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Geraldes R, Arrambide G, Banwell B, Rovira À, Cortese R, Lassmann H, Messina S, Rocca MA, Waters P, Chard D, Gasperini C, Hacohen Y, Mariano R, Paul F, DeLuca GC, Enzinger C, Kappos L, Leite MI, Sastre-Garriga J, Yousry T, Ciccarelli O, Filippi M, Barkhof F, Palace J. The influence of MOGAD on diagnosis of multiple sclerosis using MRI. Nat Rev Neurol 2024; 20:620-635. [PMID: 39227463 DOI: 10.1038/s41582-024-01005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 09/05/2024]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an immune-mediated demyelinating disease that is challenging to differentiate from multiple sclerosis (MS), as the clinical phenotypes overlap, and people with MOGAD can fulfil the current MRI-based diagnostic criteria for MS. In addition, the MOG antibody assays that are an essential component of MOGAD diagnosis are not standardized. Accurate diagnosis of MOGAD is crucial because the treatments and long-term prognosis differ from those for MS. This Expert Recommendation summarizes the outcomes from a Magnetic Resonance Imaging in MS workshop held in Oxford, UK in May 2022, in which MS and MOGAD experts reflected on the pathology and clinical features of these disorders, the contributions of MRI to their diagnosis and the clinical use of the MOG antibody assay. We also critically reviewed the literature to assess the validity of distinctive imaging features in the current MS and MOGAD criteria. We conclude that dedicated orbital and spinal cord imaging (with axial slices) can inform MOGAD diagnosis and also illuminate differential diagnoses. We provide practical guidance to neurologists and neuroradiologists on how to navigate the current MOGAD and MS criteria. We suggest a strategy that includes useful imaging discriminators on standard clinical MRI and discuss imaging features detected by non-conventional MRI sequences that demonstrate promise in differentiating these two disorders.
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Affiliation(s)
- Ruth Geraldes
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
- Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK.
| | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
- Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK
| | - Mara Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Declan Chard
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals (CLH) Biomedical Research Centre, London, UK
| | - Claudio Gasperini
- Multiple Sclerosis Centre, Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Romina Mariano
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience, University Hospital and University, Basel, Switzerland
| | - M Isabel Leite
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Tarek Yousry
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, London, UK
- University College London Hospitals (UCLH) National Institute for Health and Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Jacqueline Palace
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
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Lin TY, Motamedi S, Asseyer S, Chien C, Saidha S, Calabresi PA, Fitzgerald KC, Samadzadeh S, Villoslada P, Llufriu S, Green AJ, Preiningerova JL, Petzold A, Leocani L, Garcia-Martin E, Oreja-Guevara C, Outteryck O, Vermersch P, Balcer LJ, Kenney R, Albrecht P, Aktas O, Costello F, Frederiksen J, Uccelli A, Cellerino M, Frohman EM, Frohman TC, Bellmann-Strobl J, Schmitz-Hübsch T, Ruprecht K, Brandt AU, Zimmermann HG, Paul F. Individual Prognostication of Disease Activity and Disability Worsening in Multiple Sclerosis With Retinal Layer Thickness z Scores. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200269. [PMID: 38941572 PMCID: PMC11214150 DOI: 10.1212/nxi.0000000000200269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/06/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Retinal optical coherence tomography (OCT) provides promising prognostic imaging biomarkers for future disease activity in multiple sclerosis (MS). However, raw OCT-derived measures have multiple dependencies, supporting the need for establishing reference values adjusted for possible confounders. The purpose of this study was to investigate the capacity for age-adjusted z scores of OCT-derived measures to prognosticate future disease activity and disability worsening in people with MS (PwMS). METHODS We established age-adjusted OCT reference data using generalized additive models for location, scale, and shape for peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell-inner plexiform layer (GCIP) thicknesses, involving 910 and 423 healthy eyes, respectively. Next, we transformed the retinal layer thickness of PwMS from 3 published studies into age-adjusted z scores (pRNFL-z and GCIP-z) based on the reference data. Finally, we investigated the association of pRNFL-z or GCIP-z as predictors with future confirmed disability worsening (Expanded Disability Status Scale score increase) or disease activity (failing of the no evidence of disease activity [NEDA-3] criteria) as outcomes. Cox proportional hazards models or logistic regression analyses were applied according to the original studies. Optimal cutoffs were identified using the Akaike information criterion as well as location with the log-rank and likelihood-ratio tests. RESULTS In the first cohort (n = 863), 172 PwMS (24%) had disability worsening over a median observational period of 2.0 (interquartile range [IQR]:1.0-3.0) years. Low pRNFL-z (≤-2.04) were associated with an increased risk of disability worsening (adjusted hazard ratio (aHR) [95% CI] = 2.08 [1.47-2.95], p = 3.82e-5). In the second cohort (n = 170), logistic regression analyses revealed that lower pRNFL-z showed a higher likelihood for disability accumulation at the two-year follow-up (reciprocal odds ratio [95% CI] = 1.51[1.06-2.15], p = 0.03). In the third cohort (n = 78), 46 PwMS (59%) did not maintain the NEDA-3 status over a median follow-up of 2.0 (IQR: 1.9-2.1) years. PwMS with low GCIP-z (≤-1.03) had a higher risk of showing disease activity (aHR [95% CI] = 2.14 [1.03-4.43], p = 0.04). Compared with raw values with arbitrary cutoffs, applying the z score approach with optimal cutoffs showed better performance in discrimination and calibration (higher Harrell's concordance index and lower integrated Brier score). DISCUSSION In conclusion, our work demonstrated reference cohort-based z scores that account for age, a major driver for disease progression in MS, to be a promising approach for creating OCT-derived measures useable across devices and toward individualized prognostication.
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Affiliation(s)
- Ting-Yi Lin
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Seyedamirhosein Motamedi
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Susanna Asseyer
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Claudia Chien
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Shiv Saidha
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Peter A Calabresi
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Kathryn C Fitzgerald
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Sara Samadzadeh
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Pablo Villoslada
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Sara Llufriu
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Ari J Green
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Jana Lizrova Preiningerova
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Axel Petzold
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Letizia Leocani
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Elena Garcia-Martin
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Celia Oreja-Guevara
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Olivier Outteryck
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Patrick Vermersch
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Laura J Balcer
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Rachel Kenney
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Philipp Albrecht
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Orhan Aktas
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Fiona Costello
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Jette Frederiksen
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Antonio Uccelli
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Maria Cellerino
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Elliot M Frohman
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Teresa C Frohman
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Judith Bellmann-Strobl
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Tanja Schmitz-Hübsch
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Klemens Ruprecht
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Alexander U Brandt
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Hanna G Zimmermann
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
| | - Friedemann Paul
- From the Charité - Universitätsmedizin Berlin (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Experimental and Clinical Research Center (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.), a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (T.-Y.L., S.M., S.A., C.C., S. Samadzadeh, J.B.-S., T.S.-H., A.U.B., H.G.Z., F.P.); Neuroscience Clinical Research Center (S.M., S.A., C.C., J.B.-S., T.S.-H., H.G.Z., F.P.); Department of Psychiatry and Psychotherapy (C.C.), Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (S. Saidha, P.A.C., K.C.F.); Department of Epidemiology (K.C.F.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Regional Health Research and Molecular Medicine (S. Samadzadeh), University of Southern Denmark, Odense; Department of Neurology (S. Samadzadeh), Slagelse Hospital, Denmark; Department of Neurology (P. Villoslada), Hospital Del Mar - Pompeu Fabra University; Neuroimmunology and Multiple Sclerosis Unit (S.L.), Hospital Clinic Barcelona and IDIBAPS, Barcelona, Spain; Department of Neurology (A.J.G.), University of California San Francisco; Department of Neurology (J.L.P.), Charles University in Prague, Czech Republic; Moorfield's Eye Hospital (A.P.), The National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology Expert Center (A.P.), Amsterdam UMC, Netherlands; Experimental Neurophysiology Unit (L.L.), Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute; Vita-Salute San Raffaele University (L.L.), Milan, Italy; Miguel Servet University Hospital (E.G.-M.), Zaragoza; Department of Neurology (C.O.-G.), Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Neurology (O.O., P. Vermersch); Department of Neuroradiology (O.O., P. Vermersch), Centre Hospitalier Universitaire de Lille, France; Departments of Neurology (L.J.B., R.K.), Population Health and Ophthalmology, NYU Grossman School of Medicine, NY; Department of Neurology (P.A., O.A.), Heinrich-Heine-University, Düsseldorf, Germany; Departments of Clinical Neurosciences and Surgery Cumming School of Medicine (F.C.), University of Calgary, Alberta, Canada; Clinic of Optic Neuritis and Clinic of Multiple Sclerosis (J.F.), Department of Neurology, Rigshospitalet - Glostrup, Denmark; Department of Neurosciences (A.U., M.C.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; Laboratory of Neuroimmunology (E.M.F., T.C.F.), Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin; and Einstein Center Digital Future (H.G.Z.), Berlin, Germany
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Klyscz P, Asseyer S, Alonso R, Bereuter C, Bialer O, Bick A, Carta S, Chen JJ, Cohen L, Cohen-Tayar Y, Contentti EC, Dale RC, Flanagan EP, Gernert JA, Haas J, Havla J, Heesen C, Hellmann M, Levin N, Lopez P, Lotan I, Luis MB, Mariotto S, Mayer C, Vergara AJM, Ocampo C, Ochoa S, Oertel FC, Olszewska M, Uribe JLP, Sastre-Garriga J, Scocco D, Ramanathan S, Rattanathamsakul N, Shi FD, Shifa J, Simantov I, Siritho S, Tiosano A, Tisavipat N, Torres I, Dembinsky AV, Vidal-Jordana A, Wilf-Yarkoni A, Wu T, Zamir S, Zarco LA, Zimmermann HG, Petzold A, Paul F, Stiebel-Kalish H. Application of the international criteria for optic neuritis in the Acute Optic Neuritis Network. Ann Clin Transl Neurol 2024. [PMID: 39099240 DOI: 10.1002/acn3.52166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/03/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024] Open
Abstract
OBJECTIVE The first international consensus criteria for optic neuritis (ICON) were published in 2022. We applied these criteria to a prospective, global observational study of acute optic neuritis (ON). METHODS We included 160 patients with a first-ever acute ON suggestive of a demyelinating CNS disease from the Acute Optic Neuritis Network (ACON). We applied the 2022 ICON to all participants and subsequently adjusted the ICON by replacing a missing relative afferent pupillary defect (RAPD) or dyschromatopsia if magnetic resonance imaging pathology of the optical nerve plus optical coherence tomography abnormalities or certain biomarkers are present. RESULTS According to the 2022 ICON, 80 (50%) patients were classified as definite ON, 12 (7%) patients were classified as possible ON, and 68 (43%) as not ON (NON). The main reasons for classification as NON were absent RAPD (52 patients, 76%) or dyschromatopsia (49 patients, 72%). Distribution of underlying ON etiologies was as follows: 78 (49%) patients had a single isolated ON, 41 (26%) patients were diagnosed with multiple sclerosis, 25 (16%) patients with myelin oligodendrocyte glycoprotein antibody-associated disease, and 15 (9%) with neuromyelitis optica spectrum disorder. The application of the adjusted ON criteria yielded a higher proportion of patients classified as ON (126 patients, 79%). INTERPRETATION According to the 2022 ICON, almost half of the included patients in ACON did not fulfill the requirements for classification of definite or possible ON, particularly due to missing RAPD and dyschromatopsia. Thorough RAPD examination and formal color vision testing are critical to the application of the 2022 ICON.
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Affiliation(s)
- Philipp Klyscz
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanna Asseyer
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ricardo Alonso
- University Center of MS and NMOSD, Neurology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Charlotte Bereuter
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Omer Bialer
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Atira Bick
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Sara Carta
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - John J Chen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Leila Cohen
- University Center of MS and NMOSD, Neurology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Yamit Cohen-Tayar
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Eye Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Russell C Dale
- TY Nelson Department of Paediatric Neurology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Clinical Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan A Gernert
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Julian Haas
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Mark Hellmann
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Netta Levin
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Pablo Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Itay Lotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuroimmunology Service, Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Belen Luis
- University Center of MS and NMOSD, Neurology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Christina Mayer
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | | | - Susana Ochoa
- University Center of MS and NMOSD, Neurology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Frederike C Oertel
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maja Olszewska
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Jaume Sastre-Garriga
- Neurology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dario Scocco
- University Center of MS and NMOSD, Neurology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Sudarshini Ramanathan
- Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | | | - Fu-Dong Shi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jemal Shifa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Ilya Simantov
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Eye Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel
| | - Sasitorn Siritho
- Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Bangkok, Thailand
- Neuroscience Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Alon Tiosano
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nanthaya Tisavipat
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Isabel Torres
- Pontificia Universidad Javeriana and Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Adi Vaknin Dembinsky
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Angela Vidal-Jordana
- Neurology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Adi Wilf-Yarkoni
- Neuroimmunology Service, Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ti Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Sol Zamir
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Luis Alfonso Zarco
- Pontificia Universidad Javeriana and Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
| | - Axel Petzold
- The National Hospital for Neurology and Neurosurgery, University College London, London, UK
- Moorfields Eye Hospital, London, UK
- Neuro-ophthalmology Expert Centre, Amsterdam, Netherlands
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hadas Stiebel-Kalish
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Eye Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel
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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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El Ayoubi NK, Ismail A, Fahd F, Younes L, Chakra NA, Khoury SJ. Retinal optical coherence tomography measures in multiple sclerosis: a systematic review and meta-analysis. Ann Clin Transl Neurol 2024. [PMID: 39073308 DOI: 10.1002/acn3.52165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/12/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024] Open
Abstract
Spectral domain-optical coherence tomography plays a crucial role in the early detection and monitoring of multiple sclerosis (MS) pathophysiology. We aimed to quantify differences in retinal layer measures among different groups of MS and explored different variables that correlate with retinal measures. This study was reported according PRISMA guidelines. A comprehensive search was done across PubMed, Embase, and Google Scholar. The mean difference in thickness of retinal layers and macular volume was assessed. Meta-regression was done to assess the sources of heterogeneity. A total of 100 articles were included in the meta-analyses. The peripapillary retinal nerve fiber layer (pRNFL) thickness significantly decreased in the MSON (MD: -16.44, P < 0.001), MSNON (MD: -6.97, P < 0.001), and PMS (MD: -11.35, P < 0.001) versus HC. The macular RNFL was lower among the MSON (MD: -6.24, P = 0.013) and MSNON (MD: -3.84, P <0.001) versus HC. Macular ganglion cell layer and inner plexiform layer (GCIPL) was thinner among MSON (MD: -14.83, P <0.001), MSNON (MD: -6.38, P < 0.001), and PMS (MD: -11.52, P < 0.001) compared with control eyes. Inner nuclear layer (INL) was higher in the MSON (MD: 0.49, P < 0.001) versus HC. Outer nuclear layer (ONL) thickness significantly lower in the MSNON (MD: -1.15, P = 0.019) versus HC. Meta-regression showed that disease duration, age, EDSS score, and percentage of patients taking DMT are all negatively correlated with pRNFL and GCIPL thickness; however, female gender was correlated with less atrophy. As conclusion, the study highlights substantial thinning in the pRNFL and macular GCIPL between MS versus controls. INL as valuable parameter for capturing inflammatory disease activity.
