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Zuroff LR, Green AJ. The Study of Remyelinating Therapies in Multiple Sclerosis: Visual Outcomes as a Window Into Repair. J Neuroophthalmol 2024; 44:143-156. [PMID: 38654413 DOI: 10.1097/wno.0000000000002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Amelioration of disability in multiple sclerosis requires the development of complementary therapies that target neurodegeneration and promote repair. Remyelination is a promising neuroprotective strategy that may protect axons from damage and subsequent neurodegeneration. METHODS A review of key literature plus additional targeted search of PubMed and Google Scholar was conducted. RESULTS There has been a rapid expansion of clinical trials studying putative remyelinating candidates, but further growth of the field is limited by the lack of consensus on key aspects of trial design. We have not yet defined the ideal study population, duration of therapy, or the appropriate outcome measures to detect remyelination in humans. The varied natural history of multiple sclerosis, coupled with the short time frame of phase II clinical trials, requires that we develop and validate biomarkers of remyelination that can serve as surrogate endpoints in clinical trials. CONCLUSIONS We propose that the visual system may be the most well-suited and validated model for the study potential remyelinating agents. In this review, we discuss the pathophysiology of demyelination and summarize the current clinical trial landscape of remyelinating agents. We present some of the challenges in the study of remyelinating agents and discuss current potential biomarkers of remyelination and repair, emphasizing both established and emerging visual outcome measures.
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Affiliation(s)
- Leah R Zuroff
- Department of Neurology (LZ), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Neurology (AJG), University of California San Francisco, San Francisco, California
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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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Nij Bijvank JA, Hof SN, Prouskas SE, Schoonheim MM, Uitdehaag BMJ, van Rijn LJ, Petzold A. A novel eye-movement impairment in multiple sclerosis indicating widespread cortical damage. Brain 2023; 146:2476-2488. [PMID: 36535900 PMCID: PMC10232247 DOI: 10.1093/brain/awac474] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/04/2022] [Accepted: 11/22/2022] [Indexed: 11/04/2023] Open
Abstract
In multiple sclerosis, remyelination trials have yet to deliver success like that achieved for relapse rates with disease course modifying treatment trials. The challenge is to have a clinical, functional outcome measure. Currently, there are none that have been validated, other than visual evoked potentials in optic neuritis. Like vision, quick eye movements (saccades) are heavily dependent on myelination. We proposed that it is possible to extrapolate from demyelination of the medial longitudinal fasciculus in the brainstem to quantitative assessment of cortical networks governing saccadic eye movements in multiple sclerosis. We have developed and validated a double-step saccadic test, which consists of a pair of eye movements towards two stimuli presented in quick succession (the demonstrate eye movement networks with saccades protocol). In this single-centre, cross-sectional cohort study we interrogated the structural and functional relationships of double-step saccades in multiple sclerosis. Data were collected for double-step saccades, cognitive function (extended Rao's Brief Repeatable Battery), disability (Expanded Disability Status Scale) and visual functioning in daily life (National Eye Institute Visual Function Questionnaire). MRI was used to quantify grey matter atrophy and multiple sclerosis lesion load. Multivariable linear regression models were used for analysis of the relationships between double-step saccades and clinical and MRI metrics. We included 209 individuals with multiple sclerosis (mean age 54.3 ± 10.5 years, 58% female, 63% relapsing-remitting multiple sclerosis) and 60 healthy control subjects (mean age 52.1 ± 9.2 years, 53% female). The proportion of correct double-step saccades was significantly reduced in multiple sclerosis (mean 0.29 ± 0.22) compared to controls (0.45 ± 0.22, P < 0.001). Consistent with this, there was a significantly larger double-step dysmetric saccadic error in multiple sclerosis (mean vertical error -1.18 ± 1.20°) compared to controls (-0.54 ± 0.86°, P < 0.001). Impaired double-step saccadic metrics were consistently associated with more severe global and local grey matter atrophy (correct responses-cortical grey matter: β = 0.42, P < 0.001), lesion load (vertical error: β = -0.28, P < 0.001), progressive phenotypes, more severe physical and cognitive impairment (correct responses-information processing: β = 0.46, P < 0.001) and visual functioning. In conclusion, double-step saccades represent a robust metric that revealed a novel eye-movement impairment in individuals with multiple sclerosis. Double-step saccades outperformed other saccadic tasks in their statistical relationship with clinical, cognitive and visual functioning, as well as global and local grey matter atrophy. Double-step saccades should be evaluated longitudinally and tested as a potential novel outcome measure for remyelination trials in multiple sclerosis.
