is limited because multiple cortical areas are involved in the generation of P1 potentials, including feedback signals from higher cortical areas. Here, we show that dichoptic metacontrast masking can be used to estimate the temporal delay caused by ON. A group of 15 patients with unilateral ON, nine of which had sufficient visual acuity and volunteered to participate, and a group of healthy control subjects (N = 8) were presented with flashes of gray disks to one eye and flashes of gray annuli to the corresponding retinal location of the other eye. By asking subjects to report the subjective visibility of the target (i.e. the disk) while varying the stimulus onset asynchrony (SOA) between disk and annulus, we obtained typical U-shaped masking functions. From these functions we inferred the critical SOAmax at which the mask (i.e. the annulus) optimally suppressed the visibility of the target. ON-associated transmission delay was estimated by comparing the SOAmax between conditions in which the disk had been presented to the affected and the mask to the other eye, and vice versa. SOAmax differed on average by 28 ms, suggesting a reduction in transmission speed in the affected eye. Compared to previously reported methods assessing perceptual consequences of altered neuronal transmission speed the presented method is more accurate as it is not limited by the observers’ ability to judge subtle variations in perceived synchrony.
Collapse
|
15
|
|
16
|
Lopes Costa S, Gonçalves OF, DeLuca J, Chiaravalloti N, Chakravarthi R, Almeida J. The Temporal Dynamics of Visual Processing in Multiple Sclerosis. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:133-40. [DOI: 10.1080/23279095.2015.1020157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Silvana Lopes Costa
- Neuropsychophysiology Lab-CIPsi, University of Minho, Braga, Portugal
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Oscar F. Gonçalves
- Neuropsychophysiology Lab-CIPsi, University of Minho, Braga, Portugal
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - John DeLuca
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Neurology and Neurosciences, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nancy Chiaravalloti
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Jorge Almeida
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Proaction Lab, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
17
|
Wu GF, Parker Harp CR, Shindler KS. Optic Neuritis: A Model for the Immuno-pathogenesis of Central Nervous System Inflammatory Demyelinating Diseases. ACTA ACUST UNITED AC 2015; 11:85-92. [PMID: 29399010 DOI: 10.2174/1573395511666150707181644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Evidence for the tenuous regulation between the immune system and central nervous system (CNS) can be found with examples of interaction between these organ systems gone awry. Multiple sclerosis (MS) is the prototypical inflammatory disease of the CNS and is characterized by widely distributed inflammatory demyelinating plaques that can involve the brain, spinal cord and/or optic nerves. Optic neuritis (ON), inflammatory injury of the optic nerve that frequently occurs in patients with MS, has been the focus of intense study in part given the readily accessible nature of clinical outcome measures. Exploring the clinical and pathological features of ON in relation to other inflammatory demyelinating conditions of the CNS, namely MS and neuromyelitis optica, provides an opportunity to glean common and distinct mechanisms of disease. Emerging data from clinical studies along with various animal models involving ON implicate innate and adaptive immune responses directed at glial targets, including myelin oligodendrocyte glycoprotein and aquaporin 4. Resolution of inflammation in ON is commonly observed both clinically and experimentally, but persistent nerve injury is also one emerging hallmark of ON. One hypothesis seeking evaluation is that, in comparison to other sites targeted in MS, the optic nerve is a highly specialized target within the CNS predisposing to unique immunologic processes that generate ON. Overall, ON serves as a highly relevant entity for understanding the pathogenesis of other CNS demyelinating conditions, most notably MS.
