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Mrabet S, Falfoul Y, Bouassida M, Souissi A, El Matri K, Gharbi A, Chebil A, Kacem I, El Matri L, Gouider R. Retinal changes in multiple sclerosis: An optical coherence tomography and angiography study. Rev Neurol (Paris) 2024; 180:622-631. [PMID: 38458836 DOI: 10.1016/j.neurol.2023.11.014] [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: 06/29/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system with neuroaxonal damage. It is the principal driver of non-traumatic disability in young adults. Visual symptoms are common and optic neuritis (ON) may be the revealing feature in up to 30% of cases. Structural optical coherence tomography (OCT) represents a biomarker of central nervous system neurodegeneration in MS. OCT-angiography (OCT-A) is a noninvasive tool allowing the study of retinal vasculature and the detection of microvascular damage in neuro-retinal diseases. In this study, we aimed to assess structural and microvascular retinal changes in patients with MS with and without ON and to correlate the findings with visual function and MS disability. METHODS We conducted a cross-sectional study including patients diagnosed with MS according to the 2017 McDonald criteria. All patients underwent complete neurological examination with evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS) and an ophthalmological examination including OCT and OCT-A. Patients were compared with age- and sex-matched healthy subjects. The primary endpoints were assessment of retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL+), and ganglion cell complex (GCL++) thicknesses on OCT. Vascular densities in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) were assessed on OCT-A, as well as central avascular zone (CAZ) parameters, lacunarity and fractal dimension. RESULTS A total of 160 MS eyes with and without a previous history of ON and 64 age- and gender-matched healthy eyes were analyzed. Among 160 eyes with MS, 69 had a history of ON. We observed a decrease in RNFL and GCL++ thickness in all 12 quadrants in MS patients when compared to healthy controls. Multivariate analysis by linear regression noted a significant correlation for temporal GCL++ and inferonasal RNFL thickness that were decreased in the MS group. A greater decrease in retinal layers thickness was identified in MS patients with a history of ON. On OCT-A, vascular density in (SCP) was significantly reduced in the MS group (P<0.002). A significant correlation between RNFL thickness and retinal vascular density was found but only in less than half of the hourly quadrants. A significant correlation was noted between visual acuity and CC density (P<0.0001). We also noted an inverse correlation between EDSS scores and CC density (P=0.02 and r=-0.275) and between MSSS and RNFL/GCL++ thicknesses. CONCLUSIONS RNFL and GCL++ layers were thinner in MS patients with a history of ON and were reversely correlated with disease severity. Moreover, retinal vascular changes were observed in MS even in eyes without ON, and CC was reversely correlated with visual function and current disability. Thus, structural OCT coupled with OCT-A could represent a noninvasive and dynamic biomarker of MS severity and progression.
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Affiliation(s)
- S Mrabet
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Y Falfoul
- Department B, Hedi Raies Institute of Ophthalmology, Oculogenetic Laboratory LR14SP01, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - M Bouassida
- Department B, Hedi Raies Institute of Ophthalmology, Oculogenetic Laboratory LR14SP01, Tunis, Tunisia
| | - A Souissi
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - K El Matri
- Department B, Hedi Raies Institute of Ophthalmology, Oculogenetic Laboratory LR14SP01, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - A Gharbi
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - A Chebil
- Department B, Hedi Raies Institute of Ophthalmology, Oculogenetic Laboratory LR14SP01, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - I Kacem
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - L El Matri
- Department B, Hedi Raies Institute of Ophthalmology, Oculogenetic Laboratory LR14SP01, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - R Gouider
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia.
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Oertel FC, Zimmermann HG, Motamedi S, Bereuter C, Manthey LM, Ashtari F, Kafieh R, Dehghani A, Pourazizi M, Pandit L, D'Cunha A, Aktas O, Albrecht P, Ringelstein M, Martinez-Lapiscina EH, Sanchez Dalmau BF, Villoslada P, Asgari N, Marignier R, Cobo-Calvo A, Leocani L, Pisa M, Radaelli M, Palace J, Roca-Fernandez A, Leite MIS, Sharma S, De Seze J, Senger T, Yeaman MR, Smith TJ, Cook LJ, Brandt AU, Paul F. Retinal Changes in Double-Antibody Seronegative Neuromyelitis Optica Spectrum Disorders. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200273. [PMID: 38941573 PMCID: PMC11214151 DOI: 10.1212/nxi.0000000000200273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/29/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND OBJECTIVES To systematically describe the clinical picture of double-antibody seronegative neuromyelitis optica spectrum disorders (DN-NMOSD) with specific emphasis on retinal involvement. METHODS Cross-sectional data of 25 people with DN-NMOSD (48 eyes) with and without a history of optic neuritis (ON) were included in this study along with data from 25 people with aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder (AQP4-NMOSD, 46 eyes) and from 25 healthy controls (HCs, 49 eyes) for comparison. All groups were matched for age and sex and included from the collaborative retrospective study of retinal optical coherence tomography (OCT) in neuromyelitis optica (CROCTINO). Participants underwent OCT with central postprocessing and local neurologic examination and antibody testing. Retinal neurodegeneration was quantified as peripapillary retinal nerve fiber layer thickness (pRNFL) and combined ganglion cell and inner plexiform layer thickness (GCIPL). RESULTS This DN-NMOSD cohort had a history of [median (inter-quartile range)] 6 (5; 9) attacks within their 5 ± 4 years since onset. Myelitis and ON were the most common attack types. In DN-NMOSD eyes after ON, pRNFL (p < 0.001) and GCIPL (p = 0.023) were thinner compared with eyes of HCs. Even after only one ON episode, DN-NMOSD eyes already had considerable neuroaxonal loss compared with HCs. In DN-NMOSD eyes without a history of ON, pRNFL (p = 0.027) and GCIPL (p = 0.022) were also reduced compared with eyes of HCs. However, there was no difference in pRNFL and GCIPL between DN-NMOSD and AQP4-NMOSD for the whole group and for subsets with a history of ON and without a history of ON-as well as between variances of retinal layer thicknesses. DISCUSSION DN-NMOSD is characterized by severe retinal damage after ON and attack-independent retinal neurodegeneration. Most of the damage occurs during the first ON episode, which highlights the need for better diagnostic markers in DN-NMOSD to facilitate an earlier diagnosis as well as for effective and early treatments. In this study, people with DN-NMOSD presented with homogeneous clinical and imaging findings potentially suggesting a common retinal pathology in these patients.