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Affiliation(s)
- Nabil K El Ayoubi
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Ali Ismail
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Beirut, Lebanon
| | - Fares Fahd
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Lama Younes
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Nour A Chakra
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut, Beirut, Lebanon
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Prillard D, Charbonneau F, Clavel P, Vignal-Clermont C, Deschamps R, de la Motte MB, Guillaume J, Savatovsky J, Lecler A. Comparison of a Whole-Brain Contrast-Enhanced 3D TSE T1WI versus Orbits Contrast-Enhanced 2D Coronal T1WI at 3T MRI for the Detection of Optic Nerve Enhancement in Patients with Acute Loss of Visual Acuity. AJNR Am J Neuroradiol 2024; 45:965-970. [PMID: 38902008 DOI: 10.3174/ajnr.a8233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 02/07/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND AND PURPOSE MR imaging is the technique of choice for patients presenting with acute loss of visual acuity with no obvious ophthalmologic cause. The goal of our study was to compare orbits contrast-enhanced 2D coronal T1WI with a whole-brain contrast-enhanced 3D (WBCE-3D) TSE T1WI at 3T for the detection of optic nerve enhancement. MATERIALS AND METHODS This institutional review board-approved retrospective single-center study included patients presenting with acute loss of vision who underwent 3T MR imaging from November 2014 to February 2020. Two radiologists, blinded to all data, individually assessed the presence of enhancement of the optic nerve on orbits contrast-enhanced 2D T1WI and WBCE-3D T1WI separately and in random order. A McNemar test and a Cohen κ method were used for comparing the 2 MR imaging sequences. RESULTS One thousand twenty-three patients (638 women and 385 men; mean age, 42 [SD, 18.3] years) were included. There was a strong concordance between WBCE-3D T1WI and orbits contrast-enhanced 2D T1WI when detecting enhancement of the optic nerve: κ = 0.87 (95% CI, 0.84-0.90). WBCE-3D T1WI was significantly more likely to detect canalicular enhancement compared with orbits contrast-enhanced 2D T1WI: 178/1023 (17.4%) versus 138/1023 (13.5%) (P < .001) and 108/1023 (10.6%) versus 90/1023 (8.8%) (P = .04), respectively. The WBCE-3D T1WI sequence detected 27/1023 (3%) instances of optic disc enhancement versus 0/1023 (0%) on orbits contrast-enhanced 2D T1WI. There were significantly fewer severe artifacts on WBCE-3D T1WI compared with orbits contrast-enhanced 2D T1WI: 68/1023 (6.6%) versus 101/1023 (9.8%) (P < .001). The median reader-reported confidence was significantly higher with coronal T1WI compared with 3D TSE T1WI: 5 (95% CI, 4-5) versus 3 (95% CI, 1-4; P < .001). CONCLUSIONS Our study showed that there was a strong concordance between WBCE-3D T1WI and orbits contrast-enhanced 2D T1WI when detecting enhancement of the optic nerve in patients with acute loss of visual acuity with no obvious ophthalmologic cause. WBCE-3D T1WI demonstrated higher sensitivity and specificity in diagnosing optic neuritis, particularly in cases involving the canalicular segments.
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Affiliation(s)
- David Prillard
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | - Frédérique Charbonneau
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | - Pierre Clavel
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | | | - Romain Deschamps
- Department of Neurology (R.D., M.B.d.l.M.), A. Rothschild Foundation Hospital, Paris, France
| | | | - Jessica Guillaume
- Department of Clinical Research (J.G.), A. Rothschild Foundation Hospital, Paris, France
| | - Julien Savatovsky
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | - Augustin Lecler
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
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Samadzadeh S, Adnan R, Berglova P, Barzegar M, Debrabant B, Roikjaer SG, Levy M, Petzold A, Palace J, Flanagan EP, Mariotto S, Skou ST, Froelich A, Lotan I, Messina S, Geraldes R, Asseyer S, Stiebel-Kalish H, Oertel FC, Shaygannejad V, Sahraian MA, Kim HJ, Bennett JL, Böttcher C, Zimmermann HG, Weinshenker BG, Paul F, Asgari N. Protocol of a prospective multicenter study on comorbidity impact on multiple sclerosis and antibody-mediated diseases of the central nervous system (COMMIT). Front Immunol 2024; 15:1380025. [PMID: 39021565 PMCID: PMC11253107 DOI: 10.3389/fimmu.2024.1380025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/05/2024] [Indexed: 07/20/2024] Open
Abstract
Comorbidities in patients with multiple sclerosis (MS) and antibody-mediated diseases of the central nervous system (CNS) including neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG)-antibody-associated disease (MOGAD) are common and may influence the course of their neurological disease. Comorbidity may contribute to neuronal injury and therefore limit recovery from attacks, accelerate disease progression, and increase disability. This study aims to explore the impact of comorbidity, particularly vascular comorbidity, and related risk factors on clinical and paraclinical parameters of MS, NMOSD and MOGAD. We propose COMMIT, a prospective multicenter study with longitudinal follow-up of patients with MS, NMOSD, and MOGAD, with or without comorbidities, as well as healthy subjects as controls. Subjects will be stratified by age, sex and ethnicity. In consecutive samples we will analyze levels of inflammation and neurodegeneration markers in both fluid and cellular compartments of the peripheral blood and cerebrospinal fluid (CSF) using multiple state-of-the-art technologies, including untargeted proteomics and targeted ultrasensitive ELISA assays and quantitative reverse transcription polymerase chain reaction (RT-qPCR) as well as high-dimensional single-cell technologies i.e., mass cytometry and single-cell RNA sequencing. Algorithm-based data analyses will be used to unravel the relationship between these markers, optical coherence tomography (OCT) and magnetic resonance imaging (MRI), and clinical outcomes including frequency and severity of relapses, long-term disability, and quality of life. The goal is to evaluate the impact of comorbidities on MS, NMOSD, and MOGAD which may lead to development of treatment approaches to improve outcomes of inflammatory demyelinating diseases of the CNS.
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Affiliation(s)
- Sara Samadzadeh
- Institute of Regional Health Research and, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- The Center for Neurological Research, Department of Neurology Slagelse Hospital, Slagelse, Denmark
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
| | - Rafl Adnan
- Institute of Regional Health Research and, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- The Center for Neurological Research, Department of Neurology Slagelse Hospital, Slagelse, Denmark
| | - Paulina Berglova
- The Center for Neurological Research, Department of Neurology Slagelse Hospital, Slagelse, Denmark
| | - Mahdi Barzegar
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Birgit Debrabant
- Department of Mathematics and Computer Science, Faculty of Natural Sciences, University of Southern Denmark, Odense, Denmark
| | - Stine Gundtoft Roikjaer
- Institute of Regional Health Research and, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- The Center for Neurological Research, Department of Neurology Slagelse Hospital, Slagelse, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Axel Petzold
- The National Hospital for Neurology and Neurosurgery, and Moorfields Eye Hospital and Queen Square University College London (UCL), Institute of Neurology, London, United Kingdom
- Department of Neurology, Amsterdam The University Medical Center Utrecht (UMC), Amsterdam, Netherlands
- Department of Ophthalmology, Amsterdam The University Medical Center Utrecht (UMC), Amsterdam, Netherlands
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Eoin P. Flanagan
- Department Neurology and Center for Multiple Sclerosis (MS), and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Soeren T. Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne Froelich
- The Center for Neurological Research, Department of Neurology Slagelse Hospital, Slagelse, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Section of General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Itay Lotan
- Department of Neurology and Neuroimmunology Unit, Rabin Medical Center, Petah Tikva, Israel
- Tel Aviv University Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Susanna Asseyer
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hadas Stiebel-Kalish
- Tel Aviv University Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Neuro-Ophthalmology Unit, Rabin Medical Center, Petah Tikva, Israel
- Eye Laboratory, Felsenstein Research Institute, Tel Aviv, Israel
| | - Frederike Cosima Oertel
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Vahid Shaygannejad
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis (MS) Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Jeffrey L. Bennett
- Department of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Chotima Böttcher
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Hanna G. Zimmermann
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
| | - Brian G. Weinshenker
- Department of Neurology, University of Virginia, Charlottesville, VA, United States
| | - Friedemann Paul
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nasrin Asgari
- Institute of Regional Health Research and, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- The Center for Neurological Research, Department of Neurology Slagelse Hospital, Slagelse, Denmark
- Open Patient data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Shaw H, Feng C, Qi M, Deng Y, Chen W, Zhang Y, Wang L, Lin N, Tian G, Sha Y. Analysis of the initial orbital MRI in aquaporin-4 antibody-positive optic neuritis (AQP4-ON): lesion location and lesion length can be predictive of visual prognosis. Neuroradiology 2024; 66:897-906. [PMID: 38358511 DOI: 10.1007/s00234-024-03306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Despite mounting evidence indicating that aquaporin-4 antibody-positive optic neuritis (AQP4-ON) presents a less favorable prognosis than other types of optic neuritis, there exists substantial heterogeneity in the prognostic outcomes within the AQP4-ON cohort. Considering the persistent debate over the role of MRI in assessing the prognosis of optic neuritis, we aim to investigate the correlation between the MRI appearance and long-term visual prognosis in AQP4-ON patients. METHODS We retrospectively reviewed the ophthalmological and imaging data of AQP4-ON patients admitted to our Neuro-ophthalmology Department from January 2015 to March 2018, with consecutive follow-up visits for a minimum of 3 years. RESULTS A total of 51 AQP4-ON patients (59 eyes) meeting the criteria were enrolled in this research. After assessing the initial orbital MR images of each patient at the first onset, we observed the involvement of the canalicular segment (p < 0.001), intracranial segment (p = 0.004), optic chiasm (p = 0.009), and the presence of LEON (p = 0.002) were significantly different between recovery group and impairment group. For quantitative measurement, the length of the lesions is significantly higher in the impairment group (20.1 ± 9.3 mm) than in the recovery group (12.5 ± 5.3 mm) (p = 0.001). CONCLUSION AQP4-ON patients with involvement of canalicular, intracranial segment and optic chiasm of the optic nerve, and the longer range of lesions threaten worse vision prognoses. Timely MR examination during the initial acute phase can not only exclude the intracranial or orbital mass lesions but also indicate visual prognosis in the long term.
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Affiliation(s)
- Hanyu Shaw
- Shanghai Institution of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Chaoyi Feng
- Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Meng Qi
- Department of Radiology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yalan Deng
- Department of Radiology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Wei Chen
- Shanghai Institution of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yiyin Zhang
- Department of Radiology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Luxi Wang
- Shanghai Institution of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Naier Lin
- Department of Radiology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Guohong Tian
- Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
| | - Yan Sha
- Department of Radiology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
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9
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Gyabaah F, Petersen C, Bateman E, Deoker A. Acute-Onset Blindness in a Patient Diagnosed With Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOG-AD): A Case Report. Cureus 2024; 16:e61767. [PMID: 38975430 PMCID: PMC11227435 DOI: 10.7759/cureus.61767] [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] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Myelin oligodendrocyte glycoprotein antibody disease (MOG-AD) poses a diagnostic challenge, often masquerading as other neurological disorders such as multiple sclerosis and aquaporin-4-positive neuromyelitis optica spectrum disorder. The deceptive clinical similarities demand a nuanced approach to differentiate these conditions effectively. This entails an extensive evaluation encompassing a meticulous medical history, advanced magnetic resonance imaging (MRI), cerebrospinal fluid analysis, and serum studies. In this context, we present a compelling case involving a 28-year-old Hispanic female with a history of migraine headache. She sought medical attention due to acute peripheral vision loss, ultimately diagnosed as MOG-AD through a comprehensive clinical assessment coupled with specific diagnostic tests. This case underscores the critical importance of precision in diagnostic procedures to ensure accurate identification and subsequent tailored treatment for MOG-AD, avoiding potential pitfalls associated with its resemblance to other neurological disorders.
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Affiliation(s)
- Frederick Gyabaah
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
| | - Cyrena Petersen
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
| | - Emily Bateman
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
| | - Abhizith Deoker
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
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10
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Kleerekooper I, Wagner SK, Trip SA, Plant GT, Petzold A, Keane PA, Khawaja AP. Differentiating glaucoma from chiasmal compression using optical coherence tomography: the macular naso-temporal ratio. Br J Ophthalmol 2024; 108:695-701. [PMID: 37385651 PMCID: PMC11137440 DOI: 10.1136/bjo-2023-323529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND/AIMS The analysis of visual field loss patterns is clinically useful to guide differential diagnosis of visual pathway pathology. This study investigates whether a novel index of macular atrophy patterns can discriminate between chiasmal compression and glaucoma. METHODS A retrospective series of patients with preoperative chiasmal compression, primary open-angle glaucoma (POAG) and healthy controls. Macular optical coherence tomography (OCT) images were analysed for the macular ganglion cell and inner plexiform layer (mGCIPL) thickness. The nasal hemi-macula was compared with the temporal hemi-macula to derive the macular naso-temporal ratio (mNTR). Differences between groups and diagnostic accuracy were explored with multivariable linear regression and the area under the receiver operating characteristic curve (AUC). RESULTS We included 111 individuals (31 with chiasmal compression, 30 with POAG and 50 healthy controls). Compared with healthy controls, the mNTR was significantly greater in POAG cases (β=0.07, 95% CI 0.03 to 0.11, p=0.001) and lower in chiasmal compression cases (β=-0.12, 95% CI -0.16 to -0.09, p<0.001), even though overall mGCIPL thickness did not discriminate between these pathologies (p=0.36). The mNTR distinguished POAG from chiasmal compression with an AUC of 95.3% (95% CI 90% to 100%). The AUCs when comparing healthy controls to POAG and chiasmal compression were 79.0% (95% CI 68% to 90%) and 89.0% (95% CI 80% to 98%), respectively. CONCLUSIONS The mNTR can distinguish between chiasmal compression and POAG with high discrimination. This ratio may provide utility over-and-above previously reported sectoral thinning metrics. Incorporation of mNTR into the output of OCT instruments may aid earlier diagnosis of chiasmal compression.
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Affiliation(s)
- Iris Kleerekooper
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Dutch Expertise Centre for Neuro-ophthalmology & MS Centre, Departments of Neurology and Ophthalmology, Amsterdam UMC, Amsterdam, Netherlands
| | - Siegfried K Wagner
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - S Anand Trip
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
- University College London Hospitals (UCLH) NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gordon T Plant
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Axel Petzold
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Dutch Expertise Centre for Neuro-ophthalmology & MS Centre, Departments of Neurology and Ophthalmology, Amsterdam UMC, Amsterdam, Netherlands
| | - Pearse A Keane
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Anthony P Khawaja
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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11
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Loginovic P, Wang F, Li J, Ferrat L, Mirshahi UL, Rao HS, Petzold A, Tyrrell J, Green HD, Weedon MN, Ganna A, Tuomi T, Carey DJ, Oram RA, Braithwaite T. Applying a genetic risk score model to enhance prediction of future multiple sclerosis diagnosis at first presentation with optic neuritis. Nat Commun 2024; 15:1415. [PMID: 38418465 PMCID: PMC10902342 DOI: 10.1038/s41467-024-44917-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/09/2024] [Indexed: 03/01/2024] Open
Abstract
Optic neuritis (ON) is associated with numerous immune-mediated inflammatory diseases, but 50% patients are ultimately diagnosed with multiple sclerosis (MS). Differentiating MS-ON from non-MS-ON acutely is challenging but important; non-MS ON often requires urgent immunosuppression to preserve vision. Using data from the United Kingdom Biobank we showed that combining an MS-genetic risk score (GRS) with demographic risk factors (age, sex) significantly improved MS prediction in undifferentiated ON; one standard deviation of MS-GRS increased the Hazard of MS 1.3-fold (95% confidence interval 1.07-1.55, P < 0.01). Participants stratified into quartiles of predicted risk developed incident MS at rates varying from 4% (95%CI 0.5-7%, lowest risk quartile) to 41% (95%CI 33-49%, highest risk quartile). The model replicated across two cohorts (Geisinger, USA, and FinnGen, Finland). This study indicates that a combined model might enhance individual MS risk stratification, paving the way for precision-based ON treatment and earlier MS disease-modifying therapy.
