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Oertel FC, Zimmermann HG, Motamedi S, Bereuter C, Asseyer ES, Chien C, Marignier R, Cobo-Calvo A, Leocani L, Pisa M, Radaelli M, Villoslada P, Sanchez-Dalmau B, Martinez-Lapiscina EH, Lana-Peixoto MA, Fontenelle MA, Aktas O, Ringelstein M, Albrecht P, Green AJ, Yeaman MR, Smith TJ, Cook L, Paul F, Brandt AU. Retinal Changes After Acute and Late Optic Neuritis in Aquaporin-4 Antibody Seropositive NMOSD. J Neuroophthalmol 2023:00041327-990000000-00464. [PMID: 37782525 DOI: 10.1097/wno.0000000000001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Frederike C Oertel
- Experimental and Clinical Research Center (FCO, HGZ, SM, CB, ESA, CC, FP, AUB), 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 (FCO, HGZ, SM, CB, ESA, CC, FP, AUB), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Neurology (AJG), University of California San Francisco, San Francisco, California; Neurology (RM, ACC), Multiple Sclerosis, Myelin Disorders and Neuroinflammation Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (ACC), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Experimental Neurophysiology Unit (LL, MP, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute, Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Hospital Clinic of Barcelona-Institut d'Investigacions (PV, BS-D, EHM-L), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; CIEM MS Research Center (MAL-P, MAF), University of Minas Gerais, Medical School, Belo Horizonte, Brazil; Department of Neurology (OA, M. Ringelstein, PA), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Neurology (M. Ringelstein), Centre for Neurology and Neuropsychiatry, LVR Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Medicine (MRY), Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance, California; Department of Medicine (MRY), David Geffen School of Medicine at UCLA, Los Angeles, California; Departments of Ophthalmology and Visual Sciences (TJS), Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan; Division of Metabolism, Endocrine and Diabetes (TJS, LC), Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Neurology (FP), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; and Department of Neurology (AUB), University of California, Irvine, California
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Bsteh G, Hegen H, Altmann P, Auer M, Berek K, Di Pauli F, Kornek B, Krajnc N, Leutmezer F, Macher S, Rommer PS, Zebenholzer K, Zulehner G, Zrzavy T, Deisenhammer F, Pemp B, Berger T. Diagnostic Performance of Adding the Optic Nerve Region Assessed by Optical Coherence Tomography to the Diagnostic Criteria for Multiple Sclerosis. Neurology 2023; 101:e784-e793. [PMID: 37400245 PMCID: PMC10449446 DOI: 10.1212/wnl.0000000000207507] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/24/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The optic nerve has been recommended as an additional region for demonstrating dissemination in space (DIS) in diagnostic criteria for multiple sclerosis (MS). The aim of this study was to investigate whether adding the optic nerve region as determined by optical coherence tomography (OCT) as part of the DIS criteria improves the 2017 diagnostic criteria. METHODS From a prospective observational study, we included patients with a first demyelinating event who had complete information to assess DIS and a spectral domain OCT scan obtained within 180 days. Modified DIS criteria (DIS + OCT) were constructed by adding the optic nerve to the current DIS regions based on validated thresholds for OCT intereye differences. Time to second clinical attack was the primary endpoint. RESULTS We analyzed 267 patients with MS (mean age 31.3 years [SD 8.1], 69% female) during a median observation period of 59 months (range: 13-98). Adding the optic nerve as a fifth region improved the diagnostic performance by increasing accuracy (DIS + OCT 81.2% vs DIS 65.6%) and sensitivity (DIS + OCT 84.2% vs DIS 77.9%) without lowering specificity (DIS + OCT 52.2% vs DIS 52.2%). Fulfilling DIS + OCT criteria (≥2 of 5 DIS + OCT regions involved) indicated a similar risk of a second clinical attack (hazard ratio [HR] 3.6, CI 1.4-14.5) compared with a 2.5-fold increased risk when fulfilling DIS criteria (HR 2.5, CI 1.2-11.8). When the analysis was conducted according to topography of the first demyelinating event, DIS + OCT criteria performed similarly in both optic neuritis and nonoptic neuritis. DISCUSSION Addition of the optic nerve, assessed by OCT, as a fifth region in the current DIS criteria improves diagnostic performance by increasing sensitivity without lowering specificity. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that adding the optic nerve as determined by OCT as a fifth DIS criterion to the 2017 McDonald criteria improves diagnostic accuracy.
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Affiliation(s)
- Gabriel Bsteh
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria.
| | - Harald Hegen
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Patrick Altmann
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Michael Auer
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Klaus Berek
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Franziska Di Pauli
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Barbara Kornek
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Nik Krajnc
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Fritz Leutmezer
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Stefan Macher
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Paulus Stefan Rommer
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Karin Zebenholzer
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Gudrun Zulehner
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Tobias Zrzavy
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Florian Deisenhammer
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Berthold Pemp
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Thomas Berger
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
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