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Affiliation(s)
- Frederike C Oertel
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Hanna G Zimmermann
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Seyedamirhosein Motamedi
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Charlotte Bereuter
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Luca Magdalena Manthey
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Fereshteh Ashtari
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Rahele Kafieh
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Alireza Dehghani
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Mohsen Pourazizi
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Lekha Pandit
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Anitha D'Cunha
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Orhan Aktas
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Philipp Albrecht
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Marius Ringelstein
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Elena H Martinez-Lapiscina
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Bernardo F Sanchez Dalmau
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Pablo Villoslada
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Nasrin Asgari
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Romain Marignier
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Alvaro Cobo-Calvo
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Letizia Leocani
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Marco Pisa
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Marta Radaelli
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Jacqueline Palace
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Adriana Roca-Fernandez
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Maria Isabel S Leite
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Srilakshmi Sharma
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Jerome De Seze
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Thomas Senger
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Michael R Yeaman
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Terry J Smith
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Lawrence J Cook
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Alexander U Brandt
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Friedemann Paul
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
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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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Miscioscia A, Mainero C, Treaba CA, Silvestri E, Scialpi G, Berardi A, Causin F, Anglani MG, Rinaldi F, Perini P, Puthenparampil M, Bertoldo A, Gallo P. The contribution of paramagnetic rim and cortical lesions to physical and cognitive disability at multiple sclerosis clinical onset: evaluating the power of MRI and OCT biomarkers. J Neurol 2024:10.1007/s00415-024-12622-8. [PMID: 39155316 DOI: 10.1007/s00415-024-12622-8] [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: 06/12/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND In multiple sclerosis (MS), imaging biomarkers play a crucial role in characterizing the disease at the time of diagnosis. MRI and optical coherence tomography (OCT) provide readily available biomarkers that may help to define the patient's clinical profile. However, the evaluation of cortical and paramagnetic rim lesions (CL, PRL), as well as retinal atrophy, is not routinely performed in clinic. OBJECTIVE To identify the most significant MRI and OCT biomarkers associated with early clinical disability in MS. METHODS Brain, spinal cord (SC) MRI, and OCT scans were acquired from 45 patients at MS diagnosis to obtain: brain PRL and non-PRL, CL, SC lesion volumes and counts, brain volumetric metrics, SC C2-C3 cross-sectional area, and retinal layer thickness. Regression models assessed relationships with physical disability (Expanded Disability Status Scale [EDSS]) and cognitive performance (Brief International Cognitive Assessment for Multiple Sclerosis [BICAMS]). RESULTS In a stepwise regression (R2 = 0.526), PRL (β = 0.001, p = 0.023) and SC lesion volumes (β = 0.001, p = 0.017) were the most significant predictors of EDSS, while CL volume and age were strongly associated with BICAMS scores. Moreover, in a model where PRL and non-PRL were pooled, only the contribution of SC lesion volume was retained in EDSS prediction. OCT measures did not show associations with disability at the onset. CONCLUSION At MS onset, PRL and SC lesions exhibit the strongest association with physical disability, while CL strongly contribute to cognitive performance. Incorporating the evaluation of PRL and CL into the initial MS patient assessment could help define their clinical profile, thus supporting the treatment choice.
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Affiliation(s)
- Alessandro Miscioscia
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Bldg 149, 13th Street, Charlestown, MA, 02129, USA.
- Department of Neuroscience, University of Padua, Padua, Italy.
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy.
| | - Caterina Mainero
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Bldg 149, 13th Street, Charlestown, MA, 02129, USA
- Harvard Medical School, Boston, MA, USA
| | - Constantina A Treaba
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Bldg 149, 13th Street, Charlestown, MA, 02129, USA
- Harvard Medical School, Boston, MA, USA
| | - Erica Silvestri
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Graziana Scialpi
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
| | - Angela Berardi
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
| | | | | | - Francesca Rinaldi
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
| | - Paola Perini
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
| | - Marco Puthenparampil
- Department of Neuroscience, University of Padua, Padua, Italy
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
| | | | - Paolo Gallo
- Department of Neuroscience, University of Padua, Padua, Italy
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
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5
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Cao L, Wu J, Wang H, Kwapong WR, Yan Y, Wan J, Wang P, Liu G, Wang R, Hu F, Feng L, Wu B. Influence of Carotid Artery Stenting on the Retina and Choroid. Transl Vis Sci Technol 2024; 13:5. [PMID: 39093294 PMCID: PMC11305422 DOI: 10.1167/tvst.13.8.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/24/2024] [Indexed: 08/04/2024] Open
Abstract
Purpose The effect of carotid artery stenting in patients with unilateral carotid artery stenosis on the retina and choroid was evaluated using swept-source optical coherence tomography angiography (SS-OCTA). Methods SS-OCTA examination was conducted before stenting and 4 days and 3 months after stenting. The retinal nerve fiber layer, ganglion cell-inner plexiform layer (GCIPL), inner nuclear layer, superficial vascular complex (SVC), deep vascular complex (DVC), choroidal vascular volume (CVV), and choroidal vascular index were measured. Repeated-measures analysis of variance was performed to assess the impact of carotid artery stenting on optical coherence tomography angiography (OCTA) metrics. Results At baseline, 303 eyes from 160 patients (61.82 ± 9.98 years; 85.29% males) were enrolled. SVC and DVC densities and CVV were lower in ipsilateral eyes (stenosed side) compared to contralateral eyes (all P < 0.05). Four days after stenting, a significant increase was seen in SVC density in ipsilateral eyes (P < 0.05) while a significant increase was seen in CVV in ipsilateral eyes and contralateral eyes (both P < 0.05). Three months after stenting (63 patients with 114 eyes), a significant decrease was seen in the GCIPL thickness of ipsilateral and contralateral eyes (all P < 0.001). Conclusions Short term after carotid artery stenting, ipsilateral eyes showed a rapid and significant increase in SVC density and CVV. Translational Relevance Optical coherence tomography (OCT)/OCTA measurements may have the potential to detect retinal and choroidal changes after stenting. Future research on the long-term effect of stenting on the retina and choroid will be guided by these findings.
