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Rovira À, Vidal-Jordana A, Auger C, Sastre-Garriga J. Optic Nerve Imaging in Multiple Sclerosis and Related Disorders. Neuroimaging Clin N Am 2024; 34:399-420. [PMID: 38942524 DOI: 10.1016/j.nic.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Optic neuritis is a common feature in multiple sclerosis and in 2 other autoimmune demyelinating disorders such as aquaporin-4 IgG antibody-associated neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. Although serologic testing is critical for differentiating these different autoimmune-mediated disorders, MR imaging, which is the preferred imaging modality for assessing the optic nerve, can provide valuable information, suggesting a specific diagnosis and guiding the appropriate serologic testing.
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Affiliation(s)
- Àlex Rovira
- Department of Radiology, Section of Neuroradiology, Vall d'Hebron University Hospital, Autonomous Univesity of Barcelona, Barcelona, Spain.
| | - Angela Vidal-Jordana
- Department of Neurology, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Auger
- Department of Radiology, Section of Neuroradiology, Vall d'Hebron University Hospital, Autonomous Univesity of Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
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Laviers H, Petzold A, Braithwaite T. How far should I manage acute optic neuritis as an ophthalmologist? A United Kingdom perspective. Eye (Lond) 2024:10.1038/s41433-024-03164-4. [PMID: 38867071 DOI: 10.1038/s41433-024-03164-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/07/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
Optic neuritis (ON) is an inflammation of or around the optic nerve, frequently caused by infectious or immune-mediated inflammatory disorders. In the UK, its strongest association is with Multiple Sclerosis (MS), though the combined prevalence of other associated infectious and immune-mediated inflammatory diseases (I-IMID) is similar to that of MS-ON. Prompt identification and understanding of ON's underlying cause informs tailored management and prognosis. Several IMIDs linked to ON, such as aquaporin-4 antibody-associated optic neuritis (AQP4-ON), myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON), and neuro-sarcoidosis, show remarkable response to corticosteroid treatment. Therefore, urgent investigation and treatment are crucial in cases 'atypical' for MS-ON. Following the 1992 Optic Neuritis Treatment Trial, clinical practice has evolved, with short-course high-dose corticosteroids considered safe and effective for most people. Timely recognition of patients who could benefit is critical to avoid irreversible vision loss. This review provides a practical guide and a summary of evidence on the investigation and management of acute optic neuritis. It reflects the knowledge and limitations of current evidence, framed through the neuro-ophthalmic perspective of clinical practice at multiple UK academic centres.
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Affiliation(s)
- Heidi Laviers
- The Medical Eye Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Ophthalmology, King's College Hospital, London, UK
| | - Axel Petzold
- Neuro-ophthalmology Service, Moorfields Eye Hospital, London, UK
- Neuro-ophthalmology Service, The National Hospital for Neurology and Neurosurgery, London, UK
- Amsterdam University Medical Center (AUMC), Amsterdam, Netherlands
| | - Tasanee Braithwaite
- The Medical Eye Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- The School of Immunology and Microbial Science and The School of Life Course and Population Sciences, King's College London, London, UK.
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Akosman S, Li R, Asahi M, Kwon B, Dossantos J, Tavakoli M, Chen JJ. Trends in Plasma Exchange Use in Optic Neuritis Hospitalizations in the United States. Ophthalmology 2024:S0161-6420(24)00201-X. [PMID: 38552677 DOI: 10.1016/j.ophtha.2024.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE To report use trends of plasma exchange (PLEX) as well as sociodemographic and medical comorbidities associated with PLEX in the United States. DESIGN Retrospective cross-sectional study. PARTICIPANTS Adult patients (≥ 18 years) admitted for inpatient hospitalization with a primary diagnosis of optic neuritis (ON). METHODS Data from the National Inpatient Sample database was compiled to assess PLEX use rates between 2000 and 2020. The cohorts of patients receiving PLEX versus not receiving PLEX were analyzed between quarter 4 of 2015 through 2020 (International Classification of Diseases, Tenth Revision [ICD-10], only) for patient sociodemographic variables, medical diagnoses, insurance types, hospital characteristics, cause of disease, time to therapy, length of stay (LOS), and total charges incurred. MAIN OUTCOME MEASURES Incidence of ON, incidence of PLEX, demographics, diagnoses associated with PLEX therapy, total charges, and LOS. RESULTS From 2000 through 2020, 11 209 patients hospitalized with a primary diagnosis of ON were identified, with a significant majority managed at urban teaching hospitals. Use of PLEX increased steadily over 2 decades from 0.63% to 5.46%. Use was greatest in the western United States and least in the eastern United States. In the subset of ICD-10 cases, 3215 patients were identified. The median time to therapy of PLEX was 1 day after admission, and PLEX use was highest in patients with neuromyelitis optica spectrum disorder (NMOSD) (21.21%) and lowest in multiple sclerosis-associated ON (3.80%). Use of PLEX was associated with significantly longer LOS and higher total charges incurred. Medical comorbidities associated with PLEX included adverse reaction to glucocorticoids (adjusted odds ratio [aOR], 31.50), hemiplegia (aOR, 28.48), neuralgia (aOR, 4.81), optic atrophy (aOR, 3.74), paralytic strabismus (aOR, 2.36), and psoriasis (aOR, 1.76). CONCLUSIONS Over the last 2 decades in the United States, PLEX therapy for ON has increased, with the highest use in the western United States and for patients with the diagnosis NMOSD ON. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sinan Akosman
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Renxi Li
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Masumi Asahi
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, California
| | - Bryan Kwon
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Jason Dossantos
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Mehdi Tavakoli
- Department of Ophthalmology, George Washington University, Washington, DC
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota.
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Yang Z, Marcoci C, Öztürk HK, Giama E, Yenicelik AG, Slanař O, Linington C, Desai R, Smith KJ. Tissue Hypoxia and Associated Innate Immune Factors in Experimental Autoimmune Optic Neuritis. Int J Mol Sci 2024; 25:3077. [PMID: 38474322 DOI: 10.3390/ijms25053077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Visual loss in acute optic neuritis is typically attributed to axonal conduction block due to inflammatory demyelination, but the mechanisms remain unclear. Recent research has highlighted tissue hypoxia as an important cause of neurological deficits and tissue damage in both multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE) and, here, we examine whether the optic nerves are hypoxic in experimental optic neuritis induced in Dark Agouti rats. At both the first and second peaks of disease expression, inflamed optic nerves labelled significantly for tissue hypoxia (namely, positive for hypoxia inducible factor-1α (HIF1α) and intravenously administered pimonidazole). Acutely inflamed nerves were also labelled significantly for innate markers of oxidative and nitrative stress and damage, including superoxide, nitric oxide and 3-nitrotyrosine. The density and diameter of capillaries were also increased. We conclude that in acute optic neuritis, the optic nerves are hypoxic and come under oxidative and nitrative stress and damage. Tissue hypoxia can cause mitochondrial failure and thus explains visual loss due to axonal conduction block. Tissue hypoxia can also induce a damaging oxidative and nitrative environment. The findings indicate that treatment to prevent tissue hypoxia in acute optic neuritis may help to restore vision and protect from damaging reactive oxygen and nitrogen species.
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Affiliation(s)
- Zhiyuan Yang
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London WC1N 1PJ, UK
| | - Cristina Marcoci
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London WC1N 1PJ, UK
| | - Hatice Kübra Öztürk
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London WC1N 1PJ, UK
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
| | - Eleni Giama
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London WC1N 1PJ, UK
| | - Ayse Gertrude Yenicelik
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London WC1N 1PJ, UK
| | - Ondřej Slanař
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
| | - Christopher Linington
- School of Infection and Immunity, The Sir Graeme Davies Building, Glasgow G12 8TA, UK
| | - Roshni Desai
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London WC1N 1PJ, UK
| | - Kenneth J Smith
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London WC1N 1PJ, UK
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Dangare MS, Sasun AR, Harjpal P. Vestibular Rehabilitation Considerations in an Uncommon Optic Neuritis: A Case Report. Cureus 2024; 16:e53423. [PMID: 38435174 PMCID: PMC10908412 DOI: 10.7759/cureus.53423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Optic neuritis is an inflammatory condition that leads to inflammation and damage to the optic nerve, causing visual disturbances and pain. It is commonly associated with disorders such as multiple sclerosis and often manifests as sudden, unilateral loss of vision or blurred vision. This disorder can affect individuals of any age and may lead to decreased binocular vision, potentially resulting in difficulties with depth perception and visual coordination. Physiotherapy plays a crucial role in treating optic neuritis by addressing various aspects of the illness. We report the case of a 14-year-old male with diminution in both eyes, which was sudden in onset and painless in nature, with no history of falls, trauma, or diabetes. Magnetic resonance imaging reveals hyperintensity on short-tau inversion recovery (STIR) with mild contrast enhancement in the posterior aspects of the bilateral optic nerves (intracranial part), extending to the optic chiasm in optic neuritis. Physiotherapists employ a range of techniques to enhance the patient's overall well-being, including gaze stability exercises, eye-hand coordination exercises, and habituation exercises aimed at improving visual tracking and coordination. Additionally, physiotherapy can help reduce related symptoms such as muscle weakness, balance issues, and posture problems caused by impaired visual perception. Physical therapists endeavor to improve the quality of life for patients with optic neuritis by enhancing functional independence and contributing to a more effective approach to treatment. Notably, there was an improvement in visual scanning, spatial awareness, and eye movement control in this case.
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Affiliation(s)
- Mansee S Dangare
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anam R Sasun
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Fujii Y, Hokkoku K, Chiba T, Takahashi K, Mimura T, Ooba H, Sonoo M, Kobayashi S. [A case of acute bilateral blindness presumably caused by reversible cerebral vasoconstriction syndrome after traumatic brain injury]. Rinsho Shinkeigaku 2023; 63:824-829. [PMID: 37989288 DOI: 10.5692/clinicalneurol.cn-001889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
A 62-year-old man was admitted to our hospital for acute bilateral blindness two days after a head injury. Hemorrhagic cerebellar infarction was found on the initial MRI, and peripheral arteries were poorly visualized on MRA. On the follow-up MRA nine days later, peripheral arteries were clearly depicted. These imaging findings suggested reversible cerebral vasoconstriction syndrome (RCVS). We started steroid pulse therapy for suspected optic neuritis with no clear response. The initial fundoscopic examination revealed no abnormalities in the optic disc, but optic nerve atrophy developed one month later. Based on the course of events, we diagnosed the patient with posterior ischemic optic neuropathy triggered by RCVS.
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Affiliation(s)
- Yuki Fujii
- Department of Neurology, Teikyo University School of Medicine
| | - Keiichi Hokkoku
- Department of Neurology, Teikyo University School of Medicine
| | - Takashi Chiba
- Department of Neurology, Teikyo University School of Medicine
| | - Kazusa Takahashi
- Department of Neurology, Teikyo University School of Medicine
- Department of Neurology, Kitasato University School of Medicine
| | - Tatsuya Mimura
- Department of Ophthalmology, Teikyo University School of Medicine
| | - Hiroshi Ooba
- Department of Radiology, Teikyo University School of Medicine
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine
- Department of Orthoptics, Faculty of Medical Technology, Teikyo University
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Panyaping T, Tunlayadechanont P, Jindahra P, Cheecharoen P. Diagnostic value of contrast-enhanced 3D FLAIR sequence in acute optic neuritis. Neuroradiol J 2023; 36:674-679. [PMID: 37205609 PMCID: PMC10649524 DOI: 10.1177/19714009231177360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
PURPOSE Contrast-enhanced fluid-attenuated inversion recovery (FLAIR) sequence of the brain has the potential for detecting optic nerve abnormality. This study aimed to compare the diagnostic value of whole-brain contrast-enhanced three-dimensional FLAIR with fat suppression (CE 3D FLAIR FS) sequence in detecting acute optic neuritis to dedicated orbit MRI and clinical diagnosis. MATERIALS AND METHODS Twenty-two patients with acute optic neuritis who underwent whole-brain CE-3D-FLAIR FS and dedicated orbit MRI were retrospectively included. The hypersignal FLAIR of the optic nerve on whole-brain CE-3D-FLAIR FS, enhancement, and hypersignal T2W on orbit images were assessed. The optic nerve to frontal white matter signal intensity ratio on CE-FLAIR FS was calculated as maximum signal intensity ratio (SIR) and mean SIR. RESULTS Twenty-six hypersignals of optic nerves were found on CE-FLAIR FS from 30 pathologic nerves. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CE FLAIR FS brain and dedicated orbital images for diagnosing acute optic neuritis were 77%, 93%, 96%, 65%, and 82% and 83%, 93%, 96%, 72%, and 86%, respectively. Optic nerve to frontal white matter SIR of the affected optic nerves was higher than that of normal optic nerves. Using a cutoff maximum SIR of 1.24 and cutoff mean SIR of 1.16, the sensitivity, specificity, PPV, NPV, and accuracy were 93%, 86%, 93%, 80%, and 89% and 93%, 86%, 93%, 86%, and 91%, respectively. CONCLUSION The hypersignal of the optic nerve on whole-brain CE 3D FLAIR FS sequence has qualitative and quantitative diagnostic potential in patients with acute optic neuritis.