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Affiliation(s)
- Pavel Loginovic
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Heavitree Road, Exeter, EX1 2HZ, UK
| | - Feiyi Wang
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Jiang Li
- Weis Center for Research, Geisinger, Danville, PA, USA
| | - Lauric Ferrat
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, St Luke's Campus, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK
| | | | - H Shanker Rao
- Weis Center for Research, Geisinger, Danville, PA, USA
| | - Axel Petzold
- Neuro-ophthalmology Expert Center, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Neuro-ophthalmology, The National Hospital for Neurology and Neurosurgery, Queen Square, UCL Institute of Neurology, London, UK
- Neuro-ophthalmology service, Moorfields Eye Hospital, London, UK
| | - Jessica Tyrrell
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, EX2 5DW, UK
| | - Harry D Green
- Exeter Centre of Excellence for Diabetes Research (EXCEED), University of Exeter Medical School, St Luke's Campus, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK
| | - Michael N Weedon
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, St Luke's Campus, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK
| | - Andrea Ganna
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tiinamaija Tuomi
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Abdominal Center, Endocrinology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Helsinki, Finland
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - David J Carey
- Weis Center for Research, Geisinger, Danville, PA, USA
| | - Richard A Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, St Luke's Campus, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK.
- Academic Kidney Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
| | - Tasanee Braithwaite
- King's College London, School of Immunology & Microbial Sciences and School of Life Course and Population Sciences, London, UK
- Medical Eye Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
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Hof S, van Rijn LJ, Uitdehaag BMJ, Nij Bijvank JA, Petzold A. Measuring and predicting the effect of remyelinating therapy in multiple sclerosis: a randomised controlled trial protocol (RESTORE). BMJ Open 2024; 14:e076651. [PMID: 38296293 PMCID: PMC10828865 DOI: 10.1136/bmjopen-2023-076651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Remyelination failure hampers symptomatic recovery in multiple sclerosis (MS), underlining the importance of developing remyelinating therapies. Optic neuritis is currently the most established method of measuring remyelination in MS trials. Complementary more generalisable methods of measuring remyelination are required to confirm treatment efficacy. Measuring internuclear ophthalmoplegia (INO) with infrared oculography provides such a method. Moreover, this method can be expanded with a test for selecting likely treatment responders by using fampridine. The aim of this trial is to investigate the (long-term) remyelinating effects of clemastine fumarate in patients with MS and INO and to evaluate if treatment response can be predicted using fampridine. METHODS AND ANALYSIS RESTORE is a single-centre double-blind randomised placebo-controlled trial of clemastine fumarate versus placebo. Prior to clemastine treatment improvement in oculographic features of INO after a single 10 mg dose of fampridine is measured in all participants and used to predict the treatment response to clemastine. Eighty individuals with MS and INO will be 1:1 randomised to 4 mg of clemastine fumarate two times a day for 6 months or equivalent placebo. Our primary outcome is improvement in the Versional Dysconjugacy Index-area under the curve, measured by infrared oculography after 6 months of treatment. Participants are assessed for persistent treatment effects 6, 18 and 30 months after end of treatment. Secondary outcome measures include other oculography parameters including double-step saccades, retinal imaging, visual acuities, physical disability, cognition and patient-reported outcomes. ETHICS AND DISSEMINATION Clemastine is a registered and very well-established drug with well-known safety and side effects. The protocol was approved by the medical ethical committee of the Amsterdam UMC, location VUMC and the Dutch Central Committee on Research Involving Human Subject. Written informed consent is obtained from all participants. The results will be published in peer-reviewed medical scientific journals. TRIAL REGISTRATION NUMBER EudraCT: 2021-003677-66, ClinicalTrials.gov: NCT05338450.
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Affiliation(s)
- Sam Hof
- MS Center and Neuro-ophthalmology Expertise Center Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Laurentius J van Rijn
- Ophthalmology, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, The Netherlands
- Opthalmology, Onze Lieve Vrouwe Hospital, Amsterdam, Noord-Holland, The Netherlands
| | - Bernard M J Uitdehaag
- MS Center and Neuro-ophthalmology Expertise Center Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Jenny A Nij Bijvank
- MS Center and Neuro-ophthalmology Expertise Center Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, The Netherlands
- Ophthalmology, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Axel Petzold
- MS Center and Neuro-ophthalmology Expertise Center Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, The Netherlands
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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13
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Tejani AS, Berson E, Phillip J, Feltrin FS, Bazan C, Raj KM, Agarwal AK, Maldjian JA, Lee WC, Yu FF. Diffusion-weighted imaging of the orbit. Clin Radiol 2024; 79:10-18. [PMID: 37926649 DOI: 10.1016/j.crad.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Orbital lesions compose a heterogeneous group of pathologies that often present with non-specific imaging findings on conventional magnetic resonance imaging (MRI) sequences (T1-and T2-weighted). Accordingly, the application of diffusion MRI offers an opportunity to further distinguish between lesions along this spectrum. Diffusion-weighted imaging (DWI) represents the simplest and most frequent clinically utilised diffusion imaging technique. Recent advances in DWI techniques have extended its application to the evaluation of a wider spectrum of neurological pathology, including orbital lesions. This review details the manifestations of select orbital pathology on DWI and underscores specific situations where diffusion imaging allows for increased diagnostic sensitivity compared to more conventional MRI techniques. These examples also describe preferred management for orbital lesions identified by DWI.
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Affiliation(s)
- A S Tejani
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - E Berson
- Department of Radiology, Yale School of Medicine, New Haven, CT, USA
| | - J Phillip
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F S Feltrin
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Bazan
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - K M Raj
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A K Agarwal
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J A Maldjian
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - W-C Lee
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F F Yu
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Cardoso D, Bezerra S, Soares-dos-Reis R, Sá MJ, Guimarães J. Optic neuropathy diagnosis in the emergency room - retrospective observational study of the last 18 years. Eur J Ophthalmol 2024; 34:267-280. [PMID: 37218168 PMCID: PMC10757394 DOI: 10.1177/11206721231173005] [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: 06/13/2022] [Accepted: 04/06/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Optic neuropathies (ON), a broad spectrum of disorders of the optic nerve, are a frequent cause of visual loss, presenting either in isolation or associated to neurological or systemic disorders. They are often first evaluated in the Emergency Room (ER) and a rapid determination of the etiology is imperative for implementing timely and appropriate treatment. We aim to describe ER demographic data and clinical characteristics, as well as the performed imaging exams, of patients subsequently hospitalized and diagnosed with ON. Furthermore, we seek to explore the accuracy of ER discharge diagnosis and evaluate possible predictive factors that may influence it. METHODS We retrospectively reviewed the medical records of 192 patients admitted to the ward of the Neurology Department of Centro Hospitalar Universitário São João (CHUSJ), with a discharge diagnosis of ON. Subsequently, we selected those admitted from the ER, with clinical, laboratory and imaging data, between January 2004 and December 2021. RESULTS We included 171 patients. All participants were discharged from the ER and admitted in the ward with a main diagnostic suspicion of ON. Patients were stratified according to suspected etiology at the time of discharge: 99 inflammatory (57.9%), 38 ischemic (22.2%), 27 unspecified (15.8%) and 7 other (4.1%). By comparing with current follow-up diagnosis, 125 patients had an accurate ER diagnosis category (73.1%), 27 had an ON diagnosis of unspecified etiology that was defined only during follow-up (15.8%) and 19 had an inaccurate diagnosis category (11.1%). Diagnostic change was more common with ER ischemic diagnosis (21.1%) compared to inflammatory diagnosis (8.1%) (p = 0.034). CONCLUSIONS Our study reveals that most patients with ON can be accurately diagnosed in the ER through clinical history neurological and ophthalmological evaluation.
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Affiliation(s)
- Daniel Cardoso
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sofia Bezerra
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ricardo Soares-dos-Reis
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Neurology, Centro Hospitalar de São João (CHUSJ), Porto, Portugal
- i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Maria José Sá
- Department of Neurology, Centro Hospitalar de São João (CHUSJ), Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Joana Guimarães
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Neurology, Centro Hospitalar de São João (CHUSJ), Porto, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP), University of Porto, Portugal
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15
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Kaçar S, Coric D, Ometto G, Montesano G, Denniston AK, Keane PA, Uitdehaag BMJ, Crabb DP, Schoonheim MM, Petzold A, Strijbis EMM. Exploring Vitreous Haze as a Potential Biomarker for Accelerated Glymphatic Outflow and Neurodegeneration in Multiple Sclerosis: A Cross-Sectional Study. Brain Sci 2023; 14:36. [PMID: 38248251 PMCID: PMC10813039 DOI: 10.3390/brainsci14010036] [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: 11/09/2023] [Revised: 12/08/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The glymphatic system removes neurodegenerative debris. The ocular glymphatic outflow is from the eye to the proximal optic nerve. In multiple sclerosis (MS), atrophy of the optic nerve increases the glymphatic outflow space. Here, we tested whether vitreous haze (VH) can provide novel insights into the relationship between neurodegeneration and the ocular glymphatic system in MS. METHODS This cross-sectional study comprised 315 persons with MS and 87 healthy controls (HCs). VH was quantified from optical coherence tomography (OCT) volume scans. Neurodegeneration was determined on three-dimensional T1 (3DT1) MRI, lesion detection on fluid-attenuated inversion (FLAIR), and layer thickness on OCT. Generalized estimating equations, corrected for age, were used to analyze associations between VH and metrics for neurodegeneration, demographics, and clinical scales. Group differences were determined between mild, moderate, and severe disability. RESULTS On the group level, VH scores were comparable between MS and control (p = 0.629). In MS, VH scores declined with disease duration (β = -0.009, p = 0.004) and age (β = -0.007, p = 0.001). There was no relation between VH scores and higher age in HCs. In MS patients, VH was related to normalized gray (NGMV, β = 0.001, p = 0.011) and white matter volume (NWMV, β = 0.001, p = 0.003), macular ganglion cell-inner plexiform layer thickness (mGCIPL, β = 0.006, p < 0.001), and peripapillary retinal nerve fiber layer thickness (pRNFL, β = 0.004, p = 0.008). VH was significantly lower in severe compared to mild disability (mean difference -28.86%, p = 0.058). CONCLUSIONS There is a correlation between VH on OCT and disease duration, more severe disability and lower brain volumes in MS. Biologically, these relationships suggest accelerated glymphatic clearance with disease-related atrophy.
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Affiliation(s)
- Sezgi Kaçar
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (D.C.); (B.M.J.U.); (A.P.); (E.M.M.S.)
- Dutch Expertise Center for Neuro-Ophthalmology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Danko Coric
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (D.C.); (B.M.J.U.); (A.P.); (E.M.M.S.)
- Dutch Expertise Center for Neuro-Ophthalmology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Giovanni Ometto
- Department of Optometry and Visual Sciences, City, University of London, London WC1E 7HU, UK; (G.O.); (G.M.); (D.P.C.)
| | - Giovanni Montesano
- Department of Optometry and Visual Sciences, City, University of London, London WC1E 7HU, UK; (G.O.); (G.M.); (D.P.C.)
| | - Alastair K. Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK;
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London EC1V 9LF, UK;
| | - Pearse A. Keane
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London EC1V 9LF, UK;
| | - Bernard M. J. Uitdehaag
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (D.C.); (B.M.J.U.); (A.P.); (E.M.M.S.)
| | - David P. Crabb
- Department of Optometry and Visual Sciences, City, University of London, London WC1E 7HU, UK; (G.O.); (G.M.); (D.P.C.)
| | - Menno M. Schoonheim
- Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, VU University Medical Center, 1081 HV Amsterdam, The Netherlands;
| | - Axel Petzold
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (D.C.); (B.M.J.U.); (A.P.); (E.M.M.S.)
- Dutch Expertise Center for Neuro-Ophthalmology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
- Department of Neurology and Ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 9LF, UK
- The National Hospital for Neurology and Neurosurgery, University College London, London WC1E 7HU, UK
| | - Eva M. M. Strijbis
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (D.C.); (B.M.J.U.); (A.P.); (E.M.M.S.)
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Wilf-Yarkoni A, Feldmann K, Rubarth K, Dorsch EM, Rust R, Urman I, Hellmann MA, Friedman Y, Lotan I, Bialer O, Buenrostro GS, Zimmermann HG, Leutloff C, Schmitz-Hübsch T, Paul F, Asseyer S, Stiebel-Kalish H. Effectiveness of oral prednisone tapering following intravenous methylprednisolone for acute optic neuritis in multiple sclerosis. PLoS One 2023; 18:e0288366. [PMID: 38060614 PMCID: PMC10703274 DOI: 10.1371/journal.pone.0288366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023] Open
Abstract
Acute optic neuritis treatment lacks standardized protocols. The value of oral prednisone taper (OPT) following intravenous methylprednisolone (IVMP) on visual outcome parameters in optic neuritis (ON) has never been explored. In the present retrospective study, we investigated whether OPT after IVMP affects the structural and functional visual outcomes of inaugural clinically isolated syndrome (CIS)- or multiple sclerosis (MS)-ON. Adult patients with acute, inaugural, unilateral CIS- or MS-ON, treated with IVMP in Germany and Israel were stratified into patients treated with IVMP alone-versus IVMP and OPT. Inclusion criteria were age ≥18, CIS or MS diagnosis according to McDonald criteria 2017, available visual acuity (VA) at nadir before treatment initiation and at follow-up ≥5 months, as well as a spectral domain optic coherence tomography (OCT) data scan at follow-up. Exclusion criteria included recurrent ON, concomitant ophthalmological comorbidities, optical coherence tomography (OCT) of insufficient quality and ON-related escalation therapy after IVMP. The structural outcome was defined as the average retinal nerve fiber layer (RNFL) difference between the ON-affected and the unaffected eye, while the functional outcome was defined as the final high-contrast best-corrected VA (HC-BCVA) at follow-up compared to nadir. The comparative analysis was performed using linear regression analysis, adjusted for sex, age, and days-to-treatment. Fifty-one patients met the inclusion criteria (25% male). The mean age was 33.9 (±10.23) years. Twenty-six patients (51%) received OPT following IVMP. There was no difference in nadir HC-BCVA between the groups (0.39 No OPT; 0.49 With OPT, P = 0.36). Adjusted linear regression analysis did not indicate an influence of OPT on RNFL thickness or on HC-BCVA (beta coefficient for RNFL difference in percentages: 0.51, 95%-CI: [-4.58, 5.59], beta coefficient for logMAR: 0.11, 95%; CI [-0.12, 0.35] at follow-up. In conclusion, the addition of OPT to IVMP did not affect RNFL thickness or the final VA in a retrospective cohort of 51 patients with inaugural acute CIS- or MS-ON. The results of this exploratory study are currently being re-examined in a large-scale, demographically diverse, prospective study.