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Affiliation(s)
- Le Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Juan Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Yuying Yan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jincheng Wan
- Department of Respiratory and Critical Care Medicine, Minda Hospital of Hubei Minzu University, Enshi, China
| | - Ping Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Guina Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Fayun Hu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Feng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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6
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Camós-Carreras A, Figueras-Roca M, Dotti-Boada M, Alcubierre R, Casaroli-Marano RP, Muñoz E, Sánchez-Dalmau B. Progression of Retinal Ganglion Cell and Nerve Fiber Layer Loss in Spinocerebellar Ataxia 3 Patients. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1348-1354. [PMID: 38030858 PMCID: PMC11269372 DOI: 10.1007/s12311-023-01634-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 12/01/2023]
Abstract
Spectral domain optical coherence tomography (SD-OCT) allows noninvasive measurements of retinal neuron layers. Here, we evaluate the relationship between clinical features and anatomical SD-OCT measurements in patients with spinocerebellar ataxia type 3 (SCA3) and how they change with time. A retrospective review was conducted on SCA3 patients. Clinical variables such as disease duration, number of CAG repeats, and the Scale for the Assessment and Rating of Ataxia (SARA) score were correlated with SD-OCT measurements, including retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, macular volume (MV), and central macular thickness (CMT). Seventeen SCA3 patients with an average follow-up of 44.9 months were recruited. Clinical features with significant baseline correlations with SD-OCT measurements included disease duration (CMT r = - 0.590; GCC r = - 0.585), SARA score (CMT r = - 0.560; RNFL r = - 0.390), and number of CAG repeats (MV r = - 0.552; RNFL r = - 0.503; GCC r = - 0.493). The annual rate of change of the SARA score during follow-up was associated with that of both the MV (r = - 0.494; p = 0.005) and GCC thickness (r = - 0.454; p = 0.012). High disability (stages 2 and 3) was independently inversely associated with the annual change in MV (ß coefficient - 17.09; p = 0.025). This study provides evidence of an association between clinical features and objective anatomical measurements obtained by SD-OCT in SCA3 patients. MV and GCC thickness could serve as potential biomarkers of disease severity, as their rates of decrease seem to be related to a worsening in the SARA score. These findings highlight the potential of SD-OCT as a noninvasive tool for assessing disease severity and progression in SCA3 patients.
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Affiliation(s)
- Anna Camós-Carreras
- Ophthalmology Department, Seu Maternitat, Hospital Clínic de Barcelona, Universitat de Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain.
| | - Marc Figueras-Roca
- Ophthalmology Department, Seu Maternitat, Hospital Clínic de Barcelona, Universitat de Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain
- Fundació Per La Recerca Biomèdica-IDIBAPS, Villarroel 170, 08036, Barcelona, Spain
| | - Marina Dotti-Boada
- Ophthalmology Department, Seu Maternitat, Hospital Clínic de Barcelona, Universitat de Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - Rafel Alcubierre
- Ophthalmology Department, Seu Maternitat, Hospital Clínic de Barcelona, Universitat de Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain
| | - Ricardo Pedro Casaroli-Marano
- Ophthalmology Department, Seu Maternitat, Hospital Clínic de Barcelona, Universitat de Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain
- Fundació Per La Recerca Biomèdica-IDIBAPS, Villarroel 170, 08036, Barcelona, Spain
| | - Esteban Muñoz
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain
- Fundació Per La Recerca Biomèdica-IDIBAPS, Villarroel 170, 08036, Barcelona, Spain
- Neurology Department, Seu Villarroel, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Bernardo Sánchez-Dalmau
- Ophthalmology Department, Seu Maternitat, Hospital Clínic de Barcelona, Universitat de Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain
- Fundació Per La Recerca Biomèdica-IDIBAPS, Villarroel 170, 08036, Barcelona, Spain
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Xu Z, Li Y, Fu Q, Wang C, Yu Y, Fang X, Zhu W, Wu X, Wei R. Retinal structural thicknesses reflect clinically relevant microstructural white matter abnormalities in neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2024; 88:105713. [PMID: 38905991 DOI: 10.1016/j.msard.2024.105713] [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: 04/28/2024] [Revised: 05/17/2024] [Accepted: 06/08/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Thinning of retinal thickness seen on optical coherence tomography (OCT) is frequent in patients with neuromyelitis optica spectrum disorder (NMOSD). We explored the association between OCT metrics, MRI measurements and clinical outcomes in NMOSD. METHODS 44 NMOSD and 60 controls underwent OCT and MR imaging. Mean peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell complex (GCC) thicknesses were measured. Diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) was used to measure the white matter microstructural integrity. In NMOSD patients, Expanded Disability Status Scale (EDSS) was used to quantify disability. Visual acuity (VA) was also performed for all participants. RESULTS pRNFL thickness was positively associated with mean diffusivity in left posterior thalamic radiation (pp = 0.010) and axial kurtosis in inferior cerebellar peduncle (p = 0.023). Similarly, GCC thickness in NMOSD patients was positively associated with fractional anisotropy in right superior longitudinal fascicules (p = 0. 041) and axial kurtosis of left cerebellar peduncle (p = 0.011). CONCLUSIONS In NMOSD, pRNFL and GCC reflect integrity of clinically relevant white matter structures underlying the value of OCT metrics as markers of neuronaxonal loss and disability.
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Affiliation(s)
- Zhipeng Xu
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, NO. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, PR China
| | - Yulin Li
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, PR China
| | - Qinghui Fu
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, NO. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, PR China
| | - Caimu Wang
- Intensive Care Unit, Ninghai First Hospital, 142 Taoyuan middle road, Ninghai, Zhejiang 315600, PR China
| | - Yongwei Yu
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, NO. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, PR China
| | - Xing Fang
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, NO. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, PR China
| | - Wenli Zhu
- Department of Neurology, The First Affiliated Hospital, Zhejiang University School of Medicine, NO. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, PR China
| | - Xiaoxin Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, NO. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, PR China.
| | - Ruili Wei
- Department of Neurology, The First Affiliated Hospital, Zhejiang University School of Medicine, NO. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, PR China.