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Affiliation(s)
- Jenny A Nij Bijvank
- Amsterdam UMC, Department of Neurology, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
- Amsterdam UMC, Department of Ophthalmology, Vrije Universiteit Amsterdam, Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
| | - Sam N Hof
- Amsterdam UMC, Department of Neurology, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
| | - Stefanos E Prouskas
- Amsterdam UMC, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, MS Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
| | - Menno M Schoonheim
- Amsterdam UMC, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, MS Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Amsterdam UMC, Department of Neurology, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
| | - Laurentius J van Rijn
- Amsterdam UMC, Department of Ophthalmology, Vrije Universiteit Amsterdam, Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
- Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, 1091 AC Amsterdam, The Netherlands
| | - Axel Petzold
- Amsterdam UMC, Department of Neurology, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
- Amsterdam UMC, Department of Ophthalmology, Vrije Universiteit Amsterdam, Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
- Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery and the Queen Square Institute of Neurology, UCL, London EC1V 2PD, UK
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Omary R, Bockisch CJ, De Vere-Tyndall A, Pazahr S, Baráth K, Weber KP. Lesion follows function: video-oculography compared with MRI to diagnose internuclear ophthalmoplegia in patients with multiple sclerosis. J Neurol 2023; 270:917-924. [PMID: 36315254 PMCID: PMC9886641 DOI: 10.1007/s00415-022-11428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Video-oculography (VOG) is used to quantify functional deficits in internuclear ophthalmoplegia (INO), whereas MRI can detect the corresponding structural lesions in the medial longitudinal fasciculus (MLF). This study investigates the diagnostic agreement of MRI compared to VOG measurements. METHODS We prospectively compared structural MRI findings and functional VOG measures of 63 MS patients to assess their diagnostic agreement for INO. RESULTS MRI detected 12 true-positive and 92 true-negative MLF lesions for INO compared to VOG (12 true-positive and 38 true-negative patients) but identified one-third of the MLF lesions on the wrong side. MRI ratings were specific (92.0%) to detect MLF lesions but not sensitive (46.2%) for diagnosing INO (86.4% and 63.2% by patient). Accordingly, MRI has a high positive likelihood ratio of 5.77 but a modest negative likelihood ratio of 0.59 for the probability of INO (4.63 and 0.43) with an accuracy of 82.5% (79.4%). CONCLUSION MRI assessments are highly specific but not sensitive for detecting INO compared to VOG. While MRI identifies MLF lesions in INO, VOG quantifies the deficit. As a simple, quick, and non-invasive test for diagnosing and tracking functional INO deficits, it will hopefully find its place in the diagnostic and therapeutic pathways of MS.
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Affiliation(s)
- Rawan Omary
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Christopher J Bockisch
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.,Department of Otorhinolaryngology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Anthony De Vere-Tyndall
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Shila Pazahr
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Krisztina Baráth
- Radiologie und Neuroradiologie am Glattzentrum, Industriestrasse 63, 8304, Wallisellen, Switzerland
| | - Konrad P Weber
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland. .,Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
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Pourmohammadi A, Motahharynia A, Shaygannejad V, Ashtari F, Adibi I, Sanayei M. Working memory dysfunction differs between secondary progressive and relapsing multiple sclerosis: Effects of clinical phenotype, age, disease duration, and disability. Mult Scler Relat Disord 2023; 69:104411. [PMID: 36436396 DOI: 10.1016/j.msard.2022.104411] [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: 08/15/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive dysfunction is relatively common in patients with multiple sclerosis (MS). Although it occurs in all stages and all phenotypes of MS, it is more prevalent in secondary progressive MS (SPMS) compared to relapsing MS (RMS). It is unclear whether the higher frequency of cognitive impairment in SPMS is linked to the progressive phenotype or other clinical factors. In this study, we compared working memory in patients with RMS, SPMS, and healthy subjects. We also investigated the effects of age, disease duration, and disability on working memory performance. METHODS This case-control study enrolled 134 MS patients, 69 patients were diagnosed with RMS and 65 patients with SPMS, and 77 healthy control subjects. We designed two working memory tasks with different sets of stimuli (face vs. checkerboard) and different instructions (same or different vs. which one is the same). RESULTS Accuracy was significantly more impaired in SPMS patients than in RMS patients and both groups were worse than healthy subjects. This finding was similar between both tasks. Age and overall cognitive functions (measured with MoCA) also affected accuracy, but disease duration and disability only affected accuracy in working memory task with checkerboard stimuli. CONCLUSION MS patients are impaired in keeping the information in the visual working memory for a few seconds. Progressive phenotype significantly affected working memory accuracy, and this effect did not explain out with other demographic or clinical factors. Future studies are needed to reveal underlying mechanisms of working memory dysfunction in SPMS and working memory dysfunction as a biomarker of disease progression.