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Affiliation(s)
- Theeraphol Panyaping
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Padcha Tunlayadechanont
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Panitha Jindahra
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Piyaphon Cheecharoen
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Mahidol University, Bangkok, Thailand
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Kim HJ, Lee EJ, Kim SY, Kim H, Kim KW, Kim S, Kim H, Seo D, Lee BJ, Lim HT, Kim KK, Lim YM. Serum proteins for monitoring and predicting visual function in patients with recent optic neuritis. Sci Rep 2023; 13:5609. [PMID: 37019946 PMCID: PMC10076295 DOI: 10.1038/s41598-023-32748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
It is unclear whether serum proteins can serve as biomarkers to reflect pathological changes and predict recovery in inflammation of optic nerve. We evaluated whether serum proteins could monitor and prognosticate optic neuritis (ON). We prospectively recruited consecutive patients with recent ON, classified as ON with anti-aquaporin-4 antibody (AQP4-ON), ON with anti-myelin oligodendrocyte glycoprotein antibody (MOG-ON), and double-seronegative ON (DSN-ON). Using ultrasensitive single-molecule array assays, we measured serum neurofilament light chain and glial fibrillary acidic protein (GFAP), and brain-derived neurotrophic factor (BDNF). We analyzed the markers according to disease group, state, severity, and prognosis. We enrolled 60 patients with recent ON (15 AQP4-ON; 14 MOG-ON; 31 DSN-ON). At baseline, AQP4-ON group had significantly higher serum GFAP levels than did other groups. In AQP4-ON group, serum GFAP levels were significantly higher in the attack state than in the remission state and correlated with poor visual acuity. As a prognostic indicator, serum BDNF levels were positively correlated with follow-up visual function in the AQP4-ON group (r = 0.726, p = 0.027). Serum GFAP reflected disease status and severity, while serum BDNF was identified as a prognostic biomarker in AQP4-ON. Serum biomarkers are potentially helpful for patients with ON, particularly those with AQP4-ON.
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Affiliation(s)
- Hyo Jae Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea.
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Meidcal Center, Seoul, South Korea.
| | - Sang-Yeob Kim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Keon-Woo Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seungmi Kim
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunji Kim
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dayoung Seo
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Petzold A, Fraser CL, Abegg M, Alroughani R, Alshowaeir D, Alvarenga R, Andris C, Asgari N, Barnett Y, Battistella R, Behbehani R, Berger T, Bikbov MM, Biotti D, Biousse V, Boschi A, Brazdil M, Brezhnev A, Calabresi PA, Cordonnier M, Costello F, Cruz FM, Cunha LP, Daoudi S, Deschamps R, de Seze J, Diem R, Etemadifar M, Flores-Rivera J, Fonseca P, Frederiksen J, Frohman E, Frohman T, Tilikete CF, Fujihara K, Gálvez A, Gouider R, Gracia F, Grigoriadis N, Guajardo JM, Habek M, Hawlina M, Martínez-Lapiscina EH, Hooker J, Hor JY, Howlett W, Huang-Link Y, Idrissova Z, Illes Z, Jancic J, Jindahra P, Karussis D, Kerty E, Kim HJ, Lagrèze W, Leocani L, Levin N, Liskova P, Liu Y, Maiga Y, Marignier R, McGuigan C, Meira D, Merle H, Monteiro MLR, Moodley A, Moura F, Muñoz S, Mustafa S, Nakashima I, Noval S, Oehninger C, Ogun O, Omoti A, Pandit L, Paul F, Rebolleda G, Reddel S, Rejdak K, Rejdak R, Rodriguez-Morales AJ, Rougier MB, Sa MJ, Sanchez-Dalmau B, Saylor D, Shatriah I, Siva A, Stiebel-Kalish H, Szatmary G, Ta L, Tenembaum S, Tran H, Trufanov Y, van Pesch V, Wang AG, Wattjes MP, Willoughby E, Zakaria M, Zvornicanin J, Balcer L, Plant GT. Diagnosis and classification of optic neuritis. Lancet Neurol 2022; 21:1120-1134. [PMID: 36179757 DOI: 10.1016/s1474-4422(22)00200-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
There is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. This reality means that the diagnosis of disorders that have optic neuritis as the first manifestation can be challenging. Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease. Epidemiological data show that, cumulatively, optic neuritis is most frequently caused by many conditions other than multiple sclerosis. Worldwide, the cause and management of optic neuritis varies with geographical location, treatment availability, and ethnic background. We have developed diagnostic criteria for optic neuritis and a classification of optic neuritis subgroups. Our diagnostic criteria are based on clinical features that permit a diagnosis of possible optic neuritis; further paraclinical tests, utilising brain, orbital, and retinal imaging, together with antibody and other protein biomarker data, can lead to a diagnosis of definite optic neuritis. Paraclinical tests can also be applied retrospectively on stored samples and historical brain or retinal scans, which will be useful for future validation studies. Our criteria have the potential to reduce the risk of misdiagnosis, provide information on optic neuritis disease course that can guide future treatment trial design, and enable physicians to judge the likelihood of a need for long-term pharmacological management, which might differ according to optic neuritis subgroups.
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Ally N, Alli HD, Jeeva-Patel T, Mochan A, Sadiq E, Mayet I, Kuenast M, Rajkumar L. Optic neuritis: A South African hospital-based prospective study protocol. PLoS One 2022; 17:e0269514. [PMID: 35687597 PMCID: PMC9187063 DOI: 10.1371/journal.pone.0269514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 05/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Optic neuritis is a relatively common disease with an estimated lifetime risk of 0.6 per 1000; the estimated prevalence is 1–5 per 100 000/year. It occurs because of inflammation of the optic nerve from a variety of causes. The diagnosis of the disorder is established clinically and current literature is predominantly based on white patients from high-income countries. Optic neuritis presents differently in black patients compared to white patients. This study aims to assess the presentation and outcome of optic neuritis patients in a South African setting. Methods This is a prospective, hospital-based cohort study that will enrol patients with optic neuritis presenting to either the neurology department at Chris Hani Baragwanath Academic Hospital or the ophthalmology department at St John Eye Hospital, both in Johannesburg, South Africa. The specific aetiologies, clinical presentation and radiological findings will be studied, and the patient’s course over one year will be documented in three-monthly follow-up visits. A specific group of patients with Neuromyelitis Optica Spectrum Disorders (NMOSD) and Myelin Oligodendrocyte Glycoprotein Associated Disorders (MOGAD) optic neuritis will be followed up for 5 years at yearly intervals. Discussion This study represents one of the few cohort studies in Sub-Saharan Africa that seeks to investigate optic neuritis. Our hope is that it will lead to better insights regarding the presentation, course and outcome of this condition. We will also analyse the data with a view of developing a predictive model for good visual outcome.
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Affiliation(s)
- Naseer Ally
- Division of Ophthalmology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Hassan Dawood Alli
- Division of Ophthalmology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Trishal Jeeva-Patel
- Division of Ophthalmology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andre Mochan
- Division of Neurology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eitzaz Sadiq
- Division of Neurology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ismail Mayet
- Division of Ophthalmology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marianne Kuenast
- Department of Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Leisha Rajkumar
- Department of Radiology, University of the Witwatersrand, Johannesburg, South Africa
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11
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Jiang Z, Qian H, Wei S. Vision-Related Quality of Life in Patients With Atypical Optic Neuritis. FRONTIERS IN PAIN RESEARCH 2022; 3:871269. [PMID: 35634450 PMCID: PMC9134869 DOI: 10.3389/fpain.2022.871269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
Aim To evaluate the vision-related quality of life (QOL) in patients with atypical optic neuritis through the 39-item National Eye Institute Visual Function Questionnaire (NEI VFQ-39). Methods Fifty-seven patients with atypical optic neuritis were scheduled in the research unit from June 1 to December 31, 2019. Besides collecting the clinical data, NEI VFQ-39, the Chinese version, was applied to all subjects. The NEI VFQ-39 subscale item scores were compared among subgroups divided by different classifications, and a correlation analysis of the NEI VFQ-39 scores and best-corrected visual acuity (BCVA) for better-seeing and worse-seeing eyes was performed. Results The mean age of scheduled patients was 34.3 ± 12.4 years, with the majority being female (70.2%). The mean composite score was 58.62 ± 17.62. Twenty-nine (50.9%) patients were affected binocularly, and the most subscale scores and composite scores of binocular incidences were lower than those of monocular incidence significantly. However, there was no statistically significant difference in composite scores between patients with and without periocular pain. The patients with worse BCVA in the better-seeing eye have lower scores than those with better BCVA in the better-seeing eye. Most NEI VFQ-39 scores have strong correlations with the BCVA for better-seeing and worse-seeing eyes. Conclusion Atypical optic neuritis has a significant and comprehensive influence on patients' visual function outcomes and quality of life associated with vision. Improving their BCVA in the better-seeing eye can improve their vision-related QOL.
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Affiliation(s)
- Zhaocai Jiang
- Beijing Jingmei Group General Hospital, Beijing, China
- Senior Department of Ophthalmology, The Third Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Haiyan Qian
- Senior Department of Ophthalmology, The Third Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Shihui Wei
- Senior Department of Ophthalmology, The Third Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Shihui Wei
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12
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Neuroprotective Effects of Novel Treatments on Acute Optic Neuritis—A Meta-Analysis. Biomedicines 2022; 10:biomedicines10010192. [PMID: 35052875 PMCID: PMC8774005 DOI: 10.3390/biomedicines10010192] [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: 11/16/2021] [Revised: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
Optic neuritis, inflammation of the optic nerve, can cause visual impairment through retinal nerve fiber layer (RNFL) degeneration. Optical coherence tomography could serve as a sensitive noninvasive tool for measuring RNFL thickness and evaluating the neuroprotective effects of treatment. We conducted a meta-analysis to compare RNFL loss between novel add-on treatments and corticosteroid therapy at least 3 months after acute optic neuritis. The outcome measures were mean differences (MDs) in (1) RNFL thickness compared with the baseline in the affected and unaffected eye and (2) LogMAR visual acuity (VA). Seven studies involving five novel agents (memantine, erythropoietin, interferon-beta, phenytoin, and clemastine) were analyzed. When compared with the baseline RNFL thickness of the affected eye, the neuroprotective effects of novel add-on treatments could not be demonstrated. The difference in visual outcomes was also not significant between the two treatment groups. One study revealed that phenytoin has the potential to alleviate RNFL loss when the baseline thickness of the unaffected eye is considered. Larger randomized controlled trials with suitable outcome measures are warranted to evaluate the neuroprotective effects of novel treatments. Further studies should also tailor therapies to specific patient populations and investigate a more targeted treatment for acute optic neuritis.