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Rozhyna A, Somfai GM, Atzori M, DeBuc DC, Saad A, Zoellin J, Müller H. Exploring Publicly Accessible Optical Coherence Tomography Datasets: A Comprehensive Overview. Diagnostics (Basel) 2024; 14:1668. [PMID: 39125544 PMCID: PMC11312046 DOI: 10.3390/diagnostics14151668] [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: 05/31/2024] [Revised: 07/15/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Artificial intelligence has transformed medical diagnostic capabilities, particularly through medical image analysis. AI algorithms perform well in detecting abnormalities with a strong performance, enabling computer-aided diagnosis by analyzing the extensive amounts of patient data. The data serve as a foundation upon which algorithms learn and make predictions. Thus, the importance of data cannot be underestimated, and clinically corresponding datasets are required. Many researchers face a lack of medical data due to limited access, privacy concerns, or the absence of available annotations. One of the most widely used diagnostic tools in ophthalmology is Optical Coherence Tomography (OCT). Addressing the data availability issue is crucial for enhancing AI applications in the field of OCT diagnostics. This review aims to provide a comprehensive analysis of all publicly accessible retinal OCT datasets. Our main objective is to compile a list of OCT datasets and their properties, which can serve as an accessible reference, facilitating data curation for medical image analysis tasks. For this review, we searched through the Zenodo repository, Mendeley Data repository, MEDLINE database, and Google Dataset search engine. We systematically evaluated all the identified datasets and found 23 open-access datasets containing OCT images, which significantly vary in terms of size, scope, and ground-truth labels. Our findings indicate the need for improvement in data-sharing practices and standardized documentation. Enhancing the availability and quality of OCT datasets will support the development of AI algorithms and ultimately improve diagnostic capabilities in ophthalmology. By providing a comprehensive list of accessible OCT datasets, this review aims to facilitate better utilization and development of AI in medical image analysis.
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Affiliation(s)
- Anastasiia Rozhyna
- Informatics Institute, University of Applied Sciences Western Switzerland (HES-SO), 3960 Sierre, Switzerland
- Medical Informatics, University of Geneva, 1205 Geneva, Switzerland
| | - Gábor Márk Somfai
- Department of Ophthalmology, Stadtspital Zürich, 8063 Zurich, Switzerland
- Spross Research Institute, 8063 Zurich, Switzerland
| | - Manfredo Atzori
- Informatics Institute, University of Applied Sciences Western Switzerland (HES-SO), 3960 Sierre, Switzerland
- Department of Neuroscience, University of Padua, 35121 Padova, Italy
| | - Delia Cabrera DeBuc
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Amr Saad
- Department of Ophthalmology, Stadtspital Zürich, 8063 Zurich, Switzerland
- Spross Research Institute, 8063 Zurich, Switzerland
| | - Jay Zoellin
- Department of Ophthalmology, Stadtspital Zürich, 8063 Zurich, Switzerland
- Spross Research Institute, 8063 Zurich, Switzerland
| | - Henning Müller
- Informatics Institute, University of Applied Sciences Western Switzerland (HES-SO), 3960 Sierre, Switzerland
- Medical Informatics, University of Geneva, 1205 Geneva, Switzerland
- The Sense Research and Innovation Center, 1007 Lausanne, Switzerland
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9
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Puthenparampil M, Basili E, Ponzano M, Mauceri VA, Miscioscia A, Pilotto E, Perini P, Rinaldi F, Bovis F, Gallo P. Hyper-reflective foci changes in RRMS under natalizumab therapy. Front Immunol 2024; 15:1421755. [PMID: 39076978 PMCID: PMC11284017 DOI: 10.3389/fimmu.2024.1421755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/27/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction Microglia (MG) is suggested to play an immunopathological role of in Multiple Sclerosis (MS). Since hyper-reflective foci (HRF) might mark MG activation, in vivo analysis by Optic Coherence Tomography (OCT) in MS patients under disease modifying therapies may help to clarify MS immunopathology as well as drug's mechanism of intrathecal action. Objective To analyze HRF in patients treated with Natalizumab (NTZ), a high efficacy therapy for MS. Materials and methods The effect of NTZ on the retina of 36 Relapsing-Remitting MS patients was investigated in a prospective, single-center study. OCT was performed immediately before the first infusion and then between infusion 3 and 4, infusion 6 and 7, infusion 11 and 13. Peripapillary and macular scans were acquired, evaluating peripapillary RNFL thickness, macular volumes (vertical scans), and HRF count (horizontal scan) in Ganglion Cell Layer (GCL), Inner Plexiform Layer (IPL) and Inner Nuclear Layer (INL). Clinical examination was performed every six months. Results HRF count significantly increased under NTZ therapy (p<0.001) in both GCL (18.85 ± 6.93 at baseline, 28.24 ± 9.55 after 12 months) and IPL (25.73 ± 7.03 at baseline, 33.21 ± 8.50 after 12 months) but remained stable in INL (33.65 ± 7.76 at baseline, 36.06 ± 6.86 after 12 months, p=0.87), while no relevant modification of pRNFL and macular volumes were observed during the study. EDSS remained stable and no clinical relapse was observed between month 6 and 12. Conclusion In RRMS NTZ affects HRF count in GCL and IPL, but not in INL, suggesting that NTZ does not impact on some aspects of MS immunopathology.