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Affiliation(s)
- Ahmad Pourmohammadi
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Motahharynia
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Adibi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mehdi Sanayei
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran.
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Kim SS, Lee MH, Ji C. Unilateral Internuclear Ophthalmoplegia Following Minor Head Injury. Korean J Neurotrauma 2022; 18:329-334. [PMID: 36381451 PMCID: PMC9634317 DOI: 10.13004/kjnt.2022.18.e64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
A lesion in the medial longitudinal fasciculus (MLF) causes internuclear ophthalmoplegia (INO). Many intracranial lesions, such as multiple sclerosis or vascular disorders may be associated with INO; however, INO is a rare complication of minor head injury. The mechanism underlying injury to the MLF may be shear force on the brain stem during head trauma. The shear force can tear or stretch the fibers of the MLF and can also lead to compromise or rupture of the perforating branches of the basilar artery. We present an unusual case of unilateral INO after minor head injury in a patient with a small site of hemorrhage in the midline of the pontomesencephalic junction, confirmed by brain magnetic resonance imaging using susceptibility-weighted imaging.
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Affiliation(s)
- Seong Su Kim
- Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Min Ho Lee
- Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Cheol Ji
- Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Hof S, Loonstra F, de Ruiter L, van Rijn L, Petzold A, Uitdehaag B, Bijvank JN. The prevalence of internuclear ophthalmoparesis in a population-based cohort of individuals with multiple sclerosis. Mult Scler Relat Disord 2022; 63:103824. [DOI: 10.1016/j.msard.2022.103824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
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Internuclear Ophthalmoplegia Characterizes Multiple Sclerosis Rather Than Neuromyelitis Optica Spectrum Disease. J Neuroophthalmol 2022; 42:239-245. [PMID: 35427281 DOI: 10.1097/wno.0000000000001534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disease (NMOSD) and multiple sclerosis (MS) share clinical presentations including optic neuritis and brainstem syndromes. Internuclear ophthalmoplegia (INO) is characterized by slowed ipsilateral adduction saccades and results from a lesion in the medial longitudinal fasciculus (MLF). Although INO is a common clinical finding in MS, its prevalence in NMOSD is unknown. The objective of this work is to determine the comparative frequencies of INO in patients with NMOSD and MS and compare clinical features of both disease processes. METHODS This is a retrospective study of patients 18 years and older who have an established diagnosis of NMOSD or MS and were evaluated by both neuro-ophthalmology and neuro-immunology specialists between 2014 and 2020. Electronic medical records were screened for documentation of an acute INO at any time during follow-up. Incidence rates were calculated from number of cases of new-onset INO and patient years observed. Logistic regression was used to evaluate the likelihood of developing an INO at any time point for NMOSD vs MS patients. Multivariable analysis was performed by adjusting for age, race, gender, and length of follow-up. RESULTS Two hundred eighty patients (80 NMOSD, 200 MS) were included. Age range was 18-79 years with a mean age of 35.14 (SD ± 12.41 years). Average length of follow-up in MS and NMOSD patients was 4.18 years vs 3.79 years, respectively (P > 0.05), and disease duration before the start of the study in MS and NMOSD was 8.76 years vs 4.65 years, respectively (P < 0.01). Mean disease duration and follow-up time of both groups was 7.58 years and 4.07 ± 2.51 years, respectively. NMOSD patients were predominantly seropositive for AQP4 antibody (61.25%, n = 49). Individuals who had MOG antibody but also met NMOSD criteria were also included (18.75%, n = 15). The frequency of INO at any time point was 1.25% (n = 1) in NMOSD compared with 16% (n = 32) in MS. The incidence rate of new-onset INO in NMOSD (excluding MOGAD) was 3.8/1,000 person years and 23.9/1,000 person years in MS. Adjusted analysis showed that NMOSD patients were 13.89 times (odds ratio [OR] 0.07, 95% confidence interval [CI] 0.01-0.598, P = 0.015) less likely to develop an INO compared with those with MS when including MOGAD patients, 12.5 times less likely (OR 0.08, 95% CI: 0.10-0.67, P = 0.02) when excluding MOGAD patients and 9.62 times less likely (OR 0.10, 95% CI: 0.01-0.87, P = 0.036) for AQP4+ patients. CONCLUSIONS Our study shows that the incidence of new INO (3.8 vs 23.9 per 1,000 person years), and the odds of having INO at any time point are significantly lower in NMOSD than MS. This suggests that INO and consequently MLF lesions are less common in NMOSD. The presence of an INO may help in the differentiation of NMOSD from MS and may aid in earlier implementation of disease appropriate therapy.