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13
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Muro-Fuentes E, Moss H. Factors Associated With Increased Emergency Department Utilization in Patients With Acute Optic Neuritis. J Neuroophthalmol 2021; 41:335-341. [PMID: 34224527 PMCID: PMC8380632 DOI: 10.1097/wno.0000000000001294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Symptoms of acute vision loss and eye pain may lead patients with optic neuritis to seek care in the emergency department (ED). Given the availability of lower cost alternatives for providing medical care for optic neuritis, this study aimed to identify factors associated with higher ED utilization. METHODS Subjects with acute optic neuritis were identified through a chart review of adults with International Classification of Diseases-9 (ICD-9) or ICD-10 codes for optic neuritis with corresponding gadolinium contrast enhancement of the optic nerve on MRI in the medical record research repository of a tertiary care institution. Subjects were grouped based on the number of ED visits (0-1 and 2-3) within 2 months of either ICD code or MRI. Demographics, characteristics of disease presentation, type and location of medical care, testing (chest imaging, lumbar puncture, optical coherence tomography, spine MRI, visual field, and laboratory tests), treatment, provider specialty of follow-up visits, and duration of care were extracted from the medical record. RESULTS Of 30 acute optic neuritis subjects (age 41 ± 16 years, range 18-76, 53% [16/30] female), 19 had 0-1 ED visit and 11 had 2-3 ED visits. Most subjects were Caucasian, non-Hispanic (47%), followed by Asian (23%), Hispanic/Latino (17%), Black (10%), and others (3%). Subjects had an initial clinical encounter primarily in the outpatient setting (63%) as compared with the ED (37%). The median time from symptom onset to initial clinical encounter was 4 days with a range of 0-13. Subjects were mostly insured through a private insurance (60%), followed by Medicare/Medicaid (23%) and uninsured (17%). Fewer ED visits were associated with an initial clinical encounter in an outpatient setting (P = 0.02, chi-square), but not residential distance from the hospital or insurance type. Subjects with a higher number of ED visits were more likely to be of Hispanic/Latino ethnicity (P = 0.047, Fisher exact). There was no significant difference in the ophthalmic, radiologic, or laboratory testing performed in both groups. Both groups presented in a similar time frame with similar symptoms and clinical signs. Treatment was similar in both groups. CONCLUSIONS Subjects with their first clinical encounter for optic neuritis in the ED had more visits to the ED overall when compared with those first seen in an outpatient setting and thus strategies aimed at facilitating outpatient care may help reduce unnecessary ED visits, although some, such as insurance status, may be difficult to modify. Further study in a larger sample is needed to refine these observations.
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Affiliation(s)
| | - Heather Moss
- Spencer Center for Vision Research and the Byers Eye Institute at Stanford University, Palo Alto, CA, USA
- Department of Neurology & Neurological Sciences, Palo Alto, CA, USA
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14
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Hickman SJ, Petzold A. Update on Optic Neuritis: An International View. Neuroophthalmology 2021; 46:1-18. [PMID: 35095131 PMCID: PMC8794242 DOI: 10.1080/01658107.2021.1964541] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/26/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022] Open
Abstract
Previously, optic neuritis was thought to be typical, i.e. idiopathic or multiple sclerosis (MS) related, associated with a good visual prognosis, or atypical, i.e. not associated with MS and requiring corticosteroids or plasma exchange for vision to recover. More recently, the importance of optic neuritis in neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein (MOG) antibody disease has become more appreciated. The results of the Optic Neuritis Treatment Trial (ONTT) has influenced how optic neuritis is treated around the world. For this review we surveyed the international literature on optic neuritis in adults. Our aims were first to find the reported incidence of optic neuritis in different countries and to ascertain what percentage of cases were seropositive for anti-aquaporin 4 and anti-MOG antibodies, and second, to document the presenting features, treatment, and outcomes from a first episode of the different types of optic neuritis from these countries, and to compare the results with the outcomes of the ONTT cohort. From these data we have sought to highlight where ambiguities currently lie in how to manage optic neuritis and have made recommendations as to how future treatment trials in optic neuritis should be carried out in the current antibody testing era.
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Affiliation(s)
- Simon J. Hickman
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | - Axel Petzold
- Expertise Centrum Neuro-ophthalmology, Departments of Neurology & Ophthalmology, Amsterdam Umc, Amsterdam, The Netherlands
- Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, UK
- Department of Neuro-Ophthalmology, The National Hospital For Neurology And Neurosurgery, London, UK
- Department of Molecular Neurosciences, Ucl Institute of Neurology, London, UK
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15
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Patel SC, Smith SM, Kessler AT, Bhatt AA. Imaging of the Primary Visual Pathway based on Visual Deficits. J Clin Imaging Sci 2021; 11:19. [PMID: 33880244 PMCID: PMC8053434 DOI: 10.25259/jcis_12_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022] Open
Abstract
Vision loss can occur due to a variety of etiologies along the primary visual pathway. Understanding the anatomic organization of the visual pathway, which spans the globe to the occipital cortex, can help tailor neuroimaging to identify the cause of visual dysfunction. In this review, relevant anatomy and optimization of computed tomography and magnetic resonance imaging techniques will be described. This will be followed by a discussion of imaging findings related to pathologies at each functional anatomic level.
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Affiliation(s)
- Swapnil C Patel
- Department of Radiology, Atlantic Medical Imaging, Galloway, New Jersey, United States
| | - Stephen M Smith
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States
| | - Alexander T Kessler
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States
| | - Alok A Bhatt
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, United States
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16
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Lo C, Vuong LN, Micieli JA. Recent advances and future directions on the use of optical coherence tomography in neuro-ophthalmology. Taiwan J Ophthalmol 2021; 11:3-15. [PMID: 33767951 PMCID: PMC7971436 DOI: 10.4103/tjo.tjo_76_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022] Open
Abstract
Optical coherence tomography (OCT) is a noninvasive imaging technique used to qualitatively and quantitatively analyze various layers of the retina. OCT of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) is particularly useful in neuro-ophthalmology for the evaluation of patients with optic neuropathies and retrochiasmal visual pathway disorders. OCT allows for an objective quantification of edema and atrophy of the RNFL and GCIPL, which may be evident before obvious clinical signs and visual dysfunction develop. Enhanced depth imaging OCT allows for visualization of deep structures of the optic nerve and has emerged as the gold standard for the detection of optic disc drusen. In the evaluation of compressive optic neuropathies, OCT RNFL and GCIPL thicknesses have been established as the most important visual prognostic factor. There is increasing evidence that inclusion of OCT as part of the diagnostic criteria for multiple sclerosis (MS) increases its sensitivity. Moreover, OCT of the RNFL and GCIPL may be helpful in the early detection and monitoring the treatment of conditions such as MS and Alzheimer's disease. OCT is an important aspect of the neuro-ophthalmologic assessment and its use is likely to increase moving forward.
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Affiliation(s)
- Cody Lo
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laurel N Vuong
- The New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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17
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Riederer I, Sollmann N, Mühlau M, Zimmer C, Kirschke JS. Gadolinium-Enhanced 3D T1-Weighted Black-Blood MR Imaging for the Detection of Acute Optic Neuritis. AJNR Am J Neuroradiol 2020; 41:2333-2338. [PMID: 33122200 DOI: 10.3174/ajnr.a6807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE A 3D T1-weighted black-blood sequence was recently shown to improve the detection of contrast-enhancing lesions in the brain in patients with MS compared with a 3D T1-weighted MPRAGE sequence. We compared a contrast-enhanced 3D T1-weighted black-blood sequence with a dedicated orbital contrast-enhanced T1-weighted Dixon sequence in patients with acute optic neuritis. MATERIALS AND METHODS MR imaging data (3T) of 51 patients showing symptoms of acute optic neuritis were analyzed retrospectively, including whole-brain contrast-enhanced 3D T1-weighted black-blood and dedicated orbital coronal 2D or 3D contrast-enhanced T1-weighted Dixon sequences. Two neuroradiologists assessed the images for overall image quality, artifacts, diagnostic confidence, and visual contrast enhancement. Furthermore, the standardized contrast-to-noise ratio was calculated. The final diagnosis of acute optic neuritis was established on the basis of clinical presentation, visually evoked potentials, and optical coherence tomography. RESULTS Thirty of 51 patients were diagnosed with acute optic neuritis. Of those, 21 showed contrast-enhancing lesions in the optic nerves, similarly detectable on contrast-enhanced T1-weighted Dixon and contrast-enhanced T1-weighted black-blood images. Thus, the accuracy for each sequence was identical, with a resulting sensitivity of 70% and specificity of 90% or 100% (depending on the reader). Overall image quality, diagnostic confidence, visual contrast enhancement, and artifacts were rated similarly in contrast-enhanced 3D T1-weighted black-blood and dedicated orbital contrast-enhanced T1-weighted Dixon sequences. There was no significant difference (P = .27) in the mean standardized contrast-to-noise ratio between contrast-enhanced T1-weighted black-blood (1.76 ± 1.07) and contrast-enhanced T1-weighted Dixon (2.29 ± 2.49) sequences. CONCLUSIONS Contrast-enhanced 3D T1-weighted black-blood imaging is comparable in accuracy and qualitative/quantitative features with dedicated orbital contrast-enhanced T1-weighted Dixon imaging for the detection of acute optic neuritis. Therefore, when used, it has the potential to considerably shorten total patient imaging time.
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Affiliation(s)
- I Riederer
- From the Department of Neuroradiology (I.R., N.S., C.Z., J.S.K.)
| | - N Sollmann
- From the Department of Neuroradiology (I.R., N.S., C.Z., J.S.K.).,Neuroimaging Center TUM-NIC, Klinikum rechts der Isar (M.M. and N.S.), School of Medicine, Technical University of Munich, Munich, Germany
| | - M Mühlau
- Neurology (M.M.).,Neuroimaging Center TUM-NIC, Klinikum rechts der Isar (M.M. and N.S.), School of Medicine, Technical University of Munich, Munich, Germany
| | - C Zimmer
- From the Department of Neuroradiology (I.R., N.S., C.Z., J.S.K.)
| | - J S Kirschke
- From the Department of Neuroradiology (I.R., N.S., C.Z., J.S.K.)
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18
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Singh S, Steeves V. The contested meanings of race and ethnicity in medical research: A case study of the DynaMed Point of Care tool. Soc Sci Med 2020; 265:113112. [PMID: 33096340 DOI: 10.1016/j.socscimed.2020.113112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
Although the use of race and ethnicity for diagnostic purposes remains a controversial practice given the socially contingent meaning of the terms (Bowker and Star, 1999), health researchers continue to report possible relationships between health outcomes and race/ethnicity in the literature. As summaries of these types of studies are incorporated into commercial databases designed to provide medical practitioners with actionable information, there is a risk that the algorithms that drive the databases may unintentionally incorporate racist biases (O'Neil, 2016) in search reports that use race and ethnicity as query terms to identify findings to help in the diagnosis and treatment of particular patients. As a first step to unpacking this risk, we conducted a content analysis of the records and related citation trails in DynaMed's Point of Care (PoC) tool that refer to racial and ethnic research findings. Our analysis demonstrates that DynaMed does not control for how meanings of race and ethnicity are constructed in its entries, does not always accurately represent the nuanced and contingent nature of the findings about race/ethnicity that it cites, and relies on sources that are not always consistent with the 'evidence-based' criterion that the company self-promotes as a feature of its PoC tool. We conclude that, by failing to acknowledge the complex and contradictory ways that race and ethnicity may, or may not, correlate with the risk of a medical ailment, algorithmically-driven tools that use these concepts to establish group risks for medical ailments may unintentionally work to 'resuscitat[e] biological theories of race by modernizing old racial typologies that were based on observations of physical differences with cutting-edge genomic research' (Roberts, 2011: 567).
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Affiliation(s)
- Sachil Singh
- Department of Sociology, Queen's University, Kingston, Ontario, K7L 3N6, Canada.
| | - Valerie Steeves
- Department of Criminology, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada.
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19
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Abstract
PURPOSE OF REVIEW The diagnosis of multiple sclerosis (MS) is often challenging. This article discusses approaches to the clinical assessment for MS that may improve diagnostic accuracy. RECENT FINDINGS Contemporary diagnostic criteria for MS continue to evolve, while knowledge about diseases that form the differential diagnosis of MS continues to expand. Recent data concerning causes of MS misdiagnosis (the incorrect assignment of a diagnosis of MS) have further informed approaches to syndromes that may mimic MS and the accurate diagnosis of MS. SUMMARY This article provides a practical update on MS diagnosis through a discussion of recently revised MS diagnostic criteria, a renewed consideration of MS differential diagnosis, and contemporary data concerning MS misdiagnosis.