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Affiliation(s)
- Marco Puthenparampil
- Department of Neurosciences, University of Padua, Padua, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - Elisa Basili
- Department of Neurosciences, University of Padua, Padua, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Valentina Annamaria Mauceri
- Department of Neurosciences, University of Padua, Padua, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | | | | | - Paola Perini
- Department of Neurosciences, University of Padua, Padua, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - Francesca Rinaldi
- Department of Neurosciences, University of Padua, Padua, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - Francesca Bovis
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Paolo Gallo
- Department of Neurosciences, University of Padua, Padua, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
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10
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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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11
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Mulazzani E, Böhm L, Christmann T, Krumbholz M, Kümpfel T, Havla J. Optical coherence tomography assessment of disease activity in cryopyrin-associated periodic syndrome. Eur J Neurol 2024; 31:e16301. [PMID: 38628041 PMCID: PMC11235936 DOI: 10.1111/ene.16301] [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: 01/26/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND AND PURPOSE Cryopyrin-associated periodic syndrome is a rare autoinflammatory disease caused by gain-of-function mutations or variants in the NLRP3 gene. Clinically, patients suffer from a broad spectrum of both systemic and neurological symptoms. The aim of this study was to determine whether systemic inflammation demonstrated by serum amyloid A (SAA) elevation is associated with neuroinflammation assessed by optical coherence tomography (OCT). METHODS Thirty eyes of 15 patients with NLRP3 low penetrance mutations (PwNLRP3) and 20 eyes of 10 age- and sex-matched healthy controls were examined by spectral-domain OCT as part of routine clinical care. All retinal layers and clinical features were evaluated. RESULTS At baseline no significant retinal neuroaxonal inflammation or degeneration was observed in all measured retinal layers amongst PwNLRP3 compared with healthy controls. In a pooled analysis of all individual OCT time points a significant difference regarding the macular retinal nerve fibre layer was detected. Increased levels of SAA showed a positive association with averaged combined outer plexiform layer and outer nuclear layer volumes (ρ < 0.0001, r2 = 0.35). CONCLUSION In cryopyrin-associated periodic syndrome increased combined outer plexiform layer and outer nuclear layer volumes are mirrored by SAA increase, an acute phase reactant indicating systemic inflammation. Our findings identify OCT as a candidate biomarker to monitor subclinical neuroinflammation and to assess disease activity in PwNLRP3.
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Affiliation(s)
- E. Mulazzani
- Institute of Clinical NeuroimmunologyLMU University Hospital, LMU MunichMunichGermany
| | - L. Böhm
- Institute of Clinical NeuroimmunologyLMU University Hospital, LMU MunichMunichGermany
| | - T. Christmann
- Institute of Clinical NeuroimmunologyLMU University Hospital, LMU MunichMunichGermany
| | - M. Krumbholz
- Department of Neurology and Pain Treatment, Immanuel Klinik RüdersdorfUniversity Hospital of the Brandenburg Medical School Theodor FontaneRüdersdorf bei BerlinGermany
- Faculty of Health Sciences BrandenburgBrandenburg Medical School Theodor FontaneRüdersdorf bei BerlinGermany
- Department of Neurology and StrokeUniversity Hospital of TübingenTübingenGermany
| | - T. Kümpfel
- Institute of Clinical NeuroimmunologyLMU University Hospital, LMU MunichMunichGermany
| | - J. Havla
- Institute of Clinical NeuroimmunologyLMU University Hospital, LMU MunichMunichGermany
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12
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Ladakis DC, Vreones M, Blommer J, Harrison KL, Smith MD, Vasileiou ES, Moussa H, Ahmadi G, Ezzedin O, DuVal AL, Dewey BE, Prince JL, Fitzgerald KC, Sotirchos ES, Saidha S, Calabresi PA, Kapogiannis D, Bhargava P. Synaptic Protein Loss in Extracellular Vesicles Reflects Brain and Retinal Atrophy in People With Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200257. [PMID: 38754047 PMCID: PMC11131364 DOI: 10.1212/nxi.0000000000200257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/21/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES To assess whether the rate of change in synaptic proteins isolated from neuronally enriched extracellular vesicles (NEVs) is associated with brain and retinal atrophy in people with multiple sclerosis (MS). METHODS People with MS were followed with serial blood draws, MRI (MRI), and optical coherence tomography (OCT) scans. NEVs were immunocaptured from plasma, and synaptopodin and synaptophysin proteins were measured using ELISA. Subject-specific rates of change in synaptic proteins, as well as brain and retinal atrophy, were determined and correlated. RESULTS A total of 50 people with MS were included, 46 of whom had MRI and 45 had OCT serially. The rate of change in NEV synaptopodin was associated with whole brain (rho = 0.31; p = 0.04), cortical gray matter (rho = 0.34; p = 0.03), peripapillary retinal nerve fiber layer (rho = 0.37; p = 0.01), and ganglion cell/inner plexiform layer (rho = 0.41; p = 0.006) atrophy. The rate of change in NEV synaptophysin was also correlated with whole brain (rho = 0.31; p = 0.04) and cortical gray matter (rho = 0.31; p = 0.049) atrophy. DISCUSSION NEV-derived synaptic proteins likely reflect neurodegeneration and may provide additional circulating biomarkers for disease progression in MS.