Collapse
Affiliation(s)
- Gregory F Wu
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.,Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Chelsea R Parker Harp
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Kenneth S Shindler
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, PA 19004, USA
| |
Collapse
|
18
|
Chilińska A, Ejma M, Turno-Kręcicka A, Guranski K, Misiuk-Hojlo M. Analysis of retinal nerve fibre layer, visual evoked potentials and relative afferent pupillary defect in multiple sclerosis patients. Clin Neurophysiol 2015; 127:821-826. [PMID: 26251105 DOI: 10.1016/j.clinph.2015.06.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 06/24/2015] [Accepted: 06/27/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to analyse retinal nerve fibre layer (RNFL), pattern-reversal visual evoked potentials (pVEPs) and relative afferent pupillary defect (RAPD) changes in multiple sclerosis (MS) patients with the consideration of past optic neuritis (ON). METHODS Ophthalmological, neurological, OCT, RNFL and pVEP studies were conducted in 59 MS patients. RAPD tests were performed in 47 of them. Control group consisted of 28 healthy volunteers. RESULTS Abnormal RNFL was found in 59% of cases of eyes with ON and 28% of eyes without ON. In eyes with ON, significantly lower RNFL values were indicated in the temporal and lower quadrants. Elongation of pVEP latency was found in 83% of eyes with ON and 60% of eyes without ON. The average value of pVEP latency was larger and the amplitude was lower in the subgroup of eyes with RNFL at the borderline or below the norm. RAPD was observed only in eyes with ON and with RNFL thinning. No association was found between the RAPD and pVEP parameters. CONCLUSIONS VEPs were more frequently abnormal than RNFL in MS patients. RNFL damage in eyes without ON may indicate neurodegenerations in CNS of MS patients; it can also be the consequence of subclinical ON. SIGNIFICANCE An analysis of RNFL and VEP can be useful for evaluating the optic nerve in MS patients.
Collapse
Affiliation(s)
- Adriana Chilińska
- Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Marta Misiuk-Hojlo
- Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
19
|
Verma R, Gupta M, Chaudhari TS. Neurogenic vision loss: Causes and outcome. An experience from a tertiary center in Northern India. J Neurosci Rural Pract 2014; 5:340-8. [PMID: 25288834 PMCID: PMC4173229 DOI: 10.4103/0976-3147.139971] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Vision loss can be a consequence of numerous disorders of eye and neural pathway conveying visual input to brain. A variety of conditions can affect visual pathway producing neurogenic vision loss. The presentation and course of vision loss depends on the site of involvement and underlying etiology. We conducted this unprecedented study to evaluate the characteristics and outcome of various diseases of the visual pathway. MATERIALS AND METHODS In this prospective cohort study, we evaluated 64 patients with neurogenic visual impairment. Ophthalmological causes were excluded in all of them. Their presentation, ophthalmological characteristics and investigation findings were recorded. These patients were followed up till 6 months. RESULTS Out of 69 patients evaluated, 5 were excluded as they had ophthalmological abnormalities. The remaining 64 cases (113 eyes) were enrolled. 54 cases were due to diseases of anterior visual pathway and rest 10 had cortical vision loss. The etiologic distribution is as follows: Isolated optic neuritis- 12 (19%), multiple sclerosis- 4 (6.3%), neuromyelitis optica- 5 (7.9%), tubercular meningitis- 15 (23.8%), non-arteritic ischemic optic neuropathy, ischemic optic neuropathy complicating cavernous sinus thrombosis, cryptococcal meningitis, malignant infiltration of optic nerve, Crouzon's syndrome, calvarial thickening and traumatic occipital gliosis- 1 (1.6%) case each, idiopathic intracranial hypertension, pituitary adenoma, acute disseminated encephalomyelitis, posterior reversible leukoencephalopathy- 3 (4.8%) cases each, cortical venous thrombosis 5 (7.9%), subacute scleroing panencephalitis- 4 (6.3%) cases. CONCLUSIONS The diseases of anterior visual pathway were much more common than cortical vision loss. A majority of our patients had severe impairment of vision at presentation.
Collapse
Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Mani Gupta
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | | |
Collapse
|
20
|
Castro SMC, Damasceno A, Damasceno BP, Vasconcellos JPD, Reis F, Iyeyasu JN, Carvalho KMD. Visual pathway abnormalities were found in most multiple sclerosis patients despite history of previous optic neuritis. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:437-41. [PMID: 23857611 DOI: 10.1590/0004-282x20130058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 12/26/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE It was to investigate visual field (VF) abnormalities in a group of multiple sclerosis (MS) patients in the remission phase and the presence of magnetic resonance imaging (MRI) lesions in the optic radiations. METHODS VF was assessed in 60 participants (age range 20-51 years): 35 relapsing-remitting MS patients [20 optic neuritis (+), 15 optic neuritis (-)] and 25 controls. MRI (3-Tesla) was obtained in all patients. RESULTS Visual parameters were abnormal in MS patients as compared to controls. The majority of VF defects were diffuse. All patients except one had posterior visual pathways lesions. No significant difference in lesion number, length and distribution was noted between patients with and without history of optic neuritis. One patient presented homonymous hemianopsia. CONCLUSION Posterior visual pathway abnormalities were found in most MS patients despite history of previous optic neuritis.