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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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Singh R, Pandey S. Movement Disorder in Demyelinating Disease: Tracing the Charcot's Foot Print. Ann Indian Acad Neurol 2022; 25:821-831. [PMID: 36561038 PMCID: PMC9764914 DOI: 10.4103/aian.aian_64_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/22/2022] [Accepted: 04/02/2022] [Indexed: 12/25/2022] Open
Abstract
Movement disorders may be one of the neurological manifestations of demyelinating disorders. They can manifest in Parkinsonism or a wide spectrum of hyperkinetic movement disorders including tremor, paroxysmal dyskinesia, dystonia, chorea, and ballism. Some of these disorders occur during an acute episode of demyelination, whereas others can develop later or even may precede the onset of the demyelinating disorders. The pathophysiology of movement disorders in demyelination is complex and the current evidence indicates a wide involvement of different brain networks and spinal cord. Treatment is mainly symptomatic and oral pharmacological agents are the mainstay of the management. Botulinum toxin and neurosurgical interventions may be required in selected patients.
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Affiliation(s)
- Rashmi Singh
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India,Address for correspondence: Dr. Sanjay Pandey, Department of Neurology, Academic Block, Room No 503, Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi - 110 002, India. E-mail:
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Nij Bijvank JA, Strijbis EMM, Nauta IM, Kulik SD, Balk LJ, Stam CJ, Hillebrand A, Geurts JJG, Uitdehaag BMJ, van Rijn LJ, Petzold A, Schoonheim MM. Impaired saccadic eye movements in multiple sclerosis are related to altered functional connectivity of the oculomotor brain network. Neuroimage Clin 2021; 32:102848. [PMID: 34624635 PMCID: PMC8503580 DOI: 10.1016/j.nicl.2021.102848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/17/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
Impaired eye movements in multiple sclerosis (MS) and functional connectivity (FC) Eye movements related to altered FC of the oculomotor brain network. Lower (beta band) and higher (theta/delta band) FC related to abnormal eye movements. Regional changes were more informative than whole-network measures. Eye movement parameters also related to disability and cognitive dysfunction.
Background Impaired eye movements in multiple sclerosis (MS) are common and could represent a non-invasive and accurate measure of (dys)functioning of interconnected areas within the complex brain network. The aim of this study was to test whether altered saccadic eye movements are related to changes in functional connectivity (FC) in patients with MS. Methods Cross-sectional eye movement (pro-saccades and anti-saccades) and magnetoencephalography (MEG) data from the Amsterdam MS cohort were included from 176 MS patients and 33 healthy controls. FC was calculated between all regions of the Brainnetome atlas in six conventional frequency bands. Cognitive function and disability were evaluated by previously validated measures. The relationships between saccadic parameters and both FC and clinical scores in MS patients were analysed using multivariate linear regression models. Results In MS pro- and anti-saccades were abnormal compared to healthy controls A relationship of saccadic eye movements was found with FC of the oculomotor network, which was stronger for regional than global FC. In general, abnormal eye movements were related to higher delta and theta FC but lower beta FC. Strongest associations were found for pro-saccadic latency and FC of the precuneus (beta band β = -0.23, p = .006), peak velocity and FC of the parietal eye field (theta band β = -0.25, p = .005) and gain and FC of the inferior frontal eye field (theta band β = -0.25, p = .003). Pro-saccadic latency was also strongly associated with disability scores and cognitive dysfunction. Conclusions Impaired saccadic eye movements were related to functional connectivity of the oculomotor network and clinical performance in MS. This study also showed that, in addition to global network connectivity, studying regional changes in MEG studies could yield stronger correlations.