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Affiliation(s)
- Adi Wilf-Yarkoni
- Neuroimmunology Unit, Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kristina Feldmann
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany
- Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Emergency and Acute Medicine, Campus Mitte and Virchow, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Rubarth
- Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Charité Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Eva-Maria Dorsch
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany
- Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Rebekka Rust
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany
- Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Ilia Urman
- Neuroimmunology Unit, Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A. Hellmann
- Neuroimmunology Unit, Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yitzhak Friedman
- Neuroimmunology Unit, Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itay Lotan
- Neuroimmunology Unit, Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Bialer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel
- Neuro-Ophthalmology Unit, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
| | - Gilberto Solorza Buenrostro
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany
- Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanna G. Zimmermann
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany
- Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carla Leutloff
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany
- Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany
- Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany
- Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanna Asseyer
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany
- Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hadas Stiebel-Kalish
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel
- Neuro-Ophthalmology Unit, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
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Samadzadeh S, Olesen MN, Wirenfeldt M, Möller S, Misu T, Soelberg K, Frederiksen JL, Heegaard S, Mariotto S, Fujihara K, Ruprecht K, Andersen TL, Marignier R, Lillevang ST, Flanagan EP, Pittock SJ, Kim HJ, Bennett JL, Paul F, Sorensen GL, Weinshenker BG, Lassmann H, Asgari N. Microfibrillar-associated protein 4 as a potential marker of acute relapse in inflammatory demyelinating diseases of the central nervous system: Pathological and clinical aspects. Mult Scler 2023; 29:1721-1735. [PMID: 37830484 PMCID: PMC10880047 DOI: 10.1177/13524585231200720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Microfibrillar-associated protein 4 (MFAP4) is an extracellular matrix protein not previously described in the human central nervous system (CNS). OBJECTIVES We determined MFAP4 CNS expression and measured cerebrospinal fluid (CSF) and serum levels. METHODS Tissue was sampled at autopsy from patients with acute multiple sclerosis (MS) (n = 3), progressive MS (n = 3), neuromyelitis optica spectrum disorder (NMOSD) (n = 2), and controls (n = 9), including 6 healthy controls (HC). MFAP4 levels were measured in 152 patients: 49 MS, 62 NMOSD, 22 myelin oligodendrocyte glycoprotein-associated disease (MOGAD), and 19 isolated optic neuritis (ION). RESULTS MFAP4 localized to meninges and vascular/perivascular spaces, intense in the optic nerve. At sites of active inflammation, MFAP4 reactivity was reduced in NMOSD and acute MS and less in progressive MS. CSF MFAP4 levels were reduced during relapse and at the onset of diseases (mean U/mL: MS 14.3, MOGAD 9.7, and ION 14.6 relative to HC 17.9. (p = 0.013, p = 0.000, and p = 0.019, respectively). Patients with acute ON (n = 68) had reduced CSF MFAP4 (mean U/mL: 14.5, p = 0.006). CSF MFAP4 levels correlated negatively with relapse severity (rho = -0.41, p = 0.017). CONCLUSION MFAP4 immunoreactivity was reduced at sites of active inflammation. CSF levels of MFAP4 were reduced following relapse and may reflect disease activity.
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Affiliation(s)
- Sara Samadzadeh
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mads Nikolaj Olesen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark/Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Martin Wirenfeldt
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Pathological Anatomy and Molecular Biology, Hospital South West Jutland, Esbjerg, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kerstin Soelberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jette Lautrup Frederiksen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark
| | - Steffen Heegaard
- Departments of Ophthalmology and Pathology, Rigshospitalet, Glostrup, Denmark
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan
- Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Levin Andersen
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | | | - Eoin P Flanagan
- Department Neurology and Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sean J Pittock
- Department Neurology and Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Jeffrey L Bennett
- Department of Neurology & Ophthalmology, Programs in Neuroscience & Immunology University of Colorado, Anschutz, CO, USA
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Grith Lykke Sorensen
- Cancer and Inflammation, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Nasrin Asgari
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark Department of Neurology, Slagelse Hospital, Slagelse, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Sayin Sakul AA, Pence KB, Ormeci T, Gunal MY. Can volumetric analysis of the brain help diagnose isolated optic neuritis? Clin Anat 2023; 36:1109-1115. [PMID: 37078532 DOI: 10.1002/ca.24042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/11/2023] [Accepted: 03/23/2023] [Indexed: 04/21/2023]
Abstract
Isolated optic neuritis is a single episode inflammatory optic neuropathy. This condition, which affects the optimal function of the optic nerve, is not associated with neurological or systemic diseases. Our study aimed to compare patients with isolated optic neuritis and normal healthy individuals in terms of the cerebrum, cerebellum and hippocampus volumes by using the "volBrain Online MRI Brain Volumetry System" program. Persons diagnosed with isolated optic neuritis (n = 16) and persons without any disease (n = 16) were included in the study. VolBrain was used to process the MRI data and, the findings were compared with Mann-Whitney U test. Values with a p-value <0.05 were considered statistically significant. The cerebrum white matter volumes in the total brain and in the right-left hemispheres of the brain were statistically significantly lower in the optic neuritis group (p = 0.029; p = 0.050; p = 0.029, respectively). In the segmental cerebellum analysis, the left side lobule VIIIB, the total and right-left side lobule IX volumes were statistically significantly higher (p = 0.022; p = 0.014; p = 0.029; p = 0.018, respectively). In total, lobule I-II volume was statistically significantly lower in the optic neuritis group (p = 0.046). In the segmental hippocampus analysis, the right side CA2-CA3, the total and right-left side SR-SL-SM volumes were statistically significantly lower in the optic neuritis group (p = 0.039; p = 0.050; p = 0.016, respectively). There are neurodegenerative changes in brain volume in patients with isolated optic neuritis. Although volBrain alone is not sufficient to diagnose isolated optic neuritis, it provides quantitative data that can be used as a complementary diagnostic method.
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Affiliation(s)
- A A Sayin Sakul
- Department of Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - K B Pence
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - T Ormeci
- Department of Radiology, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - M Y Gunal
- Department of Physiology, School of Medicine, Alanya Alaaddin Keykubat University, Antalya, Turkey
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19
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Miante S, Margoni M, Moretto M, Pengo M, Carmisciano L, Spolettini P, Silvestri E, Danieletto M, Franciotta S, Miscioscia A, Bertoldo A, Puthenparampil M, Gallo P. Trans-synaptic degeneration in the optic pathway: Exploring the role of lateral geniculate nucleus in early stages of relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2023; 77:104877. [PMID: 37454566 DOI: 10.1016/j.msard.2023.104877] [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: 04/28/2023] [Revised: 06/07/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Optic pathway is considered an ideal model to study the interaction between inflammation and neurodegeneration in multiple sclerosis (MS). METHODS Optical Coherence Tomography (OCT) and 3.0 T magnetic resonance imaging (MRI) were acquired in 92 relapsing remitting (RR) MS at clinical onset. Peripapillary RNFL (pRNFL) and macular layers were measured. White matter (WM) and gray matter (GM) lesion volumes (LV), lateral geniculate nucleus (LGN) volume, optic radiations (OR) WM LV, thickness of pericalcarine cortex were evaluated. OCT and MRI control groups (healthy controls [HC]-OCT and HC-MRI) were included. RESULTS A significant thinning of temporal pRNFL and papillo-macular bundle (PMB) was observed (p<0.001) in 16 (17%) patients presented with monocular optic neuritis (MSON+), compared to 76 MSON- and 30 HC (-15 μm). In MSON-, PMB was reduced (-3 μm) compared to HC OCT (p<0.05). INL total volume was increased both in MSON+ (p<0.001) and MSON- (p = 0.033). Inner retinal layers volumes (macular RNFL, GCL and IPL) were significantly decreased in MSON+ compared to HC (p<0.001) and MSON- (p<0.001). Reduced GCL volume in the parafoveal ring was observed in MSON- compared to HCOCT (p < 0.05). LGN volume was significantly reduced only in MSON+ patients compared to HC-MRI (p<0.001) and MSON- (p<0.007). GCL, IPL and GCIP volumes associated with ipsilateral LGN volume in MSON+ and MSON-. Finally, LGN volume associated with visual cortex thickness with no significant difference between MSON+ and MSON-. CONCLUSIONS Anterograde trans-synaptic degeneration is early detectable in RRMS presenting with optic neuritis but does not involve LGN.
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Affiliation(s)
- Silvia Miante
- Multiple Sclerosis Centre, Neurology Clinic, Department of Neuroscience, University of Padua, Padua, Italy.
| | - Monica Margoni
- Multiple Sclerosis Centre, Neurology Clinic, Department of Neuroscience, University of Padua, Padua, Italy; Padova Neuroscience Centre (PNC), University of Padua, Padua, Italy
| | - Manuela Moretto
- Padova Neuroscience Centre (PNC), University of Padua, Padua, Italy; Department of Information Engineering, University of Padua, Padua, Italy
| | - Marta Pengo
- Multiple Sclerosis Centre, Neurology Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Luca Carmisciano
- DISSAL, Department of Health Science, University of Genoa, Genoa, Italy
| | - Pietro Spolettini
- Multiple Sclerosis Centre, Neurology Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Erica Silvestri
- Padova Neuroscience Centre (PNC), University of Padua, Padua, Italy; Department of Information Engineering, University of Padua, Padua, Italy
| | - Matteo Danieletto
- Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, NY
| | - Silvia Franciotta
- Multiple Sclerosis Centre, Neurology Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Alessandro Miscioscia
- Multiple Sclerosis Centre, Neurology Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Alessandra Bertoldo
- Padova Neuroscience Centre (PNC), University of Padua, Padua, Italy; Department of Information Engineering, University of Padua, Padua, Italy
| | - Marco Puthenparampil
- Multiple Sclerosis Centre, Neurology Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre, Neurology Clinic, Department of Neuroscience, University of Padua, Padua, Italy
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20
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Song H, Chuai Y, Yang M, Zhou H, Sun M, Xu Q, Wei S. Glial autoantibody prevalence in Chinese optic neuritis with onset after age 45: clinical factors for diagnosis. Front Immunol 2023; 14:1181908. [PMID: 37705973 PMCID: PMC10495982 DOI: 10.3389/fimmu.2023.1181908] [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: 03/08/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose As glial autoantibody testing is not yet available in some areas of the world, an alternative approach is to use clinical indicators to predict which subtypes of middle-aged and elderly-onset optic neuritis (ON) have manifested. Method This study was a single-center hospital-based retrospective cohort study. Middle-aged and elderly-onset ON patients (age > 45 years) who had experienced the first episode of ON were included in this cohort. Single- and multi-parametric diagnostic factors for middle-aged and elderly-onset myelin oligodendrocyte glycoprotein immunoglobulin-associated ON (MOG-ON) and aquaporin-4 immunoglobulin-related ON (AQP4-ON) were calculated. Results From January 2016 to January 2020, there were 81 patients with middle-aged and elderly-onset ON, including 32 (39.5%) AQP4-ON cases, 19 (23.5%) MOG-ON cases, and 30 (37.0%) Seronegative-ON cases. Bilateral involvement (47.4%, P = 0.025) was most common in the MOG-ON group. The presence of other concomitant autoimmune antibodies (65.6%, P = 0.014) and prior neurological history (37.5%, P = 0.001) were more common in the AQP4-ON group. The MOG-ON group had the best follow-up best-corrected visual acuity (BCVA) (89.5% ≤ 1.0 LogMAR, P = 0.001). The most sensitive diagnostic factors for middle-aged and elderly-onset MOG-ON were 'follow-up VA ≤ 0.1 logMAR' (sensitivity 0.89), 'bilateral involvement or follow-up VA ≤ 0.1 logMAR' (sensitivity 0.95), 'bilateral involvement or without neurological history' (sensitivity 1.00), and 'follow-up VA ≤ 0.1 logMAR or without neurological history' (sensitivity 1.00), and the most specific factor was 'bilateral involvement' (specificity 0.81). The most sensitive diagnostic factors for middle-aged and elderly-onset AQP4-ON were 'unilateral involvement' (sensitivity 0.88), 'unilateral involvement or neurological history' (sensitivity 0.91), and 'unilateral involvement or other autoimmune antibodies' (sensitivity 1.00), and the most specific factor was neurological history (specificity 0.98). Conclusion Based on our cohort study of middle-aged and elderly-onset ON, MOG-ON is less prevalent than AQP4-ON and Seronegative-ON. Using multiple combined parameters improves the sensitivity and negative predictive value for diagnosing middle-aged and elderly-onset MOG-ON and AQP4-ON. These combined parameters can help physicians identify and treat middle-aged and elderly-onset ON early when glial autoantibody status is not available.
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Affiliation(s)
- Honglu Song
- Department of Ophthalmology, The First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
- Department of Ophthalmology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Yucai Chuai
- Department of Special Medical Services, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Mo Yang
- Department of Neuro-ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huanfen Zhou
- Department of Ophthalmology, The First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mingming Sun
- Department of Ophthalmology, The First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Quangang Xu
- Department of Ophthalmology, The First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, The First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
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21
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Terrim S, Silva GD, de Sá E Benevides Falcao FC, Dos Reis Pereira C, de Souza Andrade Benassi T, Fortini I, Gonçalves MRR, Castro LHM, Comerlatti LR, de Medeiros Rimkus C, Adoni T, Pereira SLA, Monteiro ML, Callegaro D. Real-world application of the 2022 diagnostic criteria for first-ever episode of optic neuritis. J Neuroimmunol 2023; 381:578140. [PMID: 37364518 DOI: 10.1016/j.jneuroim.2023.578140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
Optic neuritis (ON) admits diverse differential diagnoses. Petzold proposed diagnostic criteria for ON in 2022, although real-world application of these criteria is missing. We conducted a retrospective review of patients with ON. We classified patients into definite or possible ON, and into groups A (typical neuritis), B (painless), or C (binocular) and estimated the frequency of etiologies for each group. We included 77 patients, with 62% definite and 38% possible ON. CRION and NMOSD-AQP4 negative-ON were less commonly seen in definite ON. Application of the 2022 criteria revealed a lower-than-expected frequency of definite ON, particularly for seronegative non-MS causes.
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Affiliation(s)
- Sara Terrim
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Guilherme Diogo Silva
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | | | - Clarissa Dos Reis Pereira
- Neuro-ophtalmology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, 05403-000 Sao Paulo, Brazil
| | - Thais de Souza Andrade Benassi
- Neuro-ophtalmology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, 05403-000 Sao Paulo, Brazil
| | - Ida Fortini
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Marcia Rubia Rodrigues Gonçalves
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Luiz Henrique Martins Castro
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Luiz Roberto Comerlatti
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Carolina de Medeiros Rimkus
- Radiology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, 05403-000 Sao Paulo, Brazil.
| | - Tarso Adoni
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Samira Luisa Apostolos Pereira
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Mário Luiz Monteiro
- Neuro-ophtalmology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, 05403-000 Sao Paulo, Brazil.
| | - Dagoberto Callegaro
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil
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Darakdjian M, Chaves H, Hernandez J, Cejas C. MRI pattern in acute optic neuritis: Comparing multiple sclerosis, NMO and MOGAD. Neuroradiol J 2023; 36:267-272. [PMID: 36062458 PMCID: PMC10268096 DOI: 10.1177/19714009221124308] [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: 11/15/2022] Open
Abstract
BACKGROUND Several MRI findings of optic neuritis (ON) have been described and correlated with specific underlying etiologies. Specifically, optic nerve enhancement is considered an accurate biomarker of acute ON. OBJECTIVE To identify differences in MRI patterns of optic nerve enhancement in certain demyelinating etiologies presenting with acute ON. METHODS Retrospective analysis of enhancement patterns on fat-suppressed T1-weighted images from patients presenting clinical and radiological acute ON, treated at our institution between January 2014 and June 2022. Location and extension of enhancing optic nerve segments, as well as presence of perineural enhancement were evaluated in three predetermined demyelinating conditions. Fisher's exact test and chi2 were calculated. RESULTS Fifty-six subjects met eligibility criteria. Mean age was 31 years (range 6-79) and 70% were females. Thirty-four (61%) patients were diagnosed with multiple sclerosis (MS), 8 (14%) with neuromyelitis optica (NMO), and 14 (25%) with anti-myelin oligodendrocyte glycoprotein disease (MOGAD). Bilateral involvement was more frequent in MOGAD, compared to MS and NMO (43 vs 3% and 12.5% respectively, p = 0.002). MS patients showed shorter optic nerve involvement, whereas MOGAD showed more extensive lesions (p = 0.006). Site of involvement was intraorbital in 63% MS, 89% NMO, 90% MOGAD (p = 0.051) and canalicular in 43% MS, 33% NMO and 75% MOGAD (p = 0.039). Intracranial or chiasmatic involvement and presence of perineural enhancement were not statistically different between entities. CONCLUSION In the setting of acute ON, patients presenting MOGAD were more likely to show bilateral, longitudinally extended and anterior (intraorbital and canalicular) optic nerve involvement compared to patients with MS or NMO.