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20
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Soltan Sanjari M, Pakdel F, Moosavi F, Pirmarzdashti N, Nojomi M, Haghighi A, Hashemi M, Bahmani Kashkouli M. Visual Outcomes of Adding Erythropoietin to Methylprednisolone for Treatment of Retrobulbar Optic Neuritis. J Ophthalmic Vis Res 2019; 14:299-305. [PMID: 31660109 PMCID: PMC6815326 DOI: 10.18502/jovr.v14i3.4786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the short-term visual function results and safety of erythropoietin as an add-on to the standard corticosteroid therapy in retrobulbar optic neuritis (RON). Methods In this prospective pilot study, adult patients with isolated RON with less than 10 days of onset were enrolled. Patients were consecutively assigned to standard intravenous methylprednisolone treatment either in combination with intravenous erythropoietin (20,000 units/day for three days) (group-1) or intravenous methylprednisolone alone (group-2). Primary outcome measure was best-corrected visual acuity (BCVA), which was assessed up to 120 days from the day the treatment was begun. Systemic evaluations were performed during and after treatment. Results Sixty-two patients with RON (mean age = 26.6 ± 5.77 years; range = 18–40 years) were enrolled into the study (group-1, n = 35; group-2, n = 27). BCVA three months after the treatment was 0.19 ± 0.55 logMAR and 0.11 ± 0.32 logMAR in group-1 and group-2, respectively (95% CI: -0.61 - 0.16; P = 0.62). Change in BCVA after three months was 2.84 ± 3.49 logMAR in group-1 and 2.46 ± 1.40 logMAR in group-2 (95% CI: -0.93-1.91; P = 0.57). Pace of recovery was not significantly different between the groups. No complications were detected among patients. Conclusion Intravenous erythropoietin as an add-on did not significantly improve the visual outcome in terms of visual acuity, visual field, and contrast sensitivity compared to traditional intravenous corticosteroid. This pilot study supports the safety profile of intravenous human recombinant erythropoietin, and it may help formulate future investigations with a larger sample size.
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Affiliation(s)
- Mostafa Soltan Sanjari
- Ophthalmology Department, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Pakdel
- Ophthalmology Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moosavi
- Ophthalmology Department, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Pirmarzdashti
- Ophthalmology Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Anoosheh Haghighi
- Internal Medicine Department, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masih Hashemi
- Ophthalmology Department, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bahmani Kashkouli
- Ophthalmology Department, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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21
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Rosenthal JF, Hoffman BM, Tyor WR. CNS inflammatory demyelinating disorders: MS, NMOSD and MOG antibody associated disease. J Investig Med 2019; 68:321-330. [PMID: 31582425 DOI: 10.1136/jim-2019-001126] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2019] [Indexed: 12/30/2022]
Abstract
Although Multiple Sclerosis is the most common central nervous system (CNS) inflammatory demyelinating disorder, other CNS inflammatory disorders should be included as diagnostic considerations. Neuromyelitis Optica Spectrum Disorder (NMOSD) and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease are less common but share some clinical characteristics, such as optic neuritis and myelitis, which can make a specific diagnosis challenging. However, these disorders have distinctive and generally different clinical phenotypes, prognosis and management. It is imperative to distinguish each from one another, especially since the treatments (not discussed in this review) can be different. The advent of reliable testing for anti-aquaporin-4 for NMOSD and anti-MOG antibodies has helped significantly; however, diagnosis can remain challenging, especially in sero-negative cases. Clinical indicators are important to guide diagnostic work-up. Careful review of the history, neurological exam, imaging, and/or spinal fluid results are essential to making an accurate diagnosis. In this review, we will examine the clinical presentation, diagnosis, and natural history of these inflammatory CNS disorders.
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Affiliation(s)
- Jacqueline F Rosenthal
- Neurology, Atlanta VA Medical Center, Decatur, Georgia, USA.,Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Benjamin M Hoffman
- Neurology, Atlanta VA Medical Center, Decatur, Georgia, USA.,Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William R Tyor
- Neurology, Atlanta VA Medical Center, Decatur, Georgia, USA.,Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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22
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Siuko M, Kivelä TT, Setälä K, Tienari PJ. The clinical spectrum and prognosis of idiopathic acute optic neuritis: A longitudinal study in Southern Finland. Mult Scler Relat Disord 2019; 35:215-220. [PMID: 31401426 DOI: 10.1016/j.msard.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/22/2019] [Accepted: 08/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND To analyse in a population-based setting the clinical features, prognostic factors, and seasonality of patients diagnosed with acute idiopathic optic neuritis (ON). METHODS Retrospective analysis of ophthalmological records, laboratory parameters, and magnetic resonance imaging (MRI) of patients with symptoms suggestive of ON referred to the Helsinki University Hospital (serving a population of 1.53 million in Southern Finland) were analysed between May 1, 2008 and April 14, 2012. RESULTS Of the 291 patients with suspected ON, 184 (63%) were diagnosed with ON (mean age 34 years, 76% females). Intravenous methylprednisolone treatment was administered in 131 (71%) patients. First ON was diagnosed in 123 patients (67%), 55 (30%) had a previous diagnosis of multiple sclerosis (MS) and two patients with their first ON were diagnosed with neuromyelitis optica. Evolution of best corrected visual acuity (BCVA) was analysed in 132 (72%) patients, who were reviewed median of 38 days after onset. Median and mean BCVAs in these reviewed patients were 0.4 and 0.2 at the time of diagnosis and 1.0 and 0.5 at the time of the review. Recovery was relatively good in the majority of patients; 82% (n = 108) had reached BCVA of ≥0.5 and 70% (n = 92) and BCVA of ≥0.8 at the time of the review, while thirteen (10%) had poor prognosis, BCVA ≤0.1 at review. Accessory clinical features included optic disc swelling (21%), colour vision impairment (75%), and pain with eye movements (65%). Relative afferent pupillary defect was abnormal in 76% of the patients with their first ON. Baseline visual acuity was most strongly associated with visual outcome at review (P < 0.001, linear regression). Optic disc swelling and the presence of lesions in the optic nerve on MRI had a more modest association with poorer recovery (P = 0.033 and P = 0.049, respectively), while age, sex, previous history of ON, and previous diagnosis of multiple sclerosis were not associated with outcome at review. Incidence of ON showed a clear seasonal pattern; there were two times more cases in April to June versus October to December (P = 0.03), confirming previous results from Sweden. CONCLUSIONS Our data suggest that besides baseline visual acuity, optic disc swelling and lesions in the optic nerve on MRI are associated with poorer prognosis. As in previous studies, we observed that diagnostics of ON is difficult, accessory clinical findings such as pain and RAPD are not always present. Although the diagnosis of ON is clinical, the role of MRI should be considered in differential diagnostics and in defining potential prognostic markers.
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Affiliation(s)
- Mika Siuko
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, FI-000220 Helsinki, Finland.
| | - Tero T Kivelä
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, FI-000220 Helsinki, Finland
| | - Kirsi Setälä
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, FI-000220 Helsinki, Finland
| | - Pentti J Tienari
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Molecular Neurology Programme, Research Programs Unit, Biomedicum, University of Helsinki, Helsinki, Finland
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23
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Smith D, Arthur J, Lewis Z, Snead G. Ultrasound-Assisted Diagnosis of Optic Neuritis in the Emergency Department: A Case Report. J Emerg Med 2019; 57:212-215. [PMID: 31253461 DOI: 10.1016/j.jemermed.2019.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/07/2019] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Optic neuritis is a common cause of subacute unilateral vision loss, occurring in 1-5 per 100,000 persons per year. It is more common in Caucasians, women, and those from countries with northern latitudes. Those aged 20-49 years are at greatest risk. The condition arises due to inflammation of the optic nerve. Inflammation may occur due to systemic inflammatory disorders, most commonly multiple sclerosis. CASE REPORT A 21-year-old African-American male presented to our emergency department with a complaint of painful unilateral vision loss. On examination he was found to have a relative afferent pupillary defect and red desaturation. A bedside ultrasound suggested pseudopapilledema suggestive of optic neuritis. He was admitted to Neurology for confirmation of and treatment for optic neuritis. Magnetic resonance imaging confirmed optic neuritis. The patient was treated with i.v. steroids and discharged after improvement in visual function. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Optic neuritis is a clinical diagnosis. The subtle historical components and examination findings make it a diagnostic challenge for the busy emergency physician. Early diagnosis may improve visual outcomes. Discovery of pseudopapilledema on bedside ultrasound may be seen in optic neuritis, and is another finding that emergency physicians may assess for in patient presenting with unilateral vision loss.
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Affiliation(s)
- Daniel Smith
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jason Arthur
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Zachary Lewis
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Gregory Snead
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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24
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Optical coherence tomography as a means to characterize visual pathway involvement in multiple sclerosis. Curr Opin Neurol 2019; 31:662-668. [PMID: 30074495 DOI: 10.1097/wco.0000000000000604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Optical coherence tomography (OCT) is a noninvasive in-vivo imaging tool that enables the quantification of the various retinal layer thicknesses. Given the frequent involvement of the visual pathway in multiple sclerosis, OCT has become an important tool in clinical practice, research and clinical trials. In this review, the role of OCT as a means to investigate visual pathway damage in multiple sclerosis is discussed. RECENT FINDINGS Evidence from recent OCT studies suggests that the peripapillary retinal nerve fibre layer (pRNFL) appears to be an ideal marker of axonal integrity, whereas the macular ganglion cell and inner plexiform layer (GCIP) thickness enables early detection of neuronal degeneration in multiple sclerosis. The thickness of the macular inner nuclear layer (INL) has been suggested as a biomarker for inflammatory disease activity and treatment response in multiple sclerosis. OCT parameters may also be used as an outcome measure in clinical trials evaluating the neuroprotective or regenerative potential of new treatments. SUMMARY OCT provides insights into multiple sclerosis beyond the visual pathway. It is capable of quantifying the major pathological hallmarks of the disease, specifically inflammation and neuroaxonal degeneration. OCT, therefore, has the potential to become another mainstay in the monitoring of multiple sclerosis patients.
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25
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Xu SC, Kardon RH, Leavitt JA, Flanagan EP, Pittock SJ, Chen JJ. Optical coherence tomography is highly sensitive in detecting prior optic neuritis. Neurology 2019; 92:e527-e535. [PMID: 30674600 DOI: 10.1212/wnl.0000000000006873] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 12/06/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To explore sensitivity of optical coherence tomography (OCT) in detecting prior unilateral optic neuritis. METHODS This is a retrospective, observational clinical study of all patients who presented from January 1, 2014, to January 6, 2017, with unilateral optic neuritis and OCT available at least 3 months after the attack. We compared OCT retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thicknesses between affected and unaffected contralateral eyes. We excluded patients with concomitant glaucoma or other optic neuropathies. Based on analysis of normal controls, thinning was considered significant if RNFL was at least 9 µm or GCIPL was at least 6 µm less in the affected eye compared to the unaffected eye. RESULTS Fifty-one patients (18 male and 33 female) were included in the study. RNFL and GCIPL thicknesses were significantly lower in eyes with optic neuritis compared to unaffected eyes (p < 0.001). RNFL was thinner by ≥9 µm in 73% of optic neuritis eyes compared to the unaffected eye. GCIPL was thinner by ≥6 µm in 96% of optic neuritis eyes, which was more sensitive than using RNFL (p < 0.001). When using a threshold ≤1st percentile of age-matched controls, sensitivities were 37% for RNFL and 76% for GCIPL, each of which was lower than those calculated using the intereye difference as the threshold (p < 0.01). CONCLUSIONS OCT, especially with GCIPL analysis, is a highly sensitive modality in detecting prior optic neuritis, which is made more robust by using intereye differences to approximate change. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that OCT accurately identifies patients with prior unilateral optic neuritis.
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Affiliation(s)
- Sarah Chaoying Xu
- From the Departments of Ophthalmology (S.C.X., J.A.L., J.J.C.) and Neurology (E.P.F., S.J.P., J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology (R.H.K.), University of Iowa, Iowa City
| | - Randy H Kardon
- From the Departments of Ophthalmology (S.C.X., J.A.L., J.J.C.) and Neurology (E.P.F., S.J.P., J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology (R.H.K.), University of Iowa, Iowa City
| | - Jacqueline A Leavitt
- From the Departments of Ophthalmology (S.C.X., J.A.L., J.J.C.) and Neurology (E.P.F., S.J.P., J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology (R.H.K.), University of Iowa, Iowa City
| | - Eoin P Flanagan
- From the Departments of Ophthalmology (S.C.X., J.A.L., J.J.C.) and Neurology (E.P.F., S.J.P., J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology (R.H.K.), University of Iowa, Iowa City
| | - Sean J Pittock
- From the Departments of Ophthalmology (S.C.X., J.A.L., J.J.C.) and Neurology (E.P.F., S.J.P., J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology (R.H.K.), University of Iowa, Iowa City
| | - John J Chen
- From the Departments of Ophthalmology (S.C.X., J.A.L., J.J.C.) and Neurology (E.P.F., S.J.P., J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology (R.H.K.), University of Iowa, Iowa City.