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Affiliation(s)
- J A Nij Bijvank
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - E M M Strijbis
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - I M Nauta
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - S D Kulik
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, the Netherlands
| | - L J Balk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - C J Stam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - A Hillebrand
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - J J G Geurts
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, the Netherlands
| | - B M J Uitdehaag
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - L J van Rijn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands; Onze Lieve Vrouwe Gasthuis, Department of Ophthalmology, Amsterdam, the Netherlands
| | - A Petzold
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands; Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery and the UCL Queen Square Institute of Neurology, London, United Kingdom
| | - M M Schoonheim
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, the Netherlands
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12
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Jiam NT, Murphy OC, Gold DR, Isanhart E, Sinn DI, Steenerson KK, Sharon JD. Nonvestibular Dizziness. Otolaryngol Clin North Am 2021; 54:999-1013. [PMID: 34538360 DOI: 10.1016/j.otc.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Dizziness is a common chief complaint with an extensive differential diagnosis that ranges from peripheral, central, to nonvestibular conditions. An understanding of nonvestibular conditions will aid accurate diagnosis and initiation of appropriate management. Thus, the objective of this article is to present an overview of nonvestibular etiologies that may plague a dizzy patient and the recommended treatment options.
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Affiliation(s)
- Nicole T Jiam
- Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco School of Medicine, 2233 Post Street, UCSF Box 3213, San Francisco, CA 94115, USA
| | - Olwen C Murphy
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Pathology 2-210, Baltimore, MD 21287, USA
| | - Daniel R Gold
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Pathology 2-210, Baltimore, MD 21287, USA
| | - Erin Isanhart
- Angular Momentum Physical Therapy, 4459 Scottsfield Drive, San Jose, CA 95136-1630, USA
| | - Dong-In Sinn
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Kristen K Steenerson
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA 94304, USA; Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Palo Alto, CA 94303, USA
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco School of Medicine, 2233 Post Street, Room 315, San Francisco, CA 94115, USA.
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13
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Gil-Casas A, Piñero DP, Molina-Martin A. Are near visual signs and symptoms in multiple sclerosis compatible with convergence insufficiency? Clin Exp Optom 2021; 105:631-636. [PMID: 34406109 DOI: 10.1080/08164622.2021.1961566] [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] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Optometric management of neurodegenerative diseases is essential since visual signs, such as double vision, visual acuity reduction, or oculomotricity dysfunctions, are usually present in these subjects over the course of the disease. The present paper can guide clinicians in better managing their patients with multiple sclerosis. BACKGROUND Patients with multiple sclerosis present near vision symptoms that may be related to binocular anomalies, but these symptoms have not been investigated and related to specific signs. The aim of the present study was to evaluate the binocular vision in subjects with multiple sclerosis, and to analyse if the near visual signs and symptoms observed are compatible with those found in convergence insufficiency, as occurs in other neurodegenerative diseases. METHODS A total of 57 multiple sclerosis patients and 26 healthy controls were examined and classified as potentially compatible with convergence insufficiency according to the signs and symptoms. Clinical diagnosis of convergence insufficiency was established when subjects met the following criteria: NPC breakpoint more than 6 cm, PFV ≤ than 15Δ (base-out), and exophoria greater at near than at distance at least 4Δ. Convergence Insufficiency Symptom Survey (CISS) was administered to assess the symptomatology considering a score ≥16 as positive. RESULTS According to the CISS score, 54,4% of the multiple sclerosis subjects revised showed a suspect of convergence insufficiency, with a median score of 27 (IQR 9), whereas only one subject from control group (3.8%) showed this suspect. According to the diagnostic criteria based on signs, only 15.8% of multiple sclerosis patients had a real diagnosis of convergence insufficiency. CONCLUSION Multiple sclerosis patients showed symptomatology compatible with convergence insufficiency, but this was not supported by the signs which showed a more esophoric tendency. The discrepancies between the signs and symptoms could be due to the questionnaire used including items that are also related to the cognitive function and other ocular abnormalities.