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23
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Sulaiman FN, Kamardin NF, Sultan Abdul Kader MI, Ch'ng H, Wan Abdul Halim WH. Myelin Oligodendrocyte Glycoprotein Optic Neuritis Presenting With Orbital Apex Syndrome. Cureus 2023; 15:e38975. [PMID: 37313108 PMCID: PMC10259875 DOI: 10.7759/cureus.38975] [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] [Accepted: 05/13/2023] [Indexed: 06/15/2023] Open
Abstract
A 36-year-old man presented with an acute onset of a right eye monocular altitudinal defect associated with pain on eye movement upon waking up from sleep. His right eye subsequently developed outward deviation and a total loss of vision. Clinical examination of the right eye revealed a visual acuity of no light perception (NLP) with the presence of relative afferent pupillary defect (RAPD) and involvement of cranial nerves II, III, IV, and VI. A marked optic disc swelling and peripapillary hemorrhages were seen in the right fundus. Contrast-enhanced computed tomography of the brain and orbit showed a unilateral enlargement and enhancement of the right intraorbital and intracanalicular segments of the optic nerve with surrounding fat stranding and orbital apex crowding. Magnetic resonance imaging showed T2/fluid-attenuated inversion recovery hyperintensity and enhancement of the optic nerve and the myelin sheath. Serum anti-myelin oligodendrocyte glycoprotein antibodies were detected. He was treated with corticosteroids, plasma exchange, and intravenous immunoglobulin. His vision improved slowly after treatment. This case report shows the diverse manifestations of myelin oligodendrocyte glycoprotein antibody disease, which includes the orbital apex syndrome.
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Affiliation(s)
- Farhana Nabila Sulaiman
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Ophthalmology, Hospital Selayang, Selangor, MYS
| | | | - Mohamed Iliyas Sultan Abdul Kader
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Melaka, Melaka, MYS
| | - Hannie Ch'ng
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, MYS
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Lin CW, Chen WT, Lin YH, Hung K, Chen TC. Clinical characteristics and prognosis of optic neuritis in Taiwan - a hospital-based cohort study. Mult Scler Relat Disord 2023; 75:104739. [PMID: 37148579 DOI: 10.1016/j.msard.2023.104739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Optic neuritis (ON) is an inflammatory disease of optic nerve. The distinct etiologies of ON significantly influence its clinical manifestation, neuroimaging findings, and visual outcomes. However, the clinical characteristics might be influenced by the racial differences. The purpose of this study is to investigate the clinical characteristics of various types of ON at a Taiwanese tertiary center. METHODS This cohort study analyzed 163 patients who received treatment and continued following-up for ON between 2015 and 2022. We selected patients who had been tested for anti-aquaporin-4 antibody (AQP4-Ab) and anti-myelin oligodendrocyte glycoprotein antibody (MOG-Ab). The participants were classified into four groups on the basis of their etiologies, specifically (1) multiple sclerosis (MS)-related, (2) AQP4-Ab-positive, (3) MOG-Ab-positive, or (4) idiopathic ON. The researchers recorded the patients' clinical characteristics, treatment course, magnetic resonance imaging and optical coherence tomography (OCT) findings, and visual outcomes. RESULTS MOG-Ab-positive group had higher percentages of disk swelling and pain with eye movement. Long optic nerve and perineural enhancement are the hallmarks of MOG-Ab-related ON. The ON relapse rate was higher in AQP4-Ab-positive group. Although members of AQP4-Ab-positive group received immediate steroid pulse therapy, these patients experienced the worst visual outcomes. Moreover, a thinner retinal nerve fiber layer (RNFL) was noted in AQP4-Ab-positive group. MS group had a higher incidence of extra-optic nerve lesions. Multivariate regression identified pretreatment visual acuity and RNFL thickness as the important factors affecting visual outcomes. CONCLUSIONS This cohort study identified the clinical features of different types of ON. Patients with AQP4-Ab-positive ON had poorer visual outcomes, which may be attributed to multiple relapses and profound nerve damage, as revealed by OCT findings. Patients with MOG-Ab-positive ON displayed long optic nerve enhancement but had more favorable prognoses. Thus, antibody-based classification facilitates treatment and prognosis in ON.
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Affiliation(s)
- Chao-Wen Lin
- Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, Taiwan
| | - Wei-Tse Chen
- Department of Medical Education, National Taiwan University Hospital, Taiwan
| | - Yen-Heng Lin
- Department of Medical Imaging, National Taiwan University Hospital, Taiwan
| | - Kuang Hung
- Department of Medical Imaging, National Taiwan University Hospital, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, Taiwan; Center of Frontier Medicine, National Taiwan University Hospital, Taiwan.
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25
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Silva GD, Terrim S, Falcão FCSEB, Falcão MAP, Chaves CE, Apóstolos-Pereira S, Fortini I, Gonçalves MRR, Comerlatti LR, Castro LHM, Callegaro D, Monteiro MLR. A comparative study of visual outcome in patients with optic neuritis treated with five or seven days of intravenous corticosteroid treatment. Mult Scler Relat Disord 2023; 75:104737. [PMID: 37156037 DOI: 10.1016/j.msard.2023.104737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Optic neuritis (ON), a major cause of visual impairment in young adults, is generally associated with rapid visual recovery when treated with intravenous methylprednisolone treatment (IVMPT). However, the optimal duration of such treatment is unknown, ranging from three to seven days in clinical practice. We aimed to compare the visual recovery in patients treated with 5-day or 7-day duration IVMPT. METHODS We performed a retrospective cohort study of consecutive patients with ON in São Paulo, Brazil, from 2016 to 2021. We compared the proportion of participants with visual impairment in 5-day and 7-day treatment schedules at discharge, at 1 month and between 6 and 12 months after the diagnosis of ON. The findings were adjusted to age, severity of the visual impairment, co-intervention with plasma exchange, time from symptom onset to IVMPT and the etiology of the ON to mitigate indication bias. RESULTS We included 73 patients with ON treated with 5 or 7-day duration of 1 g/d intravenous methylprednisolone therapy. Visual impairment at 6-12 months in the 5-day or the 7-day treatment groups was similar (57% x 59%, p > 0.9, Odds Ratio 1.03 [95% CI 0.59-1.84]). The results were similar after adjusting for prognostic variables and when observed at different time points. CONCLUSION Visual recovery is similar in patients treated with 5-day and 7-day duration treatments of 1 g/day intravenous methylprednisolone, suggesting a ceiling effect. Limiting the duration of the treatment can reduce hospital stay and costs, without interfering with clinical benefit.
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Affiliation(s)
| | - Sara Terrim
- Neurology Division, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Ida Fortini
- Neurology Division, University of São Paulo, São Paulo, Brazil
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26
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Schmidt MF, Pihl-Jensen G, Torm MEW, Passali M, Larsen M, Frederiksen JL. Hyperreflective dots in the avascular outer retina in relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2023; 72:104617. [PMID: 36940613 DOI: 10.1016/j.msard.2023.104617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/20/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Hyperreflective granular elements with a transient presence in the retina can be detected non-invasively by optical coherence tomography (OCT). Such foci or dots may represent aggregates of activated microglia. However, in multiple sclerosis an increased number of hyperreflective foci has so far not been demonstrated in the intrinsically hyporeflective and avascular outer nuclear layer of the retina where there are no fixed elements in healthy eyes. Therefore, the present study intended to investigate the presence of hyperreflective foci in the outer nuclear layer in patients with relapsing- remitting multiple sclerosis (RRMS) by using a high-resolution OCT scanning protocol. METHODS This cross-sectional exploratory study examined 88 eyes in 44 RRMS patients and 106 eyes in 53 age- and sex-matched healthy subjects. None of the patients had any sign of retinal disease. All patients and healthy subjects each underwent one session of spectral domain OCT imaging. A total of 23,200 B-scans extracted from 8 × 8 mm blocks of linear B-scans at 60 μm intervals were analysed for hyperreflective foci in the outer nuclear layer of the retina. Analyses were made of the total block scan and a circular 6-mm diameter fovea-centered field in each eye. Multivariate logistic regression analysis was used to assess associations between parameters. RESULTS Hyperreflective foci were observed in 31 out of 44 (70.5 %) multiple sclerosis patients compared to 1 out of 53 (1.8%) healthy subjects (p < 0.0001). From analyses of the total block scans, the median number of hyperreflective foci in the outer nuclear layer was 1 (range 0-13) in patients and 0 (range 0-2) in healthy subjects (p < 0.0001). In total, 66.2% of all hyperreflective foci were located within 6 mm of the center of the macula. There was no detectable association between the presence of hyperreflective foci and retinal nerve fiber layer or ganglion cell layer thickness. CONCLUSION Hyperreflective granular foci in the avascular outer nuclear layer of the retina seen by OCT were almost completely absent in healthy subjects, whereas they were found, albeit at low density, in the majority of patients with RRMS. Hyperreflective foci can be repeatedly examined by non-invasive means and without pupil dilation, which opens a new field of investigation of infiltrating elements in an unmyelinated part of the central nervous system.
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Affiliation(s)
- Mathias Falck Schmidt
- Department of Neurology, Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Rigshospitalet and University of Copenhagen, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark.
| | - Gorm Pihl-Jensen
- Department of Neurology, Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Rigshospitalet and University of Copenhagen, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
| | - Marie Elise Wistrup Torm
- Department of Ophthalmology, Rigshospitalet and University of Copenhagen, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
| | - Moschoula Passali
- Department of Neurology, Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Rigshospitalet and University of Copenhagen, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
| | - Michael Larsen
- Professor of Clinical Ophthalmology, Department of Ophthalmology, Rigshospitalet and University of Copenhagen, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
| | - Jette Lautrup Frederiksen
- Professor of Clinical Neurology, Department of Neurology, Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Rigshospitalet and University of Copenhagen, Valdemar Hansens Vej 13, 2600 Glostrup, Denmark
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27
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Park J, Le QV, Wu Y, Lee J, Oh YK. Tolerogenic Nanovaccine for Prevention and Treatment of Autoimmune Encephalomyelitis. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2202670. [PMID: 36208089 DOI: 10.1002/adma.202202670] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Herein, a tolerogenic nanovaccine is developed and tested on an animal model of multiple sclerosis. The nanovaccine is constructed to deliver the self-antigen, myelin oligodendrocyte glycoprotein (MOG) peptide, and dexamethasone on an abatacept-modified polydopamine core nanoparticle (AbaLDPN-MOG). AbaLDPN-MOG can target dendritic cells and undergo endocytosis followed by trafficking to lysosomes. AbaLDPN-MOG blocks the interaction between CD80/CD86 and CD28 in antigen-presenting cells and T cells, leading to decreased interferon gamma secretion. The subcutaneous administration of AbaLDPN-MOG to mice yields significant biodistribution to lymph nodes and, in experimental-autoimmune encephalomyelitis (EAE) model mice, increases the integrity of the myelin basic sheath and minimizes the infiltration of immune cells. EAE mice are treated with AbaLDPN-MOG before or after injection of the autoantigen, MOG. Preimmunization of AbaLDPN-MOG before the injection of MOG completely blocks the development of clinical symptoms. Early treatment with AbaLDPN-MOG at three days after injection of MOG also completely blocks the development of symptoms. Notably, treatment of EAE symptom-developed mice with AbaLDPN-MOG significantly alleviates the symptoms, indicating that the nanovaccine has therapeutic effects. Although AbaLDPN is used for MOG peptide delivery in the EAE model, the concept of AbaLDPN can be widely applied for the prevention and alleviation of other autoimmune diseases.
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Affiliation(s)
- Jinwon Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Quoc-Viet Le
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Yina Wu
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Jaiwoo Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Yu-Kyoung Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
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28
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Asseyer S, Asgari N, Bennett J, Bialer O, Blanco Y, Bosello F, Camos-Carreras A, Carnero Contentti E, Carta S, Chen J, Chien C, Chomba M, Dale RC, Dalmau J, Feldmann K, Flanagan EP, Froment Tilikete C, Garcia-Alfonso C, Havla J, Hellmann M, Kim HJ, Klyscz P, Konietschke F, La Morgia C, Lana-Peixoto M, Leite MI, Levin N, Levy M, Llufriu S, Lopez P, Lotan I, Lugaresi A, Marignier R, Mariotto S, Mollan SP, Ocampo C, Cosima Oertel F, Olszewska M, Palace J, Pandit L, Peralta Uribe JL, Pittock S, Ramanathan S, Rattanathamsakul N, Saiz A, Samadzadeh S, Sanchez-Dalmau B, Saylor D, Scheel M, Schmitz-Hübsch T, Shifa J, Siritho S, Sperber PS, Subramanian PS, Tiosano A, Vaknin-Dembinsky A, Mejia Vergara AJ, Wilf-Yarkoni A, Zarco LA, Zimmermann HG, Paul F, Stiebel-Kalish H. The Acute Optic Neuritis Network (ACON): Study protocol of a non-interventional prospective multicenter study on diagnosis and treatment of acute optic neuritis. Front Neurol 2023; 14:1102353. [PMID: 36908609 PMCID: PMC9998999 DOI: 10.3389/fneur.2023.1102353] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/30/2023] [Indexed: 02/26/2023] Open
Abstract
Optic neuritis (ON) often occurs at the presentation of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). The recommended treatment of high-dose corticosteroids for ON is based on a North American study population, which did not address treatment timing or antibody serostatus. The Acute Optic Neuritis Network (ACON) presents a global, prospective, observational study protocol primarily designed to investigate the effect of time to high-dose corticosteroid treatment on 6-month visual outcomes in ON. Patients presenting within 30 days of the inaugural ON will be enrolled. For the primary analysis, patients will subsequently be assigned into the MS-ON group, the aquapotin-4-IgG positive ON (AQP4-IgG+ON) group or the MOG-IgG positive ON (MOG-IgG+ON) group and then further sub-stratified according to the number of days from the onset of visual loss to high-dose corticosteroids (days-to-Rx). The primary outcome measure will be high-contrast best-corrected visual acuity (HC-BCVA) at 6 months. In addition, multimodal data will be collected in subjects with any ON (CIS-ON, MS-ON, AQP4-IgG+ON or MOG-IgG+ON, and seronegative non-MS-ON), excluding infectious and granulomatous ON. Secondary outcomes include low-contrast best-corrected visual acuity (LC-BCVA), optical coherence tomography (OCT), magnetic resonance imaging (MRI) measurements, serum and cerebrospinal fluid (CSF) biomarkers (AQP4-IgG and MOG-IgG levels, neurofilament, and glial fibrillary protein), and patient reported outcome measures (headache, visual function in daily routine, depression, and quality of life questionnaires) at presentation at 6-month and 12-month follow-up visits. Data will be collected from 28 academic hospitals from Africa, Asia, the Middle East, Europe, North America, South America, and Australia. Planned recruitment consists of 100 MS-ON, 50 AQP4-IgG+ON, and 50 MOG-IgG+ON. This prospective, multimodal data collection will assess the potential value of early high-dose corticosteroid treatment, investigate the interrelations between functional impairments and structural changes, and evaluate the diagnostic yield of laboratory biomarkers. This analysis has the ability to substantially improve treatment strategies and the accuracy of diagnostic stratification in acute demyelinating ON. Trial registration ClinicalTrials.gov, identifier: NCT05605951.