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Bilateral papillitis and vitritis as the initial ophthalmologic finding in a patient with complex medical history, leading to diagnosis of multisystem sarcoidosis. Am J Ophthalmol Case Rep 2019; 13:122-126. [PMID: 30627688 PMCID: PMC6322055 DOI: 10.1016/j.ajoc.2018.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/05/2018] [Accepted: 12/19/2018] [Indexed: 11/24/2022] Open
Abstract
Aim To report a case of bilateral papillitis as the initial ophthalmologic presentation in a patient with complex medical history and multisystemic symptoms, eventually revealing a diagnosis of sarcoidosis. Methods Retrospective interventional case report. Report A 54-year-old Caucasian woman presented with bilateral decreased vision, photophobia and eye pain for a month. She was referred for evaluation of disc edema with questionable history of vitritis. She had a complicated medical history and systemic symptoms, including: multiple tick bites; focal neurologic symptoms including tingling, headache, numbness of fingers, and stiff neck; systemic immune disease with thyroid nodule; and chest strain, mild shortness of breath, and palpitations, leading to a large differential diagnosis. Further workup ruled out infectious diseases and multiple sclerosis. After chest imaging, she was finally diagnosed via biopsy with sarcoidosis. Therapy included combined high dose prednisone taper and ongoing methotrexate. Both ocular and systemic symptoms improved after treatment, but there was limited improvement of scotoma in the left eye. Conclusion This report provides a case for ophthalmologists for papillitis as the initial manifestation of sarcoidosis, but with various potential differential diagnoses during work up.
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Coric D, Nij Bijvank JA, van Rijn LJ, Petzold A, Balk LJ. The role of optical coherence tomography and infrared oculography in assessing the visual pathway and CNS in multiple sclerosis. Neurodegener Dis Manag 2018; 8:323-335. [DOI: 10.2217/nmt-2018-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In this review, a current overview is provided of how optical coherence tomography and infrared oculography can aid in assessing the visual system and CNS in multiple sclerosis (MS). Both afferent and efferent visual disorders are common in MS and visual complaints can have a tremendous impact on daily functioning. Optical coherence tomography and infrared oculography can detect and quantify visual disorders with high accuracy, but could also serve as quantitative markers for inflammation, neurodegeneration and network changes including cognitive decline in MS patients. The assessment of the efferent and afferent visual pathways is relevant for monitoring and predicting the disease course, but is also potentially valuable as an outcome measure in therapeutic trials.
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Affiliation(s)
- Danko Coric
- Department of Neurology, Amsterdam Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jenny A Nij Bijvank
- Department of Neurology, Amsterdam Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Laurentius J van Rijn
- Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Axel Petzold
- Department of Neurology, Amsterdam Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands
- Moorfields Eye Hospital & The National Hospital for Neurology & Neurosurgery, London, UK
| | - Lisanne J Balk
- Department of Neurology, Amsterdam Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands
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28
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Tian Y, Liu Z, Tang Z, Li M, Lou X, Dong E, Liu G, Wang Y, Wang Y, Bian X, Wei S, Tian J, Ma L. Radiomics Analysis of DTI Data to Assess Vision Outcome After Intravenous Methylprednisolone Therapy in Neuromyelitis Optic Neuritis. J Magn Reson Imaging 2018; 49:1365-1373. [PMID: 30252996 DOI: 10.1002/jmri.26326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Neuromyelitis optica-optic neuritis (NMO-ON) patients are routinely treated with intravenous methylprednisolone (IVMP). For the patients nonresponsive to IVMP, more effective but aggressive therapy of plasma exchange (PE) should be employed instead of IVMP in the first line. PURPOSE To assess the visual outcomes of NMO-ON patients after IVMP by radiomics analysis of whole brain diffusion tensor imaging (DTI) data. STUDY TYPE Retrospective. POPULATION In all, 57 NMO-ON patients receiving IVMP therapy for 3 days. FIELD STRENGTH/SEQUENCE 3.0T; DTI images acquired by a single-shot echo planar image sequence; T1 images acquired by 3D fast spoiled gradient echo (3D-FSPGR) MRI. ASSESSMENT In all, 200 DTI measures were extracted from the DTI data and employed as features to construct a radiomics assessment model for visual outcomes of NMO-ON patients after IVMP. The assessment performance was evaluated by area under the receiver operating characteristic curve (AUC), classification accuracy (ACC), sensitivity, specificity, and positive and negative predicted values (PPV and NPV). The selected DTI measures would reveal the white matter impairments related to visual recovery of NMO-ON patients. STATISTICAL TESTS The relationship between the selected DTI measures and the clinical visual characteristics were investigated by Pearson correlation, Spearman's rank correlation, and one-way analysis of variance analysis. RESULTS The radiomics model obtained an ACC of 73.68% (P = 0.002), AUC of 0.7931, sensitivity of 0.6207, specificity of 0.8571, PPV of 0.8182, and NPV of 0.6857 in assessing visual outcomes of the NMO-ON patients after IVMP treatment. The selected DTI measures revealed white matter impairments related to the visual outcomes in the white matter tracts of vision-relevant regions, motor-related regions, and corpus callosum. The white matter impairments were found significantly correlated with the disease duration and the length of lesions in the optic nerve. DATA CONCLUSION Radiomics analysis of DTI data has great potential in assessing visual outcomes of NMO-ON patients after IVMP therapy. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2019;49:1365-1373.
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Affiliation(s)
- Yuan Tian
- Department of Radiology, Chinese PLA General Hospital, Beijing, P.R. China.,Department of Radiology, 309th Hospital of Chinese People's Liberation Army, Beijing, P.R. China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, P.R. China
| | - Zhenchao Tang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, P.R. China.,School of Mechanical, Electrical & Information Engineering, Shandong University, Weihai, Shandong Province, P.R. China
| | - Mingge Li
- Department of Radiology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Enqing Dong
- School of Mechanical, Electrical & Information Engineering, Shandong University, Weihai, Shandong Province, P.R. China
| | - Gang Liu
- Department of Radiology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Yulin Wang
- Department of Radiology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Yan Wang
- Department of Radiology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Xiangbin Bian
- Department of Radiology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Shihui Wei
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, P.R. China.,University of Chinese Academy of Sciences, Beijing, P.R. China
| | - Lin Ma
- Department of Radiology, Chinese PLA General Hospital, Beijing, P.R. China
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Siuko M, Kivelä TT, Setälä K, Tienari PJ. Incidence and Mimickers of Acute Idiopathic Optic Neuritis: Analysis of 291 Consecutive Patients from Southern Finland. Ophthalmic Epidemiol 2018; 25:386-391. [DOI: 10.1080/09286586.2018.1500614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mika Siuko
- Departments of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tero T. Kivelä
- Departments of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kirsi Setälä
- Departments of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pentti J. Tienari
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Molecular Neurology Program, Research Programs Unit, Biomedicum, University of Helsinki, Helsinki, Finland
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30
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Tourbah A, Gout O, Vighetto A, Deburghgraeve V, Pelletier J, Papeix C, Lebrun-Frenay C, Labauge P, Brassat D, Toosy A, Laplaud DA, Outteryck O, Moreau T, Debouverie M, Clavelou P, Heinzlef O, De Sèze J, Defer G, Sedel F, Arndt C. MD1003 (High-Dose Pharmaceutical-Grade Biotin) for the Treatment of Chronic Visual Loss Related to Optic Neuritis in Multiple Sclerosis: A Randomized, Double-Blind, Placebo-Controlled Study. CNS Drugs 2018; 32:661-672. [PMID: 29808469 PMCID: PMC6061426 DOI: 10.1007/s40263-018-0528-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chronic visual loss is a disabling feature in patients with multiple sclerosis (MS). It was recently shown that MD1003 (high-dose pharmaceutical-grade biotin or hdPB) may improve disability in patients with progressive MS. OBJECTIVE The aim of this study was to evaluate whether MD1003 improves vision compared with placebo in MS patients with chronic visual loss. METHODS The MS-ON was a 6-month, randomized, double-blind, placebo-controlled study with a 6-month open-label extension phase. Adult patients with MS-related chronic visual loss of at least one eye [visual acuity (VA) below 0.5 decimal chart] were randomized 2:1 to oral MD1003 300 mg/day or placebo. The selected eye had to show worsening of VA within the past 3 years following either acute optic neuritis (AON) or slowly progressive optic neuropathy (PON). The primary endpoint was the mean change from baseline to month 6 in VA measured in logarithm of the minimum angle of resolution (logMAR) at 100% contrast of the selected eye. Visually evoked potentials, visual field, retinal nerve fiber layer (RNFL) thickness, and health outcomes were also assessed. RESULTS Ninety-three patients received MD1003 (n = 65) or placebo (n = 28). The study did not meet its primary endpoint, as the mean change in the primary endpoint was nonsignificantly larger (p = 0.66) with MD1003 (- 0.061 logMAR, + 3.1 letters) than with placebo (- 0.036 logMAR, + 1.8 letters). Pre-planned subgroup analyses showed that 100% contrast VA improved by a mean of + 2.8 letters (- 0.058 logMAR) with MD1003 and worsened by - 1.5 letters (+ 0.029 logMAR) with placebo (p = 0.45) in the subgroup of patients with PON. MD1003-treated patients also had nonsignificant improvement in logMAR at 5% contrast and in RNFL thickness and health outcome scores when compared with placebo-treated patients. There was no superiority of MD1003 vs placebo in patients with AON. The safety profile of MD1003 was similar to that of placebo. CONCLUSIONS MD1003 did not significantly improve VA compared with placebo in patients with MS experiencing chronic visual loss. An interesting trend favoring MD1003 was observed in the subgroup of patients with PON. Treatment was overall well tolerated. TRIAL REGISTRATION EudraCT identifier 2013-002112-27. ClinicalTrials.gov Identifier: NCT02220244 FUNDING: MedDay Pharmaceuticals.
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Affiliation(s)
- Ayman Tourbah
- Department of Neurology, Faculty of Medicine, CHU de Reims, URCA, Reims, France.