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Affiliation(s)
- Amparo Gil-Casas
- Optometry Clinic, Fundació Lluís Alcanyís, University of Valencia, Valencia, Spain
| | - David P Piñero
- Optics and Visual Perception Group, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Ainhoa Molina-Martin
- Optics and Visual Perception Group, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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14
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Nij Bijvank JA, Sánchez Aliaga E, Balk LJ, Coric D, Davagnanam I, Tan HS, Uitdehaag BMJ, van Rijn LJ, Petzold A. A model for interrogating the clinico-radiological paradox in multiple sclerosis: Internuclear ophthalmoplegia. Eur J Neurol 2021; 28:1617-1626. [PMID: 33426786 PMCID: PMC8248033 DOI: 10.1111/ene.14723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
Background and purpose The clinico‐radiological paradox in multiple sclerosis (MS) is well recognized, relevant and yet poorly understood. The suitability of an in vivo model for the clinico‐radiological paradox was tested, using internuclear ophthalmoplegia (INO) and the medial longitudinal fasciculus (MLF). Methods In this cross‐sectional study lesions of the MLF were rated by an experienced MS neuroradiologist blinded to all other information. The presence of an INO was objectively determined by a validated infrared oculography protocol (DEMoNS). Clinical information, including the National Eye Institute Visual Function Questionnaire, was obtained. Results This study included 202 patients with MS. The clinico‐radiological paradox occurred in 50 patients (25%). This consisted of 45 patients having an INO without an MLF lesion and five patients with an MLF lesion but without an INO. The visual function overall score was related to the presence of an INO (p = 0.016), but not to MLF lesions seen on magnetic resonance imaging (MRI) (p = 0.207). A consensus list of potential causes for the clinico‐radiological paradox was compiled and the MRI images were deposited in a repository. Conclusion This study provides an objective and quantitative model to investigate the clinico‐radiological paradox. Our data suggest that pathology of the MLF is more frequently detected and more clinically relevant by infrared oculography than by MLF lesion rating on MRI.
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Affiliation(s)
- Jenny A Nij Bijvank
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esther Sánchez Aliaga
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lisanne J Balk
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Danko Coric
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Indran Davagnanam
- National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, Moorfields Eye Hospital, UCL, London, UK
| | - H Stevie Tan
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laurentius J van Rijn
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Axel Petzold
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, Moorfields Eye Hospital, UCL, London, UK
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15
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Jiang H, Delgado S, Wang J. Advances in ophthalmic structural and functional measures in multiple sclerosis: do the potential ocular biomarkers meet the unmet needs? Curr Opin Neurol 2021; 34:97-107. [PMID: 33278142 PMCID: PMC7856092 DOI: 10.1097/wco.0000000000000897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW Multiple sclerosis is a heterogeneous disorder. Biomarkers to monitor disease activities are highly desirable especially because of the recent shift toward personalized medicine that coincides with the expansion of disease-modifying therapy. The visual system is highly involved in multiple sclerosis, and the rapid advancement of ophthalmic techniques has boosted the development of potential ocular biomarkers for multiple sclerosis management. RECENT FINDINGS Recent studies have found that the rapid thinning of the peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layer (GCIPL) occurs in the progressive stage. Furthermore, the inter-eye thickness difference of the GCIPL could be used in identifying unilateral optic neuritis to facilitate the early diagnosis of multiple sclerosis. Moreover, the retinal microvascular alterations measured as vessel density were found to be related to the disability and visual function, although a standardized protocol to measure retinal microvascular alterations has not been well established. Additionally, aberrant ocular motility, such as fixation microsaccades, can be used to measure disability objectively. SUMMARY The fast expansion of potential ocular biomarkers measured as retinal microstructural, microvascular, and ocular motility changes may facilitate the diagnosis and management of multiple sclerosis.