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Affiliation(s)
- Dimitrios C Ladakis
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Michael Vreones
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Joseph Blommer
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Kimystian L Harrison
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Matthew D Smith
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Eleni S Vasileiou
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Hussein Moussa
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Gelareh Ahmadi
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Omar Ezzedin
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Anna L DuVal
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Blake E Dewey
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Jerry L Prince
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Kathryn C Fitzgerald
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Elias S Sotirchos
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Shiv Saidha
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Peter A Calabresi
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Dimitrios Kapogiannis
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
| | - Pavan Bhargava
- From the Department of Neurology (D.C.L., K.L.H., M.D.S., E.S.V., H.M., G.A., O.E., A.L.D., B.E.D., K.C.F., E.S.S., S.S., P.A.C., P.B.), Johns Hopkins University School of Medicine; Laboratory of Clinical Investigation (M.V., J.B., D.K.), National Institute on Aging; and Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD
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Toscano S, Chisari CG, Biondi A, Patti F. Early reduction of retinal thickness predicts physical and cognitive disability in newly diagnosed multiple sclerosis patients: results from a cross-sectional study. Neurol Sci 2024:10.1007/s10072-024-07664-9. [PMID: 38951431 DOI: 10.1007/s10072-024-07664-9] [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: 10/18/2023] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION Retinal nerve fiber layer (RNFL) thickness is a promising biomarker of axonal loss and a potential outcome predictor in Multiple Sclerosis (MS). Cognitive impairment (CoI) exhibits a high prevalence in patients with MS (pwMS), even in the early phases of the disease. Our aim was to explore the role of RNFL thickness as a predictor of physical and cognitive disability in pwMS. METHODS All newly diagnosed pwMS referred to the MS centre of the University-Hospital "Policlinico-San Marco" between 2015-2019 were evaluated at baseline and at 3 years. RNFL and ganglion cell layer (GCL) thickness for right (r.e.) and left eyes (l.e.) were measured with Optical Coherence Tomography (OCT). Disability level and cognitive profile were assessed, using the Expanded Disability Status Scale (EDSS) and the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, respectively. RESULTS We consecutively enrolled 487 pwMS, including 68 (14.0%) with primary progressive MS (PPMS). At baseline, RNFL and GCL were bilaterally thinner in PPMS (r.e. 90.4 ± 12.7; l.e. 90.2 ± 13.5, and r.e. 80.1 ± 11.2; l.e. 80.3 ± 12.6, respectively) compared to relapsing-remitting MS (RRMS) (r.e. 94.6 ± 13.1; l.e. 94.3 ± 14.8, and r.e. 85.1 ± 9.5; l.e. 84.9 ± 9.3, respectively) (p < 0.01). Both groups exhibited reduced RNFL and GCL thickness, worse cognitive performance and higher EDSS scores at 3-years follow-up compared with baseline. RNFL thickness ≤ 88.0 μm was an independent predictor of CoI (OR = 5.32; 95% CI = 1.84-9.12; p = 0.02) and disability worsening (OR = 3.18; 95% CI = 1.21-10.33; p = 0.05). DISCUSSION RNFL thickness, as a biomarker of neurodegeneration, could be considered a predictive biomarker of cognitive degeneration and physical disability in MS.
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Affiliation(s)
- Simona Toscano
- Department "GF Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, 9126, Catania, Italy
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | - Clara Grazia Chisari
- Department "GF Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, 9126, Catania, Italy
| | - Alice Biondi
- Department "GF Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, 9126, Catania, Italy
| | - Francesco Patti
- Department "GF Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, 9126, Catania, Italy.
- Department "GF Ingrassia", Section of Neurosciences, Multiple Sclerosis Center, Neurology Clinic, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
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14
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Krämer J, Balloff C, Weise M, Koska V, Uthmeier Y, Esderts I, Nguyen-Minh M, Zimmerhof M, Hartmann A, Dietrich M, Ingwersen J, Lee JI, Havla J, Kümpfel T, Kerschensteiner M, Häußler V, Heesen C, Stellmann JP, Zimmermann HG, Oertel FC, Ringelstein M, Brandt AU, Paul F, Aktas O, Hartung HP, Wiendl H, Meuth SG, Albrecht P. Evolution of retinal degeneration and prediction of disease activity in relapsing and progressive multiple sclerosis. Nat Commun 2024; 15:5243. [PMID: 38897994 PMCID: PMC11187157 DOI: 10.1038/s41467-024-49309-7] [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: 02/20/2022] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Retinal optical coherence tomography has been identified as biomarker for disease progression in relapsing-remitting multiple sclerosis (RRMS), while the dynamics of retinal atrophy in progressive MS are less clear. We investigated retinal layer thickness changes in RRMS, primary and secondary progressive MS (PPMS, SPMS), and their prognostic value for disease activity. Here, we analyzed 2651 OCT measurements of 195 RRMS, 87 SPMS, 125 PPMS patients, and 98 controls from five German MS centers after quality control. Peripapillary and macular retinal nerve fiber layer (pRNFL, mRNFL) thickness predicted future relapses in all MS and RRMS patients while mRNFL and ganglion cell-inner plexiform layer (GCIPL) thickness predicted future MRI activity in RRMS (mRNFL, GCIPL) and PPMS (GCIPL). mRNFL thickness predicted future disability progression in PPMS. However, thickness change rates were subject to considerable amounts of measurement variability. In conclusion, retinal degeneration, most pronounced of pRNFL and GCIPL, occurs in all subtypes. Using the current state of technology, longitudinal assessments of retinal thickness may not be suitable on a single patient level.
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Affiliation(s)
- Julia Krämer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.
| | - Carolin Balloff
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - Margit Weise
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Valeria Koska
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Yannik Uthmeier
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Isabell Esderts
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Mai Nguyen-Minh
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Moritz Zimmerhof
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | | | - Michael Dietrich
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jens Ingwersen
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - John-Ih Lee
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University München, München, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University München, München, Germany
| | - Martin Kerschensteiner
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University München, München, Germany
- Biomedical Center, Faculty of Medicine, Ludwig-Maximilians University München, München, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Vivien Häußler
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Aix-Marseille University, CNRS-CRMBM, UMR, 7339, Marseille, France
- APHM La Timone, CEMEREM, Marseille, France
| | - 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
| | - Frederike C Oertel
- 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
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alexander U Brandt
- 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
| | - 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
| | - Orhan Aktas
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Brain and Mind Center, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czech Republic
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- Department of Neurology, Kliniken Maria Hilf, Mönchengladbach, Germany.