- LPN EA 2027, Université Paris 8, Saint-Denis, France.
| | - Olivier Gout
- Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Alain Vighetto
- Lyon Neuroscience Research Center (CRNL), ImpAct, INSERM U1028, CNRS, UMR5292, Lyon 1 University, Lyon, France
- Department of Neurology, Hopital Neurologigue, Hospices Civils de Lyon, Bron, France
| | | | - Jean Pelletier
- Department of Neurology, APHM, Hôpital de la Timone, Marseille, France
- UMR 7339, CRMBM, CNRS, Aix-Marseille Université, Marseille, France
| | - Caroline Papeix
- Department of Neurology, GH Pitié Salpêtrière, Paris, France
| | | | - Pierre Labauge
- Department of Neurology, CHU de Montpellier, Montpellier, France
| | - David Brassat
- INSERM U1043, Centre de Resource et de Competence SEP, Hopital Pierre Paul Riquet, Université de Toulouse, Toulouse, France
| | - Ahmed Toosy
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square Multiple Sclerosis Centre, University College London, London, UK
| | - David-Axel Laplaud
- UMR 1064, INSERM, Centre de Recherche en Transplantation et Immunologie, Université de Nantes, Nantes, France
- Service Neurologie, CHU Nantes, Nantes, France
| | - Olivier Outteryck
- Department of Neurology, CHU de Lille, University of Lille, Lille, France
| | - Thibault Moreau
- Department of Neurology, University Hospital of Dijon, Dijon, France
| | | | - Pierre Clavelou
- Department of Neurology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Heinzlef
- Department of Neurology, Centre Hospitalier de Poissy, Saint Germain, France
| | - Jérôme De Sèze
- INSERM 1434, Department of Neurology, Clinical Investigation Center, CHU de Strasbourg, Strasbourg, France
| | - Gilles Defer
- Department of Neurology, CHU de Caen, Caen, France
| | | | - Carl Arndt
- Department of Ophthalmology, Faculty of Medicine, CHU de Reims, URCA, Reims, France
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Falcão-Gonçalves AB, Bichuetti DB, de Oliveira EML. Recurrent Optic Neuritis as the Initial Symptom in Demyelinating Diseases. J Clin Neurol 2018; 14:351-358. [PMID: 29856159 PMCID: PMC6031992 DOI: 10.3988/jcn.2018.14.3.351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 01/08/2023] Open
Abstract
Background and Purpose Optic neuritis (ON) is an inflammation of the optic nerve that can be recurrent, with unilateral or bilateral presentation. Diagnosing recurrent cases may be challenging. We aimed to compare patients with recurrent ON as their initial symptom according to their following final diagnoses: multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), or chronic relapsing inflammatory optic neuropathy (CRION). Methods The medical records of patients with initial recurrent ON who were followed at the Neuroimmunology Clinic of the Federal University of São Paulo between 2004 and 2016 were analyzed retrospectively. Patients were classified according to their final diagnosis into MS, NMOSD, or CRION, and the characteristics of these groups were compared to identify predictive factors. Results Thirty-three patients with recurrent ON were included, and 6, 14, and 13 had final diagnoses of MS, NMOSD, and CRION, respectively. Most of the patients were female with unilateral and severe ON in their first episode, and the initial Visual Functional System Score (VFSS) was ≥5 in 63.6%, 85.7%, and 16.7% of the patients with CRION, NMOSD, and MS, respectively. Anti-aquaporin-4 antibodies were detected in 9 of 21 (42.8%) tested patients. Seven of nine (77.8%) seropositive NMOSD patients experienced transverse myelitis episodes during the follow-up period. A multivariate regression analysis showed that the VFSS at the last medical appointment predicted the final diagnosis. Conclusions A lower VFSS at the last medical appointment was predictive of MS. Patients with NMOSD and CRION have similar clinical characteristics, whereas NMOSD patients tend to have worse visual acuity.
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Affiliation(s)
| | - Denis Bernardi Bichuetti
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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32
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Wang F, Dang Y, Wang J, Zhou T, Zhu Y. Gypenosides attenuate lipopolysaccharide-induced optic neuritis in rats. Acta Histochem 2018; 120:340-346. [PMID: 29559175 DOI: 10.1016/j.acthis.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the effect of gypenosides (GPs) on lipopolysaccharide (LPS)-induced optic neuritis rats. METHODS Optic neuritis was induced by a single microinjection of LPS into the optic nerve of Sprague Dawley rats. GPs (400 mg/kg) was administrated by gavage for 21 days. The optic nerve structure changes and demyelination were observed after hematoxylin & eosin and Luxol-fast blue staining. Apoptosis of retinal ganglion cells (RGCs) was evaluated using Brn3a-TUNEL double staining. Expression of CD68 and glial fibrillary acidic protein (GFAP) were detected using immunofluorescence staining. The mRNA levels of inflammatory factors were measured using quantitative real-time PCR. The protein expression levels in the signal transducer and activator of transcription (STAT) and nuclear factor-κB (NF-κB) pathways were detected using Western blot. RESULTS GPs treatment prevented the optic nerve structure changes and demyelination in the rats with optic neuritis. GPs treatment downregulated LPS-induced overexpressions of CD68, GFAP and pro-inflammatory factors. GPs treatment inhibited STAT1 and 3 phosphorylation and NF-κB nuclear translocation in the optic nerve and retina of rats with optic neuritis. CONCLUSION GPs attenuate LPS-induced inflammation, demyelination and optic nerve damage which may be associated with the inhibition of the NF-κB and STAT pathways.
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Ren Z, Liu Y, Li K, Duan Y, Jing H, Liang P, Sun Z, Zhang X, Mao B. Baseline Brain Activity Changes in Patients With Single and Relapsing Optic Neuritis. Front Hum Neurosci 2018; 12:144. [PMID: 29731712 PMCID: PMC5919956 DOI: 10.3389/fnhum.2018.00144] [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: 11/14/2017] [Accepted: 04/03/2018] [Indexed: 11/15/2022] Open
Abstract
Purpose: To investigate spontaneous brain activity amplitude alterations in single and relapsing optic neuritis (sON and rON, respectively) and their relationships with clinical variables. Methods: In total, 42 patients with sON, 35 patients with rON and 50 healthy volunteers were recruited. Resting-state functional Magnetic Resonance Imaging (rs-fMRI) scans were acquired for all participants and compared to investigate the changes in the amplitude of low-frequency fluctuations (ALFFs) among the three groups. The relationships between the ALFFs in regions with significant differences in the groups and clinical variables, including the logarithm of minimal angle of resolution (LogMAR), Expanded Disability Status Scale (EDSS) score and disease duration, were further explored. Results: Compared with healthy volunteers, the sON and rON patients showed significantly decreased ALFFs in several regions of the occipital and temporal lobes (i.e., inferior occipital gyrus and superior temporal gyrus; corrected p < 0.01 using AlphaSim). The sON patients showed significantly increased ALFFs in the left caudate and certain regions in the frontal lobes (i.e., medial frontal gyrus), whereas the rON patients showed increased ALFFs in the bilateral inferior temporal gyrus and left medial frontal gyrus (corrected p < 0.01 using AlphaSim). Significantly decreased ALFFs were observed in the right inferior parietal lobule (IPL), left posterior cingulate and precuneus in the rON patients compared with those in the sON patients (corrected p < 0.01 using AlphaSim). Significant correlations were observed between the disease duration and ALFF in the left middle temporal gyrus, left inferior occipital gyrus, right lingual gyrus and right IPL (p < 0.05). Conclusion: Functional impairment and adaptation occurred in both the sON and rON patients. Impairment mainly involved the occipital cortex, and functional adaptions predominantly occurred in the frontal lobe. Functional damage was more severe in the rON patients than in the sON patients and correlated with the disease duration.
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Affiliation(s)
- Zhuoqiong Ren
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing, China
| | - Yaou Liu
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing, China
- *Correspondence: Yaou Liu Kuncheng Li
| | - Kuncheng Li
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing, China
- *Correspondence: Yaou Liu Kuncheng Li
| | - Yunyun Duan
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing, China
| | - Huang Jing
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing, China
| | - Peipeng Liang
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing, China
| | - Zheng Sun
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing, China
| | | | - Bei Mao
- Beijing Tongren Hospital, Beijing, China
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Jeon H, Jeong YH, Choi HY, Lee JE, Byon I, Park SW. Clinical Features of Toxocara-Seropositive Optic Neuritis in Korea. Ocul Immunol Inflamm 2018; 27:829-835. [PMID: 29652203 DOI: 10.1080/09273948.2018.1449866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: This study was undertaken to analyze the characteristics of optic neuritis in Korean patients seropositive for Toxocara. Methods: We retrospectively reviewed data from patients diagnosed with optic neuritis and followed up for at least one month between 2012 and 2016. Patients were grouped according to Toxocara serological testing outcomes (positive or negative) and clinical characteristics were compared. Results: The seropositive and seronegative groups comprised 13 and 12 patients, respectively. The seropositive patients were older (56.8 years versus 34.5 years), reported ocular pain less frequently (30.8% versus 91.7%), and showed more frequent asymmetric optic disc swelling (72.7% versus 22.2%). During follow-up, visual acuity of all seronegative patients improved to 20/40 or better, compared with 38.5% of the seropositive group. Conclusion: Atypical features such as painless, older age, or asymmetric disc swelling in optic neuritis may be related to seropositivity for Toxocara, suggesting the possibility of undiagnosed Toxocara optic neuropathy.
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Affiliation(s)
- Hyeshin Jeon
- a Department of Ophthalmology, School of Medicine, Pusan National University , Yangsan , South Korea.,b Biomedical Research Institute, Pusan National University Hospital , Busan , South Korea
| | - Young Hwan Jeong
- a Department of Ophthalmology, School of Medicine, Pusan National University , Yangsan , South Korea
| | - Hee-Young Choi
- a Department of Ophthalmology, School of Medicine, Pusan National University , Yangsan , South Korea.,b Biomedical Research Institute, Pusan National University Hospital , Busan , South Korea
| | - Ji Eun Lee
- a Department of Ophthalmology, School of Medicine, Pusan National University , Yangsan , South Korea.,b Biomedical Research Institute, Pusan National University Hospital , Busan , South Korea
| | - Iksoo Byon
- c Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Sung Who Park
- a Department of Ophthalmology, School of Medicine, Pusan National University , Yangsan , South Korea.,b Biomedical Research Institute, Pusan National University Hospital , Busan , South Korea
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Affiliation(s)
- Tae-Seen Kang
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Woohyuk Lee
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yeon-Hee Lee
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea
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Aranda ML, González Fleitas MF, Dieguez HH, Milne GA, Devouassoux JD, Keller Sarmiento MI, Chianelli M, Sande PH, Dorfman D, Rosenstein RE. Therapeutic benefit of environmental enrichment on optic neuritis. Neuropharmacology 2017; 145:87-98. [PMID: 29233635 DOI: 10.1016/j.neuropharm.2017.12.017] [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: 07/14/2017] [Revised: 11/13/2017] [Accepted: 12/09/2017] [Indexed: 12/22/2022]
Abstract
Optic neuritis (ON) is an inflammatory, demyelinating, neurodegenerative, and presently untreatable condition of the optic nerve which might induce blindness. We analyzed the effect of environmental enrichment (EE) on visual pathway damage provoked by experimental ON induced by a microinjection of bacterial lipopolysaccharide (LPS) into the optic nerve. For this purpose, LPS was microinjected into the optic nerve from male Wistar rats. After injection, one group of animals was submitted to EE, and another group remained in standard environment (SE) for 21 days. EE prevented the decrease in pupil light reflex (PLR), visual evoked potentials, retinal anterograde transport, phosphorylated neurofilament immunoreactivity, myelination (luxol fast blue staining), and axon (toluidine blue staining) and retinal ganglion cell (Brn3a-immunoreactivity) number. EE also prevented microglial/macrophage reactivity (Iba-1- and ED1-immunoreactivity), and astrocytosis (glial fibrillary acidic protein-immunostaining) induced by experimental ON. LPS-injected optic nerves displayed oxidative damage and increased inducible nitric oxide synthase, cyclooxygenase-2, and interleukin-1β and TNFα mRNA levels which were prevented by EE. EE increased optic nerve brain-derived neurotrophic factor levels. When EE started at 4 (but not 7) days post-injection of LPS, a preservation of the PLR was observed at 21 days post-LPS, which was blocked by the daily administration of ANA-12 from day 4 to day 7 post-LPS. Moreover, EE from day 4 to day 7 post-LPS significantly preserved the PLR at 21 days post-injection. Taken together, our data suggest that EE preserved visual functions and reduced neuroinflammation of the optic nerve. This article is part of the Special Issue entitled "Neurobiology of Environmental Enrichment".
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Affiliation(s)
- Marcos L Aranda
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Paraguay 2155, 5th Floor, 1121, Buenos Aires, Argentina
| | - María F González Fleitas
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Paraguay 2155, 5th Floor, 1121, Buenos Aires, Argentina
| | - Hernán H Dieguez
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Paraguay 2155, 5th Floor, 1121, Buenos Aires, Argentina
| | - Georgia A Milne
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Paraguay 2155, 5th Floor, 1121, Buenos Aires, Argentina
| | - Julián D Devouassoux
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Paraguay 2155, 5th Floor, 1121, Buenos Aires, Argentina
| | - María I Keller Sarmiento
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Paraguay 2155, 5th Floor, 1121, Buenos Aires, Argentina
| | - Mónica Chianelli
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Paraguay 2155, 5th Floor, 1121, Buenos Aires, Argentina
| | - Pablo H Sande
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Paraguay 2155, 5th Floor, 1121, Buenos Aires, Argentina
| | - Damián Dorfman
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Paraguay 2155, 5th Floor, 1121, Buenos Aires, Argentina
| | - Ruth E Rosenstein
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Paraguay 2155, 5th Floor, 1121, Buenos Aires, Argentina.