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Affiliation(s)
- Susanna Asseyer
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nasrin Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jeffrey Bennett
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Omer Bialer
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yolanda Blanco
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, and Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Francesca Bosello
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Camos-Carreras
- Ophthalmology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Sara Carta
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - John Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, United States
| | - Claudia Chien
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mashina Chomba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Russell C Dale
- Clinical Neuroimmunology Group, Kids Neuroscience Centre, Sydney, NSW, Australia.,Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, NSW, Australia
| | - Josep Dalmau
- ICREA-IDIBAPS, Service of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Kristina Feldmann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Eoin P Flanagan
- Laboratory Medicine and Pathology, Departments of Neurology, Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Caroline Froment Tilikete
- Neuro-Ophthalmology Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, IMPACT Team, Lyon, France
| | | | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mark Hellmann
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ho Jin Kim
- Department of Neurology, National Cancer Center, Goyang, Republic of Korea
| | - Philipp Klyscz
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Konietschke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
| | - Chiara La Morgia
- Neurology Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Lana-Peixoto
- CIEM MS Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Maria Isabel Leite
- Department of Neurology, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Netta Levin
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Michael Levy
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sara Llufriu
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Itay Lotan
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Romain Marignier
- Neuro-Ophthalmology Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, IMPACT Team, Lyon, France
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Translational Brian Science, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, United Kingdom
| | | | - Frederike Cosima Oertel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maja Olszewska
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jacqueline Palace
- Department of Neurology, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Lekha Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, India
| | | | - Sean Pittock
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sudarshini Ramanathan
- Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital Westmead, Sydney, NSW, Australia.,Department of Neurology, Concord Hospital, Sydney, NSW, Australia
| | - Natthapon Rattanathamsakul
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Albert Saiz
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Sara Samadzadeh
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Bernardo Sanchez-Dalmau
- Ophthalmology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Scheel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jemal Shifa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Sasitorn Siritho
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Neuroscience Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Pia S Sperber
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Prem S Subramanian
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Alon Tiosano
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Vaknin-Dembinsky
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Adi Wilf-Yarkoni
- Department of Neurology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Luis Alfonso Zarco
- Pontificia Universidad Javeriana and Hospital Unviersitario San Ignacio, Bogotá, Colombia
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hadas Stiebel-Kalish
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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29
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Sperber PS, Brandt AU, Zimmermann HG, Bahr LS, Chien C, Rekers S, Mähler A, Böttcher C, Asseyer S, Duchow AS, Bellmann-Strobl J, Ruprecht K, Paul F, Schmitz-Hübsch T. Berlin Registry of Neuroimmunological entities (BERLimmun): protocol of a prospective observational study. BMC Neurol 2022; 22:479. [PMID: 36517734 PMCID: PMC9749207 DOI: 10.1186/s12883-022-02986-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Large-scale disease overarching longitudinal data are rare in the field of neuroimmunology. However, such data could aid early disease stratification, understanding disease etiology and ultimately improve treatment decisions. The Berlin Registry of Neuroimmunological Entities (BERLimmun) is a longitudinal prospective observational study, which aims to identify diagnostic, disease activity and prognostic markers and to elucidate the underlying pathobiology of neuroimmunological diseases. METHODS BERLimmun is a single-center prospective observational study of planned 650 patients with neuroimmunological disease entity (e.g. but not confined to: multiple sclerosis, isolated syndromes, neuromyelitis optica spectrum disorders) and 85 healthy participants with 15 years of follow-up. The protocol comprises annual in-person visits with multimodal standardized assessments of medical history, rater-based disability staging, patient-report of lifestyle, diet, general health and disease specific symptoms, tests of motor, cognitive and visual functions, structural imaging of the neuroaxis and retina and extensive sampling of biological specimen. DISCUSSION The BERLimmun database allows to investigate multiple key aspects of neuroimmunological diseases, such as immunological differences between diagnoses or compared to healthy participants, interrelations between findings of functional impairment and structural change, trajectories of change for different biomarkers over time and, importantly, to study determinants of the long-term disease course. BERLimmun opens an opportunity to a better understanding and distinction of neuroimmunological diseases.
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Affiliation(s)
- Pia S. Sperber
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Disease (DZHK), Berlin, Germany
| | - Alexander U. Brandt
- grid.266093.80000 0001 0668 7243Department of Neurology, University of California, CA Irvine, USA
| | - Hanna G. Zimmermann
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lina S. Bahr
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Claudia Chien
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sophia Rekers
- grid.7468.d0000 0001 2248 7639Berlin School of Mind and Brain, Humboldt Universität Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anja Mähler
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Chotima Böttcher
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Neuropsychiatry and Laboratory of Molecular Psychiatry, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanna Asseyer
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ankelien Solveig Duchow
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Judith Bellmann-Strobl
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Klemens Ruprecht
- grid.6363.00000 0001 2218 4662Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Clinical Neuroimmunology Group, Lindenberger Weg 80, 13125 Berlin, Germany
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Pattern ERGs suggest a possible retinal contribution to the visual acuity loss in acute optic neuritis. Doc Ophthalmol 2022; 145:185-195. [PMID: 36161379 DOI: 10.1007/s10633-022-09896-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/15/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Macular involvement in optic neuritis (ON) is well-recognised but poorly understood and may be of clinical relevance. This study explores macular structure-function correlates in acute ON. METHODS This cross-sectional cohort study recruited ON patients within 14 days of symptom onset. Subjects underwent pattern electroretinography (PERG), pattern visual evoked potentials (PVEP) and optical coherence tomography (OCT) imaging. PERG P50 and N95 components were correlated with OCT data. RESULTS Twenty-six individuals with ON were recruited, comprising eleven multiple sclerosis (MS-ON), six myelin oligodendrocyte glycoprotein associated (MOG-ON) and nine with isolated ON. These were compared with 28 healthy controls. PVEPs were undetectable in 11 (42%) of individuals with ON. When detectable, PVEP P100 was delayed (median 136 ms range 110-173 ms) and amplitude reduced (median 6 μV, range 3-14 μV) in ON compared with controls (both p < 0.001). PERG P50 component amplitudes, largely reflecting macular function, were reduced in affected eyes (median 2.3 μV; range 0.8-5.0 μV) compared with controls (3.3 μV; range 2.8-5.7 μV) and compared with fellow eyes (p < 0.001). The N95:P50 ratio was below the reference range in the affected eyes of five patients. Eight cases (32%) had subnormal P50 amplitudes (< 2.0 μV), and these patients had poorer visual acuity (p = 0.020). P50 amplitudes were positively correlated with an increase in inner nuclear layer thickness (rs = 0.36; p = 0.009) and macular ganglion cell and inner plexiform layer (mGCIPL) thickness (rs = 0.44, p = 0.022). CONCLUSION PERG P50 component reduction reveals dysfunction of inner macular layers in acute ON and correlates with structural alterations on OCT. These early macular pathologic processes are likely to contribute to the visual loss.
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Mewes D, Kuchling J, Schindler P, Khalil AAA, Jarius S, Paul F, Chien C. Diagnostik der Neuromyelitis-optica-Spektrum-Erkrankung (NMOSD) und der MOG-Antikörper-assoziierten Erkrankung (MOGAD). Klin Monbl Augenheilkd 2022; 239:1315-1324. [DOI: 10.1055/a-1918-1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ZusammenfassungDie Aquaporin-4-Antikörper-positive Neuromyelitis-optica-Spektrum-Erkrankung (engl. NMOSD) und die Myelin-Oligodendrozyten-Glykoprotein-Antikörper-assoziierte Erkrankung (engl. MOGAD) sind
Autoimmunerkrankungen des zentralen Nervensystems. Typische Erstmanifestationen sind bei Erwachsenen Optikusneuritis und Myelitis. Eine Beteiligung auch von Hirn und Hirnstamm, spätestens im
weiteren Verlauf, ist häufig. Während die NMOSD nahezu immer schubförmig verläuft, nimmt die MOGAD gelegentlich einen monophasischen Verlauf. Die Differenzialdiagnostik ist anspruchsvoll und
stützt sich auf u. a. auf radiologische und serologische Befunde. Die Abgrenzung von der häufigeren neuroinflammatorischen Erkrankung, Multiple Sklerose (MS), ist von erheblicher Bedeutung,
da sich Behandlung und langfristige Prognose von NMOSD, MOGAD und MS wesentlich unterscheiden. Die vielfältigen Symptome und die umfangreiche Diagnostik machen eine enge Zusammenarbeit
zwischen Ophthalmologie, Neurologie und Radiologie erforderlich. Dieser Artikel gibt einen Überblick über typische MRT-Befunde und die serologische Antikörperdiagnostik bei NMOSD und MOGAD.
Zwei illustrative Fallberichte aus der ärztlichen Praxis ergänzen die Darstellung.
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Affiliation(s)
- Darius Mewes
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin & Max-Delbrück-Centrum für molekulare Medizin Berlin, Berlin, Deutschland
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Biomedical Innovation Academy, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Joseph Kuchling
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Biomedical Innovation Academy, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Klinik für Neurologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Patrick Schindler
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin & Max-Delbrück-Centrum für molekulare Medizin Berlin, Berlin, Deutschland
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Klinik für Neurologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ahmed Abdelrahim Ahmed Khalil
- Centrum für Schlaganfallforschung, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Abteilung Neurologie, Max-Planck-Institut für Kognitions- und Neurowissenschaften, Leipzig, Deutschland
- Mind Brain Body Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Sven Jarius
- AG Molekulare Neuroimmunologie, Neurologische Klinik, Universität Heidelberg, Heidelberg, Deutschland
| | - Friedemann Paul
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin & Max-Delbrück-Centrum für molekulare Medizin Berlin, Berlin, Deutschland
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Klinik für Neurologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Claudia Chien
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin & Max-Delbrück-Centrum für molekulare Medizin Berlin, Berlin, Deutschland
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
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Ciapă MA, Șalaru DL, Stătescu C, Sascău RA, Bogdănici CM. Optic Neuritis in Multiple Sclerosis—A Review of Molecular Mechanisms Involved in the Degenerative Process. Curr Issues Mol Biol 2022; 44:3959-3979. [PMID: 36135184 PMCID: PMC9497878 DOI: 10.3390/cimb44090272] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Multiple sclerosis is a central nervous system inflammatory demyelinating disease with a wide range of clinical symptoms, ocular involvement being frequently marked by the presence of optic neuritis (ON). The emergence and progression of ON in multiple sclerosis is based on various pathophysiological mechanisms, disease progression being secondary to inflammation, demyelination, or axonal degeneration. Early identification of changes associated with axonal degeneration or further investigation of the molecular processes underlying remyelination are current concerns of researchers in the field in view of the associated therapeutic potential. This article aims to review and summarize the scientific literature related to the main molecular mechanisms involved in defining ON as well as to analyze existing data in the literature on remyelination strategies in ON and their impact on long-term prognosis.
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Affiliation(s)
| | - Delia Lidia Șalaru
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
- Correspondence:
| | - Cristian Stătescu
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Radu Andy Sascău
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Camelia Margareta Bogdănici
- Department of Surgical Specialties (II), University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
- Ophthalmology Clinic, Saint Spiridon Hospital, Iași 700111, Romania
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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: 80] [Impact Index Per Article: 40.0] [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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Meuth SG, Bayas A, Kallmann B, Linker R, Rieckmann P, Wattjes MP, Mäurer M, Kleinschnitz C. Long-term management of multiple sclerosis patients treated with cladribine tablets beyond year 4. Expert Opin Pharmacother 2022; 23:1503-1510. [PMID: 35930260 DOI: 10.1080/14656566.2022.2106783] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Oral cladribine is a highly effective pulsed selective immune reconstitution therapy licensed for relapsing multiple sclerosis (RMS) since 2017. A full treatment course comprises two treatment cycles given 1 year apart, followed by two treatment-free years. The management of cladribine-treated patients beyond year 4 needs to be addressed as patients have now passed the initial 4 years since European Medical Agency approval. AREAS COVERED A panel of neurologists and a neuroradiologist experienced in MS treatment/monitoring evaluated clinical trial data and real-world evidence and proposed recommendations for the management of cladribine-treated patients beyond year 4. EXPERT OPINION Continuous monitoring of disease activity during the treatment-free period is important. Subsequent management depends on the presence or absence of inflammatory disease activity, determined in the absence of consistent guidelines via practice-driven neurological decision criteria. Persisting or newly occurring inflammatory disease activity is an indication for further treatment, i.e. either re-initiation of cladribine or switching to another highly effective disease-modifying therapy. The decision to retreat or switch should be based on clinical and radiological evaluation considering disease course, treatment history, and safety aspects. In the absence of disease activity, either retreatment can be offered, or the treatment-free period can be extended under structured monitoring.
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Affiliation(s)
- Sven G Meuth
- Klinik für Neurologie des Universitätsklinikums Düsseldorf, Düsseldorf, Germany
| | - Antonios Bayas
- Klinik für Neurologie und Klinische Neurophysiologie, Medizinische Fakultät, Universität Augsburg, Augsburg, Germany
| | | | - Ralf Linker
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Peter Rieckmann
- Abteilung für Neurologie, Medical Park Loipl, Regensburg, Germany
| | - Mike P Wattjes
- Department of diagnostic and interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Mathias Mäurer
- Klinik für Neurologie, Juliusspital Würzburg Klinikum Würzburg Mitte gGmbH, Würzburg, Germany
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Pengo M, Miante S, Franciotta S, Ponzano M, Torresin T, Bovis F, Rinaldi F, Perini P, Saiani M, Margoni M, Bertoldo A, Sormani MP, Pilotto E, Midena E, Gallo P, Puthenparampil M. Retinal Hyperreflecting Foci Associate With Cortical Pathology in Multiple Sclerosis. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2022; 9:9/4/e1180. [PMID: 35606113 PMCID: PMC9128002 DOI: 10.1212/nxi.0000000000001180] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/08/2022] [Indexed: 11/15/2022]
Abstract
Background and ObjectivesMicroglia, the resident immune cell of the brain and retina, is widespread activated in the white and gray matter (GM) in multiple sclerosis (MS). The objective of this study is to evaluate the presence and number of hyperreflecting foci (HRF), considered clusters of activated and proliferating retinal microglia, and their association with clinical and radiologic disease parameters in relapsing-remitting MS (RRMS).MethodsAt baseline, 80 patients with RRMS underwent optical coherence tomography (OCT) and 3T-MRI (including 3-dimensional T1, fluid-attenuated inversion recovery, and double inversion recovery sequences), closed to their disease onset (6.3 ± 5.1 months). These patients were then clinically and radiologically followed up for a mean of 43 months, evaluating the no evidence of disease activity (NEDA) condition, further divided into clinical (cNEDA) and radiologic (rNEDA). Patients with a clinical history or MRI/OCT findings suggestive of optic neuritis (ON) were excluded from the study.ResultsCompared with healthy controls, the HRF number was significantly higher in the inner nuclear layer (INL) of patients with RRMS (19.55 ± 5.65 vs 13.84 ± 2.57, p < 0.001) and associated with INL volume (β: 1.21, p < 0.001). GM lesion volume significantly correlated with the INL HRF count (p = 0.008). Survival analysis revealed a significant association between INL HRF and both cNEDA (p = 0.017) and rNEDA (p = 0.002).DiscussionWe found a strong association between retinal microglial proliferation and cortical pathology in RRMS, a finding suggesting a possible underlying common immunopathologic mechanism. Furthermore, microglial activation at baseline was observed to predict subsequent inflammatory events, indicating that HRF might be a candidate prognostic biomarker worthy of further investigation.Classification of EvidenceThis study provides Class II evidence that in patients with early RRMS but without ON, the number of HRF on OCT of the retinal inner nuclear layer is associated with cNEDA and rNEDA.