Collapse
Affiliation(s)
- Stella Maris Costa Castro
- Department of Ophthalmo-Otolaryngology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas SP, Brazil.
| | | | | | | | | | | | | |
Collapse
|
21
|
Huseyinoglu N, Ozben S, Ekinci M, Buyukuysal C, Yıldırım M, Safak H, Huseyin H. Optical Coherence Tomography in Patients with Relapsing-Remitting Multiple Sclerosis without Optic Neuritis: A 20-Month Longitudinal Study. Neuroophthalmology 2013; 37:104-110. [PMID: 28163764 DOI: 10.3109/01658107.2013.792358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/06/2013] [Accepted: 03/21/2013] [Indexed: 11/13/2022] Open
Abstract
Optical coherence tomography is supported and used as a technique for visualisation of neuro-axonal loss in multiple sclerosis, but there are also a few studies expressing the opposite view. The aim of our study was to investigate retinal nerve fibre layer and optic nerve head parameters in patients with multiple sclerosis without a history of prior optic neuritis and symptoms of a new clinical attack during the follow-up for a total of 20-month period. Full ophthalmic evaluation was performed for all of the participants. The baseline retinal nerve fibre layer and macular thicknesses and focal and global loss of macular volume values were significantly lower in the eyes of the patients with multiple sclerosis compared with the healthy controls. No significant change between baseline and follow-up scans were found in all optical coherence tomography parameters in the multiple sclerosis group. Statistical analyses revealed significant retinal nerve fibre layer and macular thickness differences between baseline and second measurements in the controls. No significant difference in percent change between baseline and second measurements was observed between the patient and control groups. We conclude that whereas healthy subjects have an age-related tendency toward a decrease in retinal nerve fibre layer thickness, patients with multiple sclerosis patients are likely to pass through different stages of retinal thinning and thickening due to subclinical optic neuritis and, as a result, we could not detect any statistically significant change between baseline and second measurements in our multiple sclerosis patients.
Collapse
Affiliation(s)
| | | | - Metin Ekinci
- Department of Ophthalmology Kafkas University Medical Faculty Kars, Turkey
| | - Cagatay Buyukuysal
- Department of Biostatistics Bülent Ecevit University Medical Faculty, Zonguldak Turkey
| | | | | | - Halil Huseyin
- Department of Ophthalmology Kafkas University Medical Faculty Kars, Turkey
| |
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW To review the various efferent visual system disorders associated with multiple sclerosis (MS). RECENT FINDINGS Studies have supported the use of internuclear ophthalmoplegia, a model to study effects of fatigue and heat in MS patients. SUMMARY There are a host of efferent ocular manifestations that can present throughout the course of MS. These may manifest as blurred vision, potentially misleading both the patient and clinician to suspect an afferent visual deficit. Other efferent symptoms include diplopia, oscillopsia, and vertigo. The efferent system can be divided into broad categories: supranuclear, internuclear, nuclear, and gaze-holding systems. This review will briefly touch on the anatomy as well as the signs and symptoms associated with MS-related dysfunction involving these systems.
Collapse
|
23
|
Eckstein C, Saidha S, Sotirchos ES, Byraiah G, Seigo M, Stankiewicz A, Syc SB, Ford E, Sharma S, Calabresi PA, Pardo CA. Detection of clinical and subclinical retinal abnormalities in neurosarcoidosis with optical coherence tomography. J Neurol 2012; 259:1390-8. [DOI: 10.1007/s00415-011-6363-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 12/05/2011] [Accepted: 12/08/2011] [Indexed: 12/23/2022]
|