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McKee JB, Cottriall CL, Elston J, Epps S, Evangelou N, Gerry S, Kennard C, Kong Y, Koelewyn A, Kueker W, Leite MI, Palace J, Craner M. Amiloride does not protect retinal nerve fibre layer thickness in optic neuritis in a phase 2 randomised controlled trial. Mult Scler 2017; 25:246-255. [PMID: 29172994 DOI: 10.1177/1352458517742979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Recent basic and clinical evidence suggests amiloride may be neuroprotective in multiple sclerosis (MS) through the blockade of the acid sensing ion channel (ASIC). OBJECTIVE To examine the neuroprotective efficacy of amiloride in acute optic neuritis (ON). METHODS A total of 48 patients were recruited to a phase 2, double blind, single site, randomised controlled trial. Scanning laser polarimetry (GDx) at 6 months was the primary outcome measure and optical coherence tomography (OCT) and visual and electrophysiological measures were secondary outcome measures. Participants aged 18-55 years, ≤28 days of onset of first episode unilateral ON, were randomised to amiloride (10 mg daily for 5 months) or placebo ( clinicaltrials.gov , NCT 01802489). RESULTS Intention-to-treat (ITT) cohort consisted of 43 patients; 23 placebo and 20 amiloride. No significant drug-related adverse events occurred. No significant differences were found in GDx ( p = 0.840). Visual evoked potentials (VEP) were significantly prolonged in the amiloride group compared to placebo ( p = 0.004). All other secondary outcome measures showed no significant difference. Baseline analysis of OCT data demonstrated a significant pre-randomisation thinning of ganglion cell layer. CONCLUSION Amiloride has not demonstrated any neuroprotective benefit within this trial paradigm, but future neuroprotective trials in ON should target the window of opportunity to maximise potential neuroprotective benefit.
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Affiliation(s)
- Justin B McKee
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/The Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
| | - Charles L Cottriall
- The Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John Elston
- The Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Simon Epps
- Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Nikos Evangelou
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Christopher Kennard
- Medical Sciences Division, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Yazhuo Kong
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK/Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Abigail Koelewyn
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Wilhelm Kueker
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Maria Isabel Leite
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Matthew Craner
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Chen TC, Yeh CY, Lin CW, Yang CM, Yang CH, Lin IH, Chen PY, Cheng JY, Hu FR. Vascular hypoperfusion in acute optic neuritis is a potentially new neurovascular model for demyelinating diseases. PLoS One 2017; 12:e0184927. [PMID: 28926646 PMCID: PMC5605049 DOI: 10.1371/journal.pone.0184927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/02/2017] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Optic neuritis is highly correlated with multiple sclerosis and is a major cause of acute visual loss and long-term neuronal degeneration. Primary cerebral hypoperfusion has been reported in brain demyelinating diseases. This study investigated whether peripapillary perfusion is changed in patients with acute optic neuritis (AON). METHODS This three-year cohort study was conducted from September 1 2012, to August 31, 2015. Two hundred and forty-one patients with non-glaucomatous acute optic neuropathy were screened, and 42 non-highly myopic patients who had suffered their first episode of unilaterally idiopathic AON were studied. All cases received spectral-domain optical coherence tomography (OCT) examination, general survey, and standard corticosteroid therapy. OCT images were analyzed using a customized MATLAB program for measuring peripapillary choroidal thickness (PCT). Multivariate regression models were constructed to identify factors that are significantly related to peripapillary perfusion. RESULTS Decreased PCT was found in eyes experiencing AON combined with disc swelling (the ratio of lesion eye PCT/fellow eye PCT was 0.87 ± 0.08; range, from 0.75 to 1.00). In comparison to the healthy fellow eyes, approximately every 26% increase in the thickness of the retinal nerve fiber layer due to axonal swelling was associated with a 10% decreased thickness of PCT. Thinner PCT is also correlated with poorer trough vision, which may lead to poorer final vision. These findings were obvious in patients with optic papillitis but not in patients with retrobulbar neuritis. CONCLUSIONS Peripapillary vascular hypoperfusion was found in patients experiencing AON combined with disc swelling. These findings are unlike those for other ocular inflammatory diseases but are consistent with cerebral hypoperfusion, which is found in brain demyelinating diseases; thus, these findings may represent a new neurovascular model in this field.
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Affiliation(s)
- Ta-Ching Chen
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Yuan Yeh
- Department of Pathology, University of Southern California, Los Angeles, California, United States of America
| | - Chao-Wen Lin
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Hung Lin
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pao-Yang Chen
- Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Jung-Yu Cheng
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Optic Canal Decompression With Unexpected Changes in Cerebrospinal Fluid of the Optic Canal. J Craniofac Surg 2017; 28:1563-1564. [PMID: 28749847 DOI: 10.1097/scs.0000000000003934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Optic neuritis is a common inflammatory disease of the optic nerve. And the cerebral spinal fluid (CSF) in the subarachnoid space of optic nerve is thought to be homogeneous as in spine. We report a case of optic neuritis, some unexpected opaque fluid observed to flow out from the optic canal during the optic canal decompression surgery when the CSF in spine is normal. One day after the surgery, the visual acuity of the patient improved dramatically to 0.4 from 0.05. This report highlights the possible restrictive pathological changes of the CSF in the optic nerve of acute optic neuritis, which may be the reason of the dysfunction of the optic nerve.
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40
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Moss HE. Visual consequences of medications for multiple sclerosis: the good, the bad, the ugly, and the unknown. Eye Brain 2017; 9:13-21. [PMID: 28721111 PMCID: PMC5498528 DOI: 10.2147/eb.s140481] [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] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Multiple sclerosis (MS) is associated with vision changes both due to MS effects on visual pathways and due to medication effects on the visual pathways. Distinguishing the causes of vision change are critical to appropriate diagnosis and management. The incidence, presentation, and treatment of fingolimod-associated macular edema, alemtuzumab-associated thyroid orbitopathy, and progressive multifocal leukoencephalopathy in MS patients are reviewed. Evidence for beneficial effects of acute, chronic, and symptomatic MS medications on vision is presented.
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Affiliation(s)
- Heather E Moss
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA.,Department of Neurology & Neuroscience, Stanford University, Stanford, CA, USA
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Choy BNK, Ng ALK, Lai JSM. Clinical characteristics of optic neuritis in Hong Kong population: 10-year review. Int Ophthalmol 2017; 38:557-564. [PMID: 28289949 DOI: 10.1007/s10792-017-0491-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/06/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To review the clinical course of adult patients with acute optic neuritis over 10 years in Hong Kong, and the results were compared with other studies among Asian and Caucasian patients. METHODS This study retrospectively analysed the clinical features of 38 adult patients (51 eyes) presented with optic neuritis in a Hong Kong hospital over 10 years (2001-2010). RESULTS Optic neuritis had a female predominance (68%). The mean age of presentation was 40 years old. Disc swelling (39%) was more common compared to the optic neuritis treatment trial (ONTT). The recovery time ranged from no recovery to 5 years, with a mean of 6.0 months. However, vision continued to deteriorate despite initial improvement in 45% of patients. Only 11.8% of the eyes attained final visual acuity (VA) of 1.0 or better, while 31.4% had VA 0.1 or worse. Multiple sclerosis or neuromyelitis optica only occurred in 10.4% of patients. Three of our patients who did not receive any treatment showed faster recovery than the average. CONCLUSIONS Optic neuritis in Hong Kong is mostly a clinically isolated syndrome. Our patients presented at a later age and showed a worse visual outcome. Corticosteroid according to ONTT protocol remained our mainstay of treatment although it did not benefit our patients as much as ONTT study. More work on the long-term prognosis and treatment strategies is worthwhile among Chinese optic neuritis patients.
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Affiliation(s)
- Bonnie Nga Kwan Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong SAR, China.
| | - Alex Lap Ki Ng
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong SAR, China
| | - Jimmy Shiu Ming Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong SAR, China
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Boegel KH, Tyan AE, Iyer VR, Rykken JB, McKinney AM. Utility of coronal contrast-enhanced fat-suppressed FLAIR in the evaluation of optic neuropathy and atrophy. Eur J Radiol Open 2017; 4:13-18. [PMID: 28275657 PMCID: PMC5331143 DOI: 10.1016/j.ejro.2017.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Evaluating chronic sequelae of optic neuritis, such as optic neuropathy with or without optic nerve atrophy, can be challenging on whole brain MRI. This study evaluated the utility of dedicated coronal contrast-enhanced fat-suppressed FLAIR (CE-FS-FLAIR) MR imaging to detect optic neuropathy and optic nerve atrophy. Materials and methods Over 4.5 years, a 3 mm coronal CE-FS-FLAIR sequence at 1.5T was added to the routine brain MRIs of 124 consecutive patients, 102 of whom had suspected or known demyelinating disease. Retrospective record reviews confirmed that 28 of these 102 had documented onset of optic neuritis >4 weeks prior to the brain MRI. These 28 were compared to the other 22 (“controls”) of the 124 patients who lacked a history of demyelinating disease or visual symptoms. Using coronal CE-FS-FLAIR, two neuroradiologists separately graded each optic nerve (n = 50 patients, 100 total nerves) as either negative, equivocal, or positive for optic neuropathy or atrophy. The scoring was later repeated. Results The mean time from acute optic neuritis onset to MRI was 4.1 ± 4.6 years (range 34 days-17.4 years). Per individual nerve grading, the range of sensitivity, specificity, and accuracy of coronal CE-FS-FLAIR in detecting optic neuropathy was 71.4–77.1%, 93.8–95.4%, and 85.5–89.0%, respectively, with strong interobserver (k = 0.667 − 0.678, p < 0.0001), and intraobserver (k = 0.706 − 0.763, p < 0.0001) agreement. For optic atrophy, interobserver agreement was moderate (k = 0.437 − 0.484, p < 0.0001), while intraobserver agreement was moderate-strong (k = 0.491 − 0.596, p < 0.0001). Conclusion Coronal CE-FS-FLAIR is quite specific in detecting optic neuropathy years after the onset of acute optic neuritis, but is less useful in detecting optic nerve atrophy.
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Aranda ML, Fleitas MFG, Dieguez H, Iaquinandi A, Sande PH, Dorfman D, Rosenstein RE. Melatonin as a Therapeutic Resource for Inflammatory Visual Diseases. Curr Neuropharmacol 2017; 15:951-962. [PMID: 28088912 PMCID: PMC5652015 DOI: 10.2174/1570159x15666170113122120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/15/2016] [Accepted: 01/06/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Uveitis and optic neuritis are prevalent ocular inflammatory diseases, and highly damaging ocular conditions. Both diseases are currently treated with corticosteroids, but they do not have adequate efficacy and are often associated with severe side effects. Thus, uveitis and optic neuritis remain a challenging field to ophthalmologists and a significant public health concern. OBJECTIVE This review summarizes findings showing the benefits of a treatment with melatonin in experimental models of these inflammatory ocular diseases. RESULTS Oxidative and nitrosative damage, tumor necrosis factor, and prostaglandin production have been involved in the pathogeny of uveitis and optic neuritis. Melatonin is an efficient antioxidant and antinitridergic, and has the ability to reduce prostaglandin and tumor necrosis factor levels both in the retina and optic nerve. Moreover, melatonin not only prevents functional and structural consequences of experimental uveitis and optic neuritis, but it is also capable of suppressing the actively ongoing ocular inflammatory response. CONCLUSIONS Since melatonin protects ocular tissues against inflammation, it could be a potentially useful anti-inflammatory therapy in ophthalmology.