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Affiliation(s)
- Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Silvia Delgado
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Electrical and Computer Engineering, University of Miami, Miami, FL, USA
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16
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Grillini A, Renken RJ, Vrijling ACL, Heutink J, Cornelissen FW. Eye Movement Evaluation in Multiple Sclerosis and Parkinson's Disease Using a Standardized Oculomotor and Neuro-Ophthalmic Disorder Assessment (SONDA). Front Neurol 2020; 11:971. [PMID: 33013643 PMCID: PMC7506055 DOI: 10.3389/fneur.2020.00971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022] Open
Abstract
Evaluating the state of the oculomotor system of a patient is one of the fundamental tests done in neuro-ophthalmology. However, up to date, very few quantitative standardized tests of eye movements' quality exist, limiting this assessment to confrontational tests reliant on subjective interpretation. Furthermore, quantitative tests relying on eye movement properties, such as pursuit gain and saccade dynamics are often insufficient to capture the complexity of the underlying disorders and are often (too) long and tiring. In this study, we present SONDA (Standardized Oculomotor and Neurological Disorder Assessment): this test is based on analyzing eye tracking recorded during a short and intuitive continuous tracking task. We tested patients affected by Multiple Sclerosis (MS) and Parkinson's Disease (PD) and find that: (1) the saccadic dynamics of the main sequence alone are not sufficient to separate patients from healthy controls; (2) the combination of spatio-temporal and statistical properties of saccades and saccadic dynamics enables an identification of oculomotor abnormalities in both MS and PD patients. We conclude that SONDA constitutes a powerful screening tool that allows an in-depth evaluation of (deviant) oculomotor behavior in a few minutes of non-invasive testing.
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Affiliation(s)
- Alessandro Grillini
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Remco J Renken
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Anne C L Vrijling
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Huizen, Netherlands
| | - Joost Heutink
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Huizen, Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - Frans W Cornelissen
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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17
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Bartuzel MM, Wróbel K, Tamborski S, Meina M, Nowakowski M, Dalasiński K, Szkulmowska A, Szkulmowski M. High-resolution, ultrafast, wide-field retinal eye-tracking for enhanced quantification of fixational and saccadic motion. BIOMEDICAL OPTICS EXPRESS 2020; 11:3164-3180. [PMID: 32637248 PMCID: PMC7316009 DOI: 10.1364/boe.392849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 05/23/2023]
Abstract
We introduce a novel, noninvasive retinal eye-tracking system capable of detecting eye displacements with an angular resolution of 0.039 arcmin and a maximum velocity of 300°/s across an 8° span. Our system is designed based on a confocal retinal imaging module similar to a scanning laser ophthalmoscope. It utilizes a 2D MEMS scanner ensuring high image frame acquisition frequencies up to 1.24 kHz. In contrast with leading eye-tracking technology, we measure the eye displacements via the collection of the observed spatial excursions for all the times corresponding a full acquisition cycle, thus obviating the need for both a baseline reference frame and absolute spatial calibration. Using this approach, we demonstrate the precise measurement of eye movements with magnitudes exceeding the spatial extent of a single frame, which is not possible using existing image-based retinal trackers. We describe our retinal tracker, tracking algorithms and assess the performance of our system by using programmed artificial eye movements. We also demonstrate the clinical capabilities of our system with in vivo subjects by detecting microsaccades with angular extents as small as 0.028°. The rich kinematic ocular data provided by our system with its exquisite degree of accuracy and extended dynamic range opens new and exciting avenues in retinal imaging and clinical neuroscience. Several subtle features of ocular motion such as saccadic dysfunction, fixation instability and abnormal smooth pursuit can be readily extracted and inferred from the measured retinal trajectories thus offering a promising tool for identifying biomarkers of neurodegenerative diseases associated with these ocular symptoms.