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15
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Krajnc N, Frank F, Macher S, Michl M, Müller N, Maier S, Zaic S, Wöber C, Pemp B, Broessner G, Bsteh G. Plasma calcitonin gene-related peptide levels in idiopathic intracranial hypertension: an exploratory study. J Headache Pain 2024; 25:92. [PMID: 38834953 DOI: 10.1186/s10194-024-01799-y] [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: 03/24/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a debilitating condition characterized by increased intracranial pressure often presenting with chronic migraine-like headache. Calcitonin gene-related peptide (CGRP) plays an important pathophysiological role in primary headaches such as migraine, whilst its role in IIH has not yet been established. METHODS This longitudinal exploratory study included patients with IIH, episodic migraine (EM) in a headache-free interval and healthy controls (HC). Blood samples were collected from a cubital vein and plasma CGRP (pCGRP) levels were measured by standardized ELISA. RESULTS A total of 26 patients with IIH (mean age 33.2 years [SD 9.2], 88.5% female, median BMI 34.8 kg/m2 [IQR 30.0-41.4]), 30 patients with EM (mean age 27.6 years [7.5], 66.7% female) and 57 HC (mean age 25.3 years [5.2], 56.1% female) were included. pCGRP levels displayed a wide variation in IIH as well as in EM and HC on a group-level. Within IIH, those with migraine-like headache had significantly higher pCGRP levels than those with non-migraine-like headache (F(2,524) = 84.79; p < 0.001) and headache absence (F(2,524) = 84.79; p < 0.001) throughout the observation period, explaining 14.7% of the variance in pCGRP levels. CGRP measurements showed strong intraindividual agreement in IIH (ICC 0.993, 95% CI 0.987-0.996, p < 0.001). No association was found between pCGRP levels and ophthalmological parameters. CONCLUSIONS Although interindividual heterogeneity of pCGRP levels is generally high, migraine-like headache seems to be associated with higher pCGRP levels. CGRP may play a role in the headache pathophysiology at least in a subgroup of IIH.
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Affiliation(s)
- Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Florian Frank
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Martin Michl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Nina Müller
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Sarah Maier
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Sina Zaic
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria.
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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Zhang Z, Kwapong WR, Cao L, Feng Z, Liu P, Wang R, Wu B, Zhang S. Correlation between serum biomarkers, brain volume, and retinal neuronal loss in early-onset Alzheimer's disease. Neurol Sci 2024; 45:2615-2623. [PMID: 38216851 DOI: 10.1007/s10072-023-07256-z] [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: 08/30/2023] [Accepted: 12/04/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE To compare the peripapillary retinal nerve fiber layer (pRNFL), retinal nerve fiber layer (RNFL), and ganglion cell complex (GCC) thickness measurement in early-onset Alzheimer's disease (EOAD) and controls using spectral domain optical coherence tomography (SD-OCT). We also assessed the relationship between SD-OCT measurements and cognitive measures, serum biomarkers for Alzheimer's disease (AD), and cerebral microstructural volume. METHODS pRNFL, RNFL, and GCC thicknesses were measured in 43 EOAD and 42 controls using SD-OCT. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to assess cognitive status, magnetic resonance imaging (MRI) tool was used to quantify cerebral microstructural volume, and serum biomarkers were quantified from peripheral blood. RESULTS EOAD patients had thinner pRNFL (P < 0.001), RNFL (P = 0.008), and GCC (P = 0.018) thicknesses compared to controls after adjusting for multiple factors. pRNFL thickness correlated (P = 0.016) with serum t-tau level. Serum Aβ42 (P < 0.05) concentration correlated with RNFL thickness. Importantly, occipital lobe volume (P = 0.010) correlated with GCC thicknesses in EOAD patients. CONCLUSION Our findings suggest that retinal thickness may be useful markers for assessing neurodegenerative process in EOAD.
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Affiliation(s)
- Ziyi Zhang
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - William Robert Kwapong
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Le Cao
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Zijuan Feng
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Peng Liu
- Department of Emergency, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Ruilin Wang
- Department of Ophthalmology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Bo Wu
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Shuting Zhang
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China.
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Kwapong WR, Yan Y, Cao L, Wang H, Ye C, Jiang S, Tao W, Wu B. Retinal Ischemic Perivascular Lesion Reflects Cerebral Small Vessel Disease Burden in Single Subcortical Infarction. J Am Heart Assoc 2024; 13:e033081. [PMID: 38639343 PMCID: PMC11179934 DOI: 10.1161/jaha.123.033081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Retinal ischemic perivascular lesions (RIPLs) are an indicator of ischemia in the middle retina. We aimed to determine the relationship between RIPLs and single subcortical infarction (SSI). We also investigated the differences in cerebral small vessel disease imaging burden between groups with and without RIPLs in SSI. METHODS AND RESULTS In this case-control study, we enrolled 82 patients with SSI and 72 nonstroke controls. All participants underwent magnetic resonance imaging and swept-source optical coherence tomography/optical coherence tomography angiography. Small vessel disease markers such as lacunes, cerebral microbleeds, white matter hyperintensity, and perivascular spaces were rated on brain imaging. RIPLs were assessed via swept-source optical coherence tomography. Optical coherence tomography angiography was used to measure the superficial vascular complex and deep vascular complex of the retina. After adjusting for risk factors, the presence of RIPLs was significantly associated with SSI (odds ratio [OR], 1.506 [95% CI, 1.365-1.662], P<0.001). Eyes with RIPLs showed lower deep vascular complex density (P=0.035) compared with eyes without RIPLs in patients with SSI. After adjusting for vascular risk factors, the presence of RIPLs in patients with SSI was associated with an increased periventricular white matter hyperintensity burden (β=0.414 [95% CI, 0.181-0.647], P<0.001) and perivascular spaces-basal ganglia (β=0.296 [95% CI, 0.079-0.512], P=0.008). CONCLUSIONS RIPLs are associated with SSI independent of underlying risk factors. The relationship between the presence of RIPLs and small vessel disease markers provides evidence that RIPLs might be an additional indicator of cerebral ischemic changes.