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Affiliation(s)
- Marcos L. Aranda
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - María Florencia González Fleitas
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - Hernán Dieguez
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - Agustina Iaquinandi
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - Pablo H. Sande
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | | | - Ruth E. Rosenstein
- Address correspondence to this author at the Department of Human Biochemistry, School of Medicine, CEFyBO, University of Buenos Aires, CONICET, Paraguay 2155, 5th Floor, (1121), Buenos Aires, Argentina;, Tel: 54-11-45083672 (ext 37); Fax: 54-11-45083672 (ext 317);, E-mail:
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Lochner P, Leone MA, Fassbender K, Cantello R, Coppo L, Nardone R, Zorzi G, Lesmeister M, Comi C, Brigo F. Transorbital Sonography and Visual Outcome for the Diagnosis and Monitoring of Optic Neuritis. J Neuroimaging 2016; 27:92-96. [DOI: 10.1111/jon.12405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/07/2016] [Accepted: 10/11/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Piergiorgio Lochner
- Department of Neurology; Saarland University Medical Center; Homburg Germany
- Department of Translational Medicine, Section of Neurology; University of Piemonte Orientale ‘‘A. Avogadro’’; Novara Italy
| | - Maurizio A. Leone
- SC Neurologia, Dept of Medical Sciences; IRCCS “Casa Sollievo della Sofferenza”; San Giovanni Rotondo Italy
| | - Klaus Fassbender
- Department of Neurology; Saarland University Medical Center; Homburg Germany
| | - Roberto Cantello
- Department of Translational Medicine, Section of Neurology; University of Piemonte Orientale ‘‘A. Avogadro’’; Novara Italy
| | - Lorenzo Coppo
- Department of Translational Medicine, Section of Neurology; University of Piemonte Orientale ‘‘A. Avogadro’’; Novara Italy
| | - Raffaele Nardone
- Department of Neurology, Christian Doppler Klinik; Paracelsus Medical University; Salzburg Austria
| | - Gianni Zorzi
- Department of Ophthalmology, Orthoptic Service; Hospital of Merano; Italy
| | - Martin Lesmeister
- Department of Neurology; Saarland University Medical Center; Homburg Germany
| | - Cristoforo Comi
- Department of Translational Medicine, Section of Neurology; University of Piemonte Orientale ‘‘A. Avogadro’’; Novara Italy
- Interdisciplinary Research Center of Autoimmune Diseases; Novara Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement. Section of Clinical Neurology; University of Verona; Verona Italy
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Wan H, He H, Zhang F, Sha Y, Tian G. Diffusion-weighted imaging helps differentiate multiple sclerosis and neuromyelitis optica-related acute optic neuritis. J Magn Reson Imaging 2016; 45:1780-1785. [PMID: 27859858 DOI: 10.1002/jmri.25528] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/11/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hailin Wan
- Department of Radiology, Shanghai Pudong Hospital; Fudan University; Shanghai China
| | - Huijin He
- Department of Radiology, Shanghai Pudong Hospital; Fudan University; Shanghai China
| | - Fang Zhang
- Department of Radiology, Eye & ENT Hospital; Fudan University; Shanghai China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital; Fudan University; Shanghai China
| | - Guohong Tian
- Department of Ophthalmology, Eye & ENT Hospital; Fudan University; Shanghai China
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Ramdas S, Morrison D, Absoud M, Lim M. Acute onset blindness: a case of optic neuritis and review of childhood optic neuritis. BMJ Case Rep 2016; 2016:bcr-2016-214929. [PMID: 27702928 DOI: 10.1136/bcr-2016-214929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Optic neuritis (ON) is an acquired disorder of the optic nerve due to inflammation, demyelination or degeneration. We report a child who presented with acute onset bilateral visual loss who, following a diagnosis of ON, was treated and had excellent visual recovery. Paediatric ON is considered to be different clinical entity to adult ON. Although in children ON is usually parainfectious or postinfectious, it can be the first presenting feature of multiple sclerosis or neuromyelitis optica spectrum disease. In this paper, we discuss the literature on treatment of ON and prediction of risk of recurrence.
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Affiliation(s)
- Sithara Ramdas
- Department of Paediatric Neurology, Evelina London Children's Hospital at Guy's and St Thomas' NHS Trust, London, UK
| | - Danny Morrison
- Children's Eye Department, Guy's and St Thomas' NHS Trust, London, UK
| | - Michael Absoud
- Department of Paediatric Neurology, Evelina London Children's Hospital at Guy's and St Thomas' NHS Trust, London, UK
| | - Ming Lim
- Department of Paediatric Neurology, Evelina London Children's Hospital at Guy's and St Thomas' NHS Trust, London, UK
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Brettschneider J, Petzold A, Junker A, Tumani H. Axonal damage markers in the cerebrospinal fluid of patients with clinically isolated syndrome improve predicting conversion to definite multiple sclerosis. Mult Scler 2016; 12:143-8. [PMID: 16629417 DOI: 10.1191/135248506ms1263oa] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Clinically isolated syndrome (CIS) represents the earliest phase of multiple sclerosis (MS). This study tested whether biomarkers for axonal degeneration can improve upon sensitivity and specificity of magnetic resonance imaging (MRI) parameters in predicting conversion from CIS to MS. Patients with CIS ( n=52), relapsing-remitting MS (RRMS, n=38) and age-matched controls ( n=25) were included. Cerebrospinal fluid (CSF) levels of tau and neurofilaments (NfHSMI35) were measured using ELISA. The MRI T2-lesion load and the Expanded Disability Status Scale (EDSS) were recorded. CSF tau and NfHSMI35 were elevated in CIS compared to controls (p<0.05). RRMS patients with acute relapse had higher NfHSMI35 levels than stable patients. Tau and NfHSMI35 levels correlated with EDSS in CIS and RRMS. In RRMS, the number of T2-lesions correlated with tau levels ( R=0.53, P=0.01). The sensitivity predicting the conversion from CIS to MS was higher for the combination of CSF markers (either tau or NfHSMI35 elevated) than for MRI (40 versus 34%), but could be further increased to 60% if CSF and MRI criteria were combined. Similarly, the combination of tau and NfHSMI35 showed higher specificity (94%) than MRI (82%). Tau and NfHSMI35 are valuable biomarkers for axonal damage in the CIS patients. Predicting conversion from CIS to MS can be improved if CSF markers are combined with MRI.
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Lim ET, Grant D, Pashenkov M, Keir G, Thompson EJ, Söderström M, Giovannoni G. Cerebrospinal fluid levels of brain specific proteins in optic neuritis. Mult Scler 2016; 10:261-5. [PMID: 15222688 DOI: 10.1191/1352458504ms1020oa] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study evaluates levels of cerebrospinal fluid (C SF) brain-specific proteins (BSP) in subjects with optic neuritis (O N) who are at high risk of progression to multiple sclerosis (MS). Forty-one subjects had acute O N and 17 subjects with other neurological diseases (OND) served as controls. Twenty-o ne subjects with O N had white matter lesions on magnetic resonance imaging (MRI) and intrathecal synthesis of oligoclonal IgG bands (OB) consistent with being at high risk of progression to MS; eight of whom later were diagnosed with clinically definite MS (C DMS). Levels of S100B, ferritin and two neurofilament heavy chain phosphoforms (NfHSMI34 and NfHSMI35) were analysed using ELISA technique. A putative index of ‘axonal health’ was expressed as a ratio of NfHSMI34 to NfHSMI35. NfHSMI34 and the NfHSMI34:SMI35 were significantly elevated in subjects with O N compared to controls. No significant differences in levels of C SF BSP were seen between O N subjects with C DMS plus those at high risk of progression to MS and O N subjects with normal MRI and negative C SF analysis. In conclusion, there is evidence of axonal damage in subjects who present with O N, which is independent of the diagnosis of C DMS.
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Affiliation(s)
- E T Lim
- Department of Neuroinflammation, Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Alexandre B, Vandermeeren Y, Dewit O, Moreels T, de Boer N, Dhar A, Ziady C, Shitrit ABG, Steinwurz F, Jojic N, Costantino G, Bihin B, Rahier JF, Katsanos KH. Optic Neuritis Associated or Not with TNF Antagonists in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2016; 10:541-8. [PMID: 26759360 PMCID: PMC4957451 DOI: 10.1093/ecco-jcc/jjw003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 12/08/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Acute optic neuritis [ON] is an inflammatory condition affecting the optic nerve. Clinicians should suspect optic neuritis in cases of painful and rapidly progressive loss of central visual field. This condition may be associated with a multitude of diseases, and mostly with multiple sclerosis [MS] where it may present as an initial symptom. The literature reports that optic neuritis and MS occur in patients with inflammatory bowel disease [IBD] before and after the era of anti-tumour necrosis factor-α [TNFα] drugs. At the present moment, there is little consensus for managing this complication, currently treated with corticosteroids and discontinuation of the causative agents. METHODS We collected cases through a retrospective multicentre European Crohn's and Colitis Organisation CONFER [COllaborative Network For Exceptionally Rare case reports] project. We also performed a comprehensive retrospective search of the available literature on this topic. RESULTS We report herein 12 new cases of ON, including 10 under anti-TNF therapy, collected through the CONFER project. We also compare characteristics of ON associated or not with anti-TNFα agents. CONCLUSIONS The exceptional and current observation of distant family history of MS in 17% of our patients who developed ON, despite the small number and the lack of a control arm, might be an important signal that should be taken into account in our therapeutic strategies in the future.
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Affiliation(s)
- Benjamin Alexandre
- Department of Internal Medicine and Hepato-gastroenterology Unit, Notre-Dame de Grâce Hospital, Gosselies, Belgium,*Corresponding author. Benjamin Alexandre, MD, Department of Internal Medecine and Hepato-gastroenterology Unit, Notre-Dame de Grâce Hospital, 212 Chaussée de Nivelles, 6041 Gosselies, Belgium. Tel: +32 71 37 91 27;
| | - Yves Vandermeeren
- Department of Neurology, Université Catholique de Louvain, Yvoir, Belgium
| | - Olivier Dewit
- Department of Gastroenterology, Université Catholique de Louvain, St-Luc Hospital, Brussels, Belgium
| | - Tom Moreels
- Department of Gastroenterology, Université Catholique de Louvain, St-Luc Hospital, Brussels, Belgium
| | - Nanne de Boer
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Anjan Dhar
- Darlington Memorial and Bishop Auckland Hospitals, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Chris Ziady
- Department of Gastroenterology, Kloof Hospital, Pretoria, South Africa
| | | | - Flavio Steinwurz
- Department of Gastroenterology, Hospital Israelita Albert Einstein, Sao Paolo, Brazil
| | - Njegica Jojic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia
| | - Giuseppe Costantino
- Department of Internal Medicine and Medical Therapy University of Messina, Messina, Italy
| | - Benoit Bihin
- Scientific Support Unit, Université Catholique de Louvain, Yvoir, Belgium
| | - Jean-François Rahier
- Department of Gastroenterology, Université Catholique de Louvain, Yvoir, Belgium
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Aranda ML, González Fleitas MF, De Laurentiis A, Keller Sarmiento MI, Chianelli M, Sande PH, Dorfman D, Rosenstein RE. Neuroprotective effect of melatonin in experimental optic neuritis in rats. J Pineal Res 2016; 60:360-72. [PMID: 26882296 DOI: 10.1111/jpi.12318] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/09/2016] [Indexed: 12/16/2022]
Abstract
Optic neuritis (ON) is an inflammatory, demyelinating, and neurodegenerative condition of the optic nerve, which might induce permanent vision loss. Currently, there are no effective therapies for this disorder. We have developed an experimental model of primary ON in rats through a single microinjection of 4.5 μg of bacterial lipopolysaccharide (LPS) into the optic nerve. Since melatonin acts as a pleiotropic therapeutic agent in various neurodegenerative diseases, we analyzed the effect of melatonin on LPS-induced ON. For this purpose, LPS or vehicle were injected into the optic nerve from adult male Wistar rats. One group of animals received a subcutaneous pellet of 20 mg melatonin at 24 hr before vehicle or LPS injection, and another group was submitted to a sham procedure. Melatonin completely prevented the decrease in visual evoked potentials (VEPs), and pupil light reflex (PLR), and preserved anterograde transport of cholera toxin β-subunit from the retina to the superior colliculus. Moreover, melatonin prevented microglial reactivity (ED1-immunoreactivity, P < 0.01), astrocytosis (glial fibrillary acid protein-immunostaining, P < 0.05), demyelination (luxol fast blue staining, P < 0.01), and axon (toluidine blue staining, P < 0.01) and retinal ganglion cell (Brn3a-immunoreactivity, P < 0.01) loss, induced by LPS. Melatonin completely prevented the increase in nitric oxide synthase 2, cyclooxygenase-2 levels (Western blot) and TNFα levels, and partly prevented lipid peroxidation induced by experimental ON. When the pellet of melatonin was implanted at 4 days postinjection of LPS, it completely reversed the decrease in VEPs and PLR. These data suggest that melatonin could be a promising candidate for ON treatment.
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Affiliation(s)
- Marcos L Aranda
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - María F González Fleitas
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | | | - María I Keller Sarmiento
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - Mónica Chianelli
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - Pablo H Sande
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - Damián Dorfman
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - Ruth E Rosenstein
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
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