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Affiliation(s)
- Maciej M. Bartuzel
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University in Toruń, Grudziądzka 5, Toruń 87-100, Poland
- Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wyb. Wyspiańskiego 27, Wrocław 50-370, Poland
| | - Krystian Wróbel
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University in Toruń, Grudziądzka 5, Toruń 87-100, Poland
| | - Szymon Tamborski
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University in Toruń, Grudziądzka 5, Toruń 87-100, Poland
| | - Michał Meina
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University in Toruń, Grudziądzka 5, Toruń 87-100, Poland
- AM2M Ltd. L.P., Mickiewicza 7/17, Toruń 87-100, Poland
| | | | | | | | - Maciej Szkulmowski
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University in Toruń, Grudziądzka 5, Toruń 87-100, Poland
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18
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Gil-Casas A, Piñero DP, Molina-Martin A. Binocular, Accommodative and Oculomotor Alterations In Multiple Sclerosis: A Review. Semin Ophthalmol 2020; 35:103-115. [PMID: 32228341 DOI: 10.1080/08820538.2020.1744671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis (MS) is an acquired demyelinating and inflammatory neurodegenerative disease affecting the central nervous system (CNS). Clinical and subclinical ocular disturbances occur in almost all patients with MS. The objective of this narrative review was to collect and summarize the available scientific information on oculomotor, accommodative and binocular alterations that have been reported in MS. A systematic search strategy with the following descriptors was carried out: multiple sclerosis, ocular motility disorders, internuclear ophthalmoplegia, nystagmus, vergences, fixation, pupil reflex, accommodation and stereopsis. According to the search, some oculomotor alterations were found to be commonly reported in MS, such as alterations in saccades and nystagmus. In contrast, accommodative, vergence and stereopsis alterations have not been comprehensively studied despite their relevance, with only minimal evidence showing a potential negative impact of the disease on these aspects. In conclusion, oculomotor impairment is a common component of disability in MS patients and should be considered when managing this type of patients. More research is still needed to know the real impact of this disease on binocular vision and accommodation.
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Affiliation(s)
- Amparo Gil-Casas
- Clínica Optométrica, Foundation Lluís Alcanyís, University of Valencia, Valencia, Spain
| | - David P Piñero
- Optics and Visual Perception Group (GOPV). Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Ainhoa Molina-Martin
- Optics and Visual Perception Group (GOPV). Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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19
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Nij Bijvank J, Petzold A, Coric D, Tan H, Uitdehaag B, Balk L, van Rijn L. Saccadic delay in multiple sclerosis: A quantitative description. Vision Res 2020; 168:33-41. [DOI: 10.1016/j.visres.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
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20
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Weidemann ML, Trentzsch K, Torp C, Ziemssen T. [Enhancing monitoring of disease progression-remote sensoring in multiple sclerosis]. DER NERVENARZT 2019; 90:1239-1244. [PMID: 31641794 DOI: 10.1007/s00115-019-00817-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As a result of innovations in the digitalization of healthcare new technologies, such as remote sensoring are gaining in importance for the collection of real-life data in addition to the regular medical examination. This enables a closer view into the daily lives of patients with multiple sclerosis and a more detailed monitoring of disease progression. OBJECTIVE This article gives a summary of sensor-based measurement technologies in the field of multiple sclerosis RESULTS: A wide variety of sensor-based measurement technologies are already available, which largely focus on gait analysis and mobility. Furthermore, there are many innovative approaches for a sensor-based collation of the multifocal symptoms of multiple sclerosis, for example technologies focus on the area of stress surveillance, the autonomic nervous system, GPS tracking and sleep monitoring. DISCUSSION Despite the existence of many already available technologies, the aim is now to find a practical way to integrate them into the daily routine of patient monitoring, which includes standardized data collection, evaluation and interpretation. Only at this point a perspective benefit for treating physicians and patients can be achieved.
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Affiliation(s)
- M L Weidemann
- Zentrum für klinische Neurowissenschaften, Multiple Sklerose Zentrum, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - K Trentzsch
- Zentrum für klinische Neurowissenschaften, Multiple Sklerose Zentrum, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - C Torp
- Zentrum für klinische Neurowissenschaften, Multiple Sklerose Zentrum, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - T Ziemssen
- Zentrum für klinische Neurowissenschaften, Multiple Sklerose Zentrum, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland.
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21
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Saccadic fatigability in the oculomotor system. J Neurol Sci 2019; 402:167-174. [DOI: 10.1016/j.jns.2019.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/29/2019] [Accepted: 05/20/2019] [Indexed: 11/17/2022]
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22
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Villoslada P, Green AJ, Galetta S. Personalizing medical care for patients with MS. Neurology 2019; 92:929-930. [DOI: 10.1212/wnl.0000000000007493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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