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Ma KSK, Lee CM, Chen PH, Yang Y, Dong YW, Wang YH, Wei JCC, Zheng WJ. Risk of Autoimmune Diseases Following Optic Neuritis: A Nationwide Population-Based Cohort Study. Front Med (Lausanne) 2022; 9:903608. [PMID: 35770018 PMCID: PMC9234206 DOI: 10.3389/fmed.2022.903608] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/02/2022] [Indexed: 01/13/2023] Open
Abstract
ObjectivesOptic neuritis is (ON) is believed to be an immune-mediated disease; however, the association between optic neuritis and autoimmune diseases remains unclear. This study aimed to identify the incidence rate and adjusted hazard ratio (aHR) of autoimmune diseases in patients with optic neuritis.MethodsThis nationwide, population-based, retrospective cohort study collected patients’ data between 1999 and 2013 from the National Health Insurance Research Database in Taiwan. A total of 9,235 patients were included. Using 1:4 propensity scoring, 1,847 patients were enrolled in the optic neuritis group and 7,388 in the non-optic neuritis group according to age, sex, comorbidities, and corticosteroid use. Follow-up was started from the index date and the endpoint was a diagnosis of new-onset autoimmune diseases including, myasthenia gravis (MG), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and ankylosing spondylitis (AS).ResultsThe Kaplan-Meier curves depicted that patients with optic neuritis had a higher cumulative incidence of autoimmune diseases than patients without optic neuritis. Cox proportional hazard regression showed that patients with optic neuritis were at a high risk of autoimmune diseases (aHR: 1.40; 95% C.I., 1.05–1.87), including MG (aHR: 4.16, 95% C.I.: 1.33–12.94), SLE (aHR: 3.33, 95% C.I.: 1.24–8.97), and AS (aHR: 2.86, 95% C.I.: 1.54–5.31). Subgroup analysis provided that patients with optic neuritis aged below 65 years (aHR: 1.42, 95% C.I.: 1.03–1.96) or who were females (aHR: 1.59, 95% C.I.: 1.11–2.27) had a significantly increased risk of autoimmune diseases compared to respective controls. The use of corticosteroids reduced the risk of autoimmune diseases in patients with optic neuritis (aHR for corticosteroids non-users: 1.46, 95% C.I.: 1.03–2.07).ConclusionPatients with optic neuritis presented with a high risk of autoimmune diseases such as MG, SLE, and AS, especially patients with optic neuritis who were young or females. Corticosteroids attenuated the link between optic neuritis and subsequent autoimmune diseases.
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Affiliation(s)
- Kevin Sheng-Kai Ma
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Chee-Ming Lee
- Department of Ophthalmology, Jen-Ai Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Health and Leisure Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Po-Hung Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yan Yang
- Department of Ultrasound, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Wei Dong
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- *Correspondence: James Cheng-Chung Wei,
| | - Wen Jie Zheng
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Wen Jie Zheng,
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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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Longoni G, Brown RA, Oyefiade A, Iruthayanathan R, Wilbur C, Shams S, Noguera A, Grover SA, O'Mahony J, Chung L, Wan MJ, Mah JK, Costello F, Arnold DL, Marrie RA, Bar-Or A, Banwell B, Mabbott D, Reginald AY, Yeh EA. Progressive retinal changes in pediatric multiple sclerosis. Mult Scler Relat Disord 2022; 61:103761. [PMID: 35349885 DOI: 10.1016/j.msard.2022.103761] [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: 10/21/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/19/2022]
Abstract
Objectives To determine to what extent acute demyelinating episodes versus chronic degenerative phenomena drive retinal neuroaxonal damage in pediatric acquired demyelinating syndromes (ADS). Methods We acquired optical coherence tomography (OCT) data (follow-up range: 2 weeks - 5 years, at variable intervals from presentation) in pediatric participants who had multiple sclerosis (MS), monophasic ADS, or were healthy. Multivariable mixed effects models were used to assess the association of the number of demyelinating episodes (either optic neuritis [ON], or non-ON relapses) with changes in retinal nerve fiber layer (RNFL) or ganglion cell layer-inner plexiform layer (GCIPL) thickness. Results 64 OCT sans from 23 MS, and 33 scans from 12 monophasic ADS participants were compared with 68 scans from 62 healthy participants. The first ON episode had the biggest impact on RNFL or GCIPL thickness in monophasic ADS (RNFL: -7.9 µm, CI=5.5, p = 0.0056; GCIPL: -8.4 µm, CI=4.4, p = 0.0002) and MS (RNFL: -16 µm, CI = 3.7, p < 10-6; GCIPL: -15 µm, CI = 2.6, p < 10-6). Non-ON relapses were also associated with small but significant retinal thickness reductions in MS (RNFL: -2.6 µm/relapse, CI = 1.4, p = 0.0003; GCIPL: -2.8 µm/relapse, CI = 0.89, p < 10-6). MS participants showed progressive GCIPL thinning independent of acute demyelinating episodes (-2.7 µm/year, CI = 1.9, p = 0.0058). Conclusions We showed a prominent impact of early ON episodes on OCT measures of neuroaxonal structure in patients with ADS. We also demonstrated negative effects of non-ON relapses, and the presence of chronic retinal neurodegenerative changes, in youth with MS.
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Affiliation(s)
- Giulia Longoni
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Robert A Brown
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Ade Oyefiade
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Renisha Iruthayanathan
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Colin Wilbur
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Shahriar Shams
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Austin Noguera
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephanie A Grover
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Julia O'Mahony
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Luke Chung
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael J Wan
- Department of Ophthalmology and Visual Sciences, The University of Toronto, Toronto, ON, Canada
| | - Jean K Mah
- Departments of Clinical Neurosciences and Surgery, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Fiona Costello
- Departments of Clinical Neurosciences and Surgery, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Douglas L Arnold
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Amit Bar-Or
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenda Banwell
- Division of Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Donald Mabbott
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Arun Y Reginald
- Department of Ophthalmology and Visual Sciences, The University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, Division of Neurology, University of Toronto, Toronto, ON, Canada.
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Reith W, Hausmann A, Kettner M. [New MRI guidelines for multiple sclerosis]. Radiologe 2022; 62:322-326. [PMID: 35316355 DOI: 10.1007/s00117-022-00991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND To improve the efficient use of magnetic resonance imaging (MRI) in routine clinical practice, an expert panel has revised the guidelines for its use in the diagnosis and monitoring of multiple sclerosis (MS). OBJECTIVES The revised guidelines now take into account new developments and relevant advances in knowledge, such as the ongoing debate about safety related to intravenous gadolinium-based contrast agents. The value of spinal cord MRI for diagnostic, prognostic, and surveillance purposes has been re-evaluated. Standardization of brain and spinal cord MRI protocols for diagnosis, assessment of prognosis, and monitoring of therapy, as well as the use of 3D-FLAIR (three-dimensional fluid-attenuated inversion recovery) as the most important sequence in the diagnosis of lesions in the brain have been included, as this allows better interpretation and comparability, e.g., in follow-up assessments.
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Affiliation(s)
- Wolfgang Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland.
| | - Alena Hausmann
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland
| | - Michael Kettner
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland
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Denis M, Woillez JP, Smirnov VM, Drumez E, Lannoy J, Boucher J, Zedet M, Pruvo JP, Labreuche J, Zephir H, Leclerc X, Outteryck O. Optic Nerve Lesion Length at the Acute Phase of Optic Neuritis Is Predictive of Retinal Neuronal Loss. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2022; 9:9/2/e1135. [PMID: 35091465 PMCID: PMC8802684 DOI: 10.1212/nxi.0000000000001135] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/03/2021] [Indexed: 11/15/2022]
Abstract
Background and Objectives Acute optic neuritis (ON) is a classical presenting symptom of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and anti–MOG-associated disorders. The resulting visual impairment is variable and can be severe. Clinicians are in need of predictive biomarkers to optimize the management of acute ON. In this longitudinal study (IRMANO, NCT03651662), we evaluated the ability of optic nerve lesion length measured on MRI at the acute phase of ON to predict retinal neuro-axonal loss and visual impairment at a chronic stage. Methods We conducted a longitudinal study (IRMANO, NCT03651662) of patients who presented a clinical episode of ON (≤8 weeks). All patients underwent a retinal optical coherence tomography (OCT) and a brain/optic nerve MRI, including 3D double-inversion recovery (DIR) sequence at the acute phase of ON and 12 months later. Primary outcomes were optic nerve DIR hypersignal lesion length, macular ganglion cell–inner plexiform layer (GCIPL) volume measured on OCT, and low-contrast monocular visual acuity (LCMVA). Results The study group included 51 patients (33 women, mean age of 32.4 years ± 7.9). We recruited patients with a clinically isolated syndrome (n = 20), a relapsing-remitting MS (n = 23), an isolated ON (n = 6), and a first clinical episode of NMOSD (n = 2). Optic nerve DIR hypersignal was observed in all but 1 symptomatic optic nerves. At inclusion, the mean optic nerve lesion length (in mm) was 12.35 ± 5.98. The mean GCIPL volume (in mm3) significantly decreased between inclusion (1.90 ± 0.18) and M12 (1.67 ± 0.21; p < 0.0001). Optic nerve lesion length at inclusion was significantly associated with GCIPL thinning (estimate ± SD; −0.012 ± 0.004; p = 0.0016) and LCMVA at M12 (0.016 ± 0.003; p < 0.001). Optic nerve lesion length significantly increased at M12 (15.76 ± 8.70; p = 0.0007). The increase in optic nerve lesion length was significantly associated with the GCIPL thinning between inclusion and M12 (−0.012 ± 0.003; p = 0.0011). Discussion At the acute phase of ON, optic nerve lesion length is an imaging biomarker predictive of retinal neuro-axonal loss and chronic visual impairment, which can help to stratify future therapeutic strategies in acute ON. Classification of Evidence This study provides Class I evidence that optic nerve lesion length measured on MRI during the acute phase of a first episode of ON is associated with long-term retinal neuro-axonal loss and visual impairment.
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Foo R, Yau C, Singhal S, Tow S, Loo JL, Tan K, Milea D. Optic Neuritis in the Era of NMOSD and MOGAD: A Survey of Practice Patterns in Singapore. Asia Pac J Ophthalmol (Phila) 2022; 11:184-195. [PMID: 35533337 DOI: 10.1097/apo.0000000000000513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The Optic Neuritis Treatment Trial was a landmark study with implications worldwide. In the advent of antibody testing for neuromyelitis optica spectrum disease (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), emerging concepts, such as routine antibody testing and management, remain controversial, resulting mostly from studies in White populations. We evaluate the practice patterns of optic neuritis investigation and management by neuro-ophthalmologists and neurologists in Singapore. DESIGN 21-question online survey consisting of 4 clinical vignettes. METHODS The survey was sent to all Singapore Medical Council- registered ophthalmologists and neurologists who regularly manage patients with optic neuritis. RESULTS Forty-two recipients (17 formally trained neuro-ophthalmol-ogists [100% response rate] and 25 neurologists) responded. Participants opted for routine testing of anti-aquaporin-4 antibodies (88.1% in mild optic neuritis and 97.6% in severe optic neuritis). Anti-MOG antibodies were frequently obtained (76.2% in mild and 88.1% in severe optic neuritis). Plasmapheresis was rapidly initiated (85.7%) in cases of nonresponse to intravenous steroids, even before obtaining anti-aquaporin-4 or anti-MOG serology results. In both NMOSD and MOGAD, oral mycophenolate mofetil was the preferred option if chronic immunosuppression was necessary. Steroids were given for a longer duration and tapered more gradually than in idiopathic optic neuritis cases. CONCLUSIONS Serological testing for NMOSD and MOGAD is considered as a routine procedure in cases of optic neuritis in Singapore, possibly due to local epidemiological features of these conditions. Chronic oral immunosuppression is preferred for the long term, but further research is necessary to establish the efficacy and cost-effectiveness of these practices.
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Affiliation(s)
- Reuben Foo
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
| | - Christine Yau
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
| | - Shweta Singhal
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Singapore Eye Research Institute, Singapore City, Singapore
- Duke-NUS Medical School, Singapore City, Singapore
| | - Sharon Tow
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Duke-NUS Medical School, Singapore City, Singapore
| | - Jing-Liang Loo
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Singapore Eye Research Institute, Singapore City, Singapore
- National University Hospital, Singapore City, Singapore
| | - Kevin Tan
- Duke-NUS Medical School, Singapore City, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore City, Singapore
| | - Dan Milea
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Singapore Eye Research Institute, Singapore City, Singapore
- Duke-NUS Medical School, Singapore City, Singapore
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The forgotten tract of vision in multiple sclerosis: vertical occipital fasciculus, its fiber properties, and visuospatial memory. Brain Struct Funct 2022; 227:1479-1490. [PMID: 35174417 DOI: 10.1007/s00429-022-02464-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
Abstract
Visual disturbances are a common disease manifestation in multiple sclerosis (MS) due to lesions damaging white matter tracts involved in vision. Vertical occipital fasciculus (VOF), a tract located vertically in the occipital lobe, was neglected for more than a century. We hypothesize that VOF is involved in integrating information between dorsal and ventral visual streams. Thus, its damage in MS, as well as its probable role in visual processing (by using MS as a VOF damage model) needs to be clarified. To study fiber characteristics of VOF in MS, and their clinical and visual learning associations, 57 relapsing-remitting MS (RRMS) and 25 healthy controls (HC) were recruited. We acquired MS Functional Composite, Expanded Disability Status Scale (EDSS), and Brief Visuospatial Memory Test-Revised (BVMT-R), and diffusion MRI scans. Tractography of VOF and optic radiation (OR) was done. VOF's metrics were statistically tested for between-group differences and clinical and visual tests associations. Along-tract analysis and laterality were also tested. RRMS patients had higher mean, axial, and radial diffusivity (nearly in all fiber points), and lower fractional anisotropy in bilateral VOFs compared to HC. No laterality was noted. These were associated with poor clinical outcomes, poor visual scores in EDSS, and lower total immediate and delayed recall in BVMT-R in RRMS, after adjusting for age, gender, and fiber metrics of OR. VOF damage is present in RRMS and is associated with visual symptoms and visuospatial learning impairments. It seems VOF is involved in integrating information between visual streams.
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Nij Bijvank J, Uitdehaag BMJ, Petzold A. Retinal inter-eye difference and atrophy progression in multiple sclerosis diagnostics. J Neurol Neurosurg Psychiatry 2022; 93:216-219. [PMID: 34764152 PMCID: PMC8785044 DOI: 10.1136/jnnp-2021-327468] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The visual system could be included in the diagnostic criteria for multiple sclerosis (MS) to demonstrate dissemination in space (DIS) and dissemination in time (DIT). OBJECTIVE To investigate the diagnostic value of retinal asymmetry in MS. METHODS A prospective, longitudinal study in individuals with MS (n=151) and healthy controls (n=27). Optical coherence tomography (OCT) was performed at 0, 2 and 4 years. Macular ganglion cell and inner plexiform layer (mGCIPL) thickness was determined as well as measures for retinal asymmetry: the inter-eye percentage difference (IEPD) and inter-eye absolute difference (IEAD). Receiver operator characteristics curves were plotted and the area under the curve (AUC) was calculated for group comparisons of the mGCIPL, IEPD, IEAD and atrophy rates. RESULTS The diagnostic accuracy of both the IEPD and IEAD for differentiating bilateral and unilateral MS optic neuritis was high and stable over time (AUCs 0.88-0.93). The IEPD slightly outperformed the IEAD. Atrophy rates showed low discriminatory abilities for differentiating MS from controls (AUC 0.49-0.58). CONCLUSION The inter-eye differences of the mGCIPL have value for demonstration of DIS but in individuals with longstanding MS not for DIT. This may be considered as a test to detect DIS in future diagnostic criteria. Validation in a large prospective study in people presenting with symptoms suggestive of MS is required.
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Affiliation(s)
- Jenny Nij Bijvank
- Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands .,Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
| | - B M J Uitdehaag
- Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
| | - Axel Petzold
- Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands.,Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands.,Neuro-ophthalmology, Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery and the UCL Queen Square Institute of Neurology, London, UK
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Fernandez VC, Villa AM. Acute optic neuritis: What do complementary tests add to diagnosis? Mult Scler Relat Disord 2022; 57:103348. [PMID: 35158457 DOI: 10.1016/j.msard.2021.103348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/13/2021] [Accepted: 10/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Optic neuritis (ON) is the inflammation of the optic nerve due in many cases, to a pathological immune response. Since its symptoms can be subtle, diagnosis is sometimes challenging. The value of complementary tests for diagnosis and prognosis of ON was demonstrated in retrospective analysis, but their utility in the acute period of ON has been scarcely studied. The aim of this study is to determine the usefulness of clinical assessment, optical coherence tomography (OCT), visual evoked potentials (VEP) and orbit magnetic resonance imaging (MRI) for making diagnosis and prognosis of acute ON (AON). MATERIALS AND METHODS A cross-sectional study was conducted including patients with ON within 90 days of symptom onset. A complete neuro-ophthalmological evaluation, OCT, VEP and MRI were carried out, determining in each case its sensitivity, specificity and predictive values in the diagnosis of ON and the assessment of its severity. RESULTS 75 eyes of 34 patients with ON were included. Regarding diagnosis, low contrast visual acuity (LCVA) displayed the highest sensitivity (100%), being superior than the sensitivity of all complementary tools, always below 80%. Orbit MRI abnormal findings has a Specificity of 100% to confirm diagnosis. Regarding severity assessment and prognosis, Ganglion cell +inner plexiform layer (GCIP) thickness, but not retinal nerve fibre layer (RNFL), correlates significantly with patients' visual acuity (VA) (p < 0.05). Furthermore, both P100latency and VEP's amplitude showed to be significantly associated with VA (p < 0.05) in the acute period. The combination of two predictors (measurement of RNFL and GCIP) are capable of explaining 60% of the variation of the patient's visual acuity, with statistical significance (p = 0.02) CONCLUSIONS: In depth neuro-ophthalmological assessment during the acute phase of ON, including contrast sensitivity measurement, proved to be superior to complementary tests for diagnosis, surpassing the performance of OCT and VEP. However, these tools can add to prognosis, as GCIP thickness and VEP's amplitude correlate with disease severity and its findings could encourage prompt aggressive treatments in AON.
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Affiliation(s)
- Victoria Carla Fernandez
- Sección de Neuroinmunología, División Neurología. Hospital J. M. Ramos Mejía. Centro Universitario de Neurología. Universidad de Buenos Aires (UBA), Buenos Aires, Argentina; Centro Argentino de Neuroinmunología (CADENI), Facultad de Medicina. Universidad de Buenos Aires, Argentina.
| | - Andres Maria Villa
- Sección de Neuroinmunología, División Neurología. Hospital J. M. Ramos Mejía. Centro Universitario de Neurología. Universidad de Buenos Aires (UBA), Buenos Aires, Argentina; Centro Argentino de Neuroinmunología (CADENI), Facultad de Medicina. Universidad de Buenos Aires, Argentina
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Carnero Contentti E, López PA, Criniti J, Pettinicchi JP, Cristiano E, Patrucco L, Bribiesca Contreras E, Gómez-Figueroa E, Flores-Rivera J, Correa-Díaz EP, Toral Granda AM, Ortiz Yepez MA, Gualotuña Pachacama WA, Piedra Andrade JS, Galleguillos L, Tkachuk V, Nadur D, Daccach Marques V, Soto de Castillo I, Casas M, Cohen L, Alonso R, Caride A, Lana-Peixoto M, Rojas JI. Chiasmatic lesions on conventional magnetic resonance imaging during the first event of optic neuritis in patients with neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein-associated disease in a Latin American cohort. Eur J Neurol 2021; 29:802-809. [PMID: 34799965 DOI: 10.1111/ene.15178] [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] [Received: 10/03/2021] [Accepted: 11/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Optic neuritis (ON) is often the initial symptom of neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-associated disease (MOGAD). We aimed to compare the frequency and pattern of chiasmatic lesions in MOGAD-related ON (MOGAD-ON) and NMOSD-related ON (NMOSD-ON) using conventional brain imaging (magnetic resonance imaging [MRI]) in Latin America (LATAM). METHODS We reviewed the medical records and brain MRI (≤30 days from ON onset) of patients with a first event of MOGAD-ON and NMOSD-ON. Patients from Argentina (n = 72), Chile (n = 21), Ecuador (n = 31), Brazil (n = 30), Venezuela (n = 10) and Mexico (n = 82) were included. Antibody status was tested using a cell-based assay. Demographic, clinical, imaging and prognostic (as measured by the Visual Functional System Score [VFSS] of the Expanded Disability Status Scale) data were compared. RESULTS A total of 246 patients (208 NMOSD and 38 MOGAD) were included. No differences were found in gender and ethnicity between the groups. We observed chiasmatic lesions in 66/208 (31.7%) NMOSD-ON and in 5/38 (13.1%) MOGAD-ON patients (p = 0.01). Of these patients with chiasmatic lesions, 54/66 (81.8%) and 4/5 had associated longitudinally extensive optic nerve lesions, 45/66 (68%) and 4/5 had bilateral lesions, and 31/66 (47%) and 4/5 showed gadolinium-enhancing chiasmatic lesions, respectively. A positive correlation was observed between VFSS and presence of bilateral (r = 0,28, p < 0.0001), chiasmatic (r = 0.27, p = 0.0001) and longitudinally extensive lesions (r = 0,25, p = 0.0009) in the NMOSD-ON group, but no correlations were observed in the MOGAD-ON group. CONCLUSIONS Chiasmatic lesions were significantly more common in NMOSD than in MOGAD during an ON attack in this LATAM cohort. Further studies are needed to assess the generalizability of these results.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | | | - Enrique Gómez-Figueroa
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores-Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | | | | | | | | | - Verónica Tkachuk
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Debora Nadur
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Magdalena Casas
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Leila Cohen
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Marco Lana-Peixoto
- Department of Neurology, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina.,Service of Neurology, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Lin TY, Chien C, Lu A, Paul F, Zimmermann HG. Retinal optical coherence tomography and magnetic resonance imaging in neuromyelitis optica spectrum disorders and MOG-antibody associated disorders: an updated review. Expert Rev Neurother 2021; 21:1101-1123. [PMID: 34551653 DOI: 10.1080/14737175.2021.1982697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein IgG antibody-associated disorders (MOGAD) comprise two groups of rare neuroinflammatory diseases that cause attack-related damage to the central nervous system (CNS). Clinical attacks are often characterized by optic neuritis, transverse myelitis, and to a lesser extent, brainstem encephalitis/area postrema syndrome. Retinal optical coherence tomography (OCT) is a non-invasive technique that allows for in vivo thickness quantification of the retinal layers. Apart from OCT, magnetic resonance imaging (MRI) plays an increasingly important role in NMOSD and MOGAD diagnosis based on the current international diagnostic criteria. Retinal OCT and brain/spinal cord/optic nerve MRI can help to distinguish NMOSD and MOGAD from other neuroinflammatory diseases, particularly from multiple sclerosis, and to monitor disease-associated CNS-damage. AREAS COVERED This article summarizes the current status of imaging research in NMOSD and MOGAD, and reviews the clinical relevance of OCT, MRI and other relevant imaging techniques for differential diagnosis, screening and monitoring of the disease course. EXPERT OPINION Retinal OCT and MRI can visualize and quantify CNS damage in vivo, improving our understanding of NMOSD and MOGAD pathology. Further efforts on the standardization of these imaging techniques are essential for implementation into clinical practice and as outcome parameters in clinical trials.
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Affiliation(s)
- Ting-Yi Lin
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Chien
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Angelo Lu
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Meneguette NS, Almeida KMFR, Figueiredo MTJDO, de Araújo E Araújo ACR, Alvarenga MP, Vasconcelos CCF, Nascimento ACB, Colombini GNUI, Petzold A, Alvarenga RMP. Optic neuritis in Asian type opticospinal multiple sclerosis (OSMS-ON) in a non-Asian population: A functional-structural paradox. Mult Scler Relat Disord 2021; 56:103260. [PMID: 34562767 DOI: 10.1016/j.msard.2021.103260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/23/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Biomarkers have improved the classification of autoimmune inflammatory disorders, including optic neuritis (ON) as a frequent presentation of multiple sclerosis, neuromyelitis spectrum disorders, MOG antibody-related disease (MOGAD), and opticospinal multiple sclerosis (OSMS). The phenotype of OSMS in non-Asian populations is less well known. OBJECTIVE We investigated the clinical features and prognosis of OSMS-ON in a Brazilian cohort. METHODS This was a single-center cohort study of patients from Rio de Janeiro (Brazil) with OSMS. All individuals were MOG- and AQP4-seronegative, clinically diagnosed with ON, and had magnetic resonance imaging-confirmed transverse myelitis (TM). Subjects and healthy controls (HCs) were assessed for visual acuity (logMAR VA), automated perimetry mean deviation (MD), intraocular pressure, and spectral-domain optical coherence tomography (OCT), followed by automated retinal layer segmentation of the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell and inner plexiform layer (mGCIPL). Receiver operator characteristic curves were plotted and the area under the curve (AUC) was calculated for group comparisons of retinal asymmetry of the pRNFL and mGCIPL. RESULTS The 30 patients with OSMS were predominantly female and white. The mean age was 48 years (range 20-70 years). Unilateral ON was the index event in 83.3% of patients. Over the average 18-year follow-up period, there were 89 relapses of ON. In individuals with OSMS, the average VA was 0.07±0.14 in the right eye (RE) and 0.13±0.30 in the left eye (LE). The MD was -5.37±5.88 dB and -5.23±3.34 dB for the RE and LE, respectively. There was a significant cumulative loss of VA (p = 0.0003) and MD (p = 0.0001) with a higher number of recurrent episodes. Atrophy of the pRNFL thickness was significant in OSMS (RE, 78.62 ± 16.01 µm; LE, 79.86 ± 13.79 µm) relative to the HC group (RE, 98.87 ± 10.68 µm; LE, 97.87 ± 10.85 µm, p = 0.0001). Likewise, there was significant mGCIPL atrophy in patients with OSMS (RE, 74.96 ± 14.46 µm; LE, 73.88 ± 13.79 µm) relative to the HC group (RE, 90.50 ± 6.74 µm; LE, 90.41± 6.89 µm; p = 0.0001). Retinal asymmetry, inter-eye percentage, and absolute differences accurately separated patients with unilateral ON from HCs (AUC=0.89 and AUC=0.85, respectively). CONCLUSION A structural-functional paradox was found in OSMS with a high diagnostic value for a novel metric based on retinal asymmetry. The functional visual outcome are excellent despite significant structural damage to the inner retinal layers in patients with a high ON relapse rate and long-term bilateral sequential involvement.
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Affiliation(s)
- Nathalie Stéphanie Meneguette
- Department of Neurology and Ophthalmology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Ana Carolina Ribeiro de Araújo E Araújo
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazi; Multiple Sclerosis Center, Federal Hospital of Lagoa, Rio de Janeiro, Brazil
| | - Marcos Papais Alvarenga
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazi; Multiple Sclerosis Center, Federal Hospital of Lagoa, Rio de Janeiro, Brazil
| | | | | | | | - Axel Petzold
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery, Queen Square UCL Institute of Neurology, London, United Kingdom; Expert Centre Neuro-ophthalmology, Amsterdam UMC, the Netherlands.
| | - Regina Maria Papais Alvarenga
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazi; Multiple Sclerosis Center, Federal Hospital of Lagoa, Rio de Janeiro, Brazil.
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Three "Red Lines" for Pattern Recognition-Based Differential Diagnosis Using Optical Coherence Tomography in Clinical Practice. J Neuroophthalmol 2021; 41:385-398. [PMID: 34415273 DOI: 10.1097/wno.0000000000001173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) devices for imaging of the eye are broadly available. The test is noninvasive, rapid, and well-tolerated by patients. This creates a large number of OCT images and patient referrals. Interpretation of OCT findings at the interface between neurological and ophthalmologic conditions has become a key skill in the neuro-ophthalmology service. Similar to the interpretation of visual fields, recogntion of the vertical and horizontal medians are helpful. A third "red line" is added, which will be reviewed here. EVIDENCE Levels 1a to 5 evidence. ACQUISITION Literature research. RESULTS There is level 1a evidence that neurodegeneration of the brain is associated with inner retinal layer atrophy. Predominantly, this is driven by retrograde (trans-synaptic) axonal degeneration from the brain to the eye. This process typically stops at the level of the inner nuclear layer (INL). Anterograde (Wallerian) axonal degeneration from the eye to the brain can trespass the INL. The geography of atrophy and swelling of individual macular retinal layers distinguishes prechiasmal from postchiasmal pathology. The emerging patterns are a front-back "red line" at the INL; a vertical "red line" through the macula for chiasmal/postchiasmal pathology; and a horizontal "red line" through the macular for pathology pointing to the optic disc. This is summarized by illustrative case vignettes. CONCLUSIONS The interpretation of patterns of individual retinal layer atrophy (3 "red lines") needs to be combined with recognition of localized layer thickening (edema, structural) at the macula. Certain macular patterns point to pathology at the level of the optic disc. This requires revision of the optic disc OCT and will guide need for further investigations. The 3 "red lines" proposed here may be found useful in clinical practice and the related mnemonics ("half moon," "sunset," "rainbow") for teaching.
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Marmoy OR, Viswanathan S. Clinical electrophysiology of the optic nerve and retinal ganglion cells. Eye (Lond) 2021; 35:2386-2405. [PMID: 34117382 PMCID: PMC8377055 DOI: 10.1038/s41433-021-01614-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
Clinical electrophysiological assessment of optic nerve and retinal ganglion cell function can be performed using the Pattern Electroretinogram (PERG), Visual Evoked Potential (VEP) and the Photopic Negative Response (PhNR) amongst other more specialised techniques. In this review, we describe these electrophysiological techniques and their application in diseases affecting the optic nerve and retinal ganglion cells with the exception of glaucoma. The disease groups discussed include hereditary, compressive, toxic/nutritional, traumatic, vascular, inflammatory and intracranial causes for optic nerve or retinal ganglion cell dysfunction. The benefits of objective, electrophysiological measurement of the retinal ganglion cells and optic nerve are discussed, as are their applications in clinical diagnosis of disease, determining prognosis, monitoring progression and response to novel therapies.
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Affiliation(s)
- Oliver R Marmoy
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK.
- UCL-GOS Institute for Child Health, University College London, London, UK.
- Manchester Metropolitan University, Manchester, UK.
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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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