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Affiliation(s)
- William R. Kwapong
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Yuying Yan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Le Cao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Hang Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Chen Ye
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Shuai Jiang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Wendan Tao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Bo Wu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
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Emamverdi M, Vatanatham C, Fasih-Ahmad S, Wang Z, Mishra Z, Jain A, Ganegoda A, Clark ME, Habibi A, Ashrafkhorasani M, Owsley C, Curcio CA, Hu ZJ, Sadda SR. Probing Deposit-Driven Age-Related Macular Degeneration Via Thicknesses of Outer Retinal Bands and Choroid: ALSTAR2 Baseline. Invest Ophthalmol Vis Sci 2024; 65:17. [PMID: 38717424 PMCID: PMC11090139 DOI: 10.1167/iovs.65.5.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose We aimed to identify structural differences in normal eyes, early age-related macular degeneration (AMD), and intermediate AMD eyes using optical coherence tomography (OCT) in a well-characterized, large cross-sectional cohort. Methods Subjects ≥ 60 years with healthy normal eyes, as well as early or intermediate AMD were enrolled in the Alabama Study on Age-related Macular Degeneration 2 (ALSTAR2; NCT04112667). Using Spectralis HRA + OCT2, we obtained macular volumes for each participant. An auto-segmentation software was used to segment six layers and sublayers: photoreceptor inner and outer segments, subretinal drusenoid deposits (SDDs), retinal pigment epithelium + basal lamina (RPE + BL), drusen, and choroid. After manually refining the segmentations of all B-scans, mean thicknesses in whole, central, inner and outer rings of the ETDRS grid were calculated and compared among groups. Results This study involved 502 patients, 252 were healthy, 147 had early AMD, and 103 had intermediate AMD eyes (per Age-Related Eye Disease Study [AREDS] 9-step). Intermediate AMD eyes exhibited thicker SDD and drusen, thinner photoreceptor inner segments, and RPE compared to healthy and early AMD eyes. They also had thicker photoreceptor outer segments than early AMD eyes. Early AMD eyes had thinner photoreceptor outer segments than normal eyes but a thicker choroid than intermediate AMD eyes. Using the Beckman scale, 42% of the eyes initially classified as early AMD shifted to intermediate AMD, making thickness differences for photoreceptor outer segments and choroid insignificant. Conclusions With AMD stages, the most consistent structural differences involve appearance of drusen and SDD, followed by RPE + BL thickness, and then thickness of photoreceptor inner and outer segments. Structural changes in the transition from aging to intermediate AMD include alterations in the outer retinal bands, including the appearance of deposits on either side of the RPE.
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Affiliation(s)
- Mehdi Emamverdi
- Doheny Eye Institute, Pasadena, California, United States
- Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | | | | | - Ziyuan Wang
- Doheny Eye Institute, Pasadena, California, United States
| | - Zubin Mishra
- Doheny Eye Institute, Pasadena, California, United States
| | - Anjal Jain
- Doheny Eye Institute, Pasadena, California, United States
| | | | - Mark E. Clark
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Abbas Habibi
- Doheny Eye Institute, Pasadena, California, United States
- Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | - Maryam Ashrafkhorasani
- Doheny Eye Institute, Pasadena, California, United States
- Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Zhihong J. Hu
- Doheny Eye Institute, Pasadena, California, United States
| | - SriniVas R. Sadda
- Doheny Eye Institute, Pasadena, California, United States
- Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States
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Tisavipat N, Stiebel-Kalish H, Palevski D, Bialer OY, Moss HE, Chaitanuwong P, Padungkiatsagul T, Henderson AD, Sotirchos ES, Singh S, Salman AR, Tajfirouz DA, Chodnicki KD, Pittock SJ, Flanagan EP, Chen JJ. Acute Optic Neuropathy in Older Adults: Differentiating Between MOGAD Optic Neuritis and Nonarteritic Anterior Ischemic Optic Neuropathy. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200214. [PMID: 38547435 DOI: 10.1212/nxi.0000000000200214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/12/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Myelin oligodendrocyte glycoprotein antibody-associated disease optic neuritis (MOGAD-ON) and nonarteritic anterior ischemic optic neuropathy (NAION) can cause acute optic neuropathy in older adults but have different managements. We aimed to determine differentiating factors between MOGAD-ON and NAION and the frequency of serum MOG-IgG false positivity among patients with NAION. METHODS In this international, multicenter, case-control study at tertiary neuro-ophthalmology centers, patients with MOGAD presenting with unilateral optic neuritis as their first attack at age 45 years or older and age-matched and sex-matched patients with NAION were included. Comorbidities, clinical presentations, acute optic disc findings, optical coherence tomography (OCT) findings, and outcomes were compared between MOGAD-ON and NAION. Multivariate analysis was performed to find statistically significant predictors of MOGAD-ON. A separate review of consecutive NAION patients seen at Mayo Clinic, Rochester, from 2018 to 2022, was conducted to estimate the frequency of false-positive MOG-IgG in this population. RESULTS Sixty-four patients with unilateral MOGAD-ON were compared with 64 patients with NAION. Among patients with MOGAD-ON, the median age at onset was 56 (interquartile range [IQR] 50-61) years, 70% were female, and 78% were White. Multivariate analysis showed that eye pain was strongly associated with MOGAD-ON (OR 32.905; 95% CI 2.299-473.181), while crowded optic disc (OR 0.033; 95% CI 0.002-0.492) and altitudinal visual field defect (OR 0.028; 95% CI 0.002-0.521) were strongly associated with NAION. On OCT, peripapillary retinal nerve fiber layer (pRNFL) thickness in unilateral MOGAD-ON was lower than in NAION (median 114 vs 201 μm, p < 0.001; median pRNFL thickening 25 vs 102 μm, p < 0.001). MOGAD-ON had more severe vision loss at nadir (median logMAR 1.0 vs 0.3, p < 0.001), but better recovery (median logMAR 0.1 vs 0.3, p = 0.002). In the cohort of consecutive NAION patients, 66/212 (31%) patients with NAION were tested for MOG-IgG and 8% (95% CI 1%-14%) of those had false-positive serum MOG-IgG at low titers. DISCUSSION Acute unilateral optic neuropathy with optic disc edema in older adults can be caused by either MOGAD-ON or NAION. Detailed history, the degree of pRNFL swelling on OCT, and visual outcomes can help differentiate the entities and prevent indiscriminate serum MOG-IgG testing in all patients with acute optic neuropathy.
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Affiliation(s)
- Nanthaya Tisavipat
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Hadas Stiebel-Kalish
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Dahlia Palevski
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Omer Y Bialer
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Heather E Moss
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Pareena Chaitanuwong
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Tanyatuth Padungkiatsagul
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Amanda D Henderson
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Elias S Sotirchos
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Shonar Singh
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Abdul-Rahman Salman
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Deena A Tajfirouz
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Kevin D Chodnicki
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
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20
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Courtie E, Kirkpatrick JRM, Taylor M, Faes L, Liu X, Logan A, Veenith T, Denniston AK, Blanch RJ. Optical coherence tomography angiography analysis methods: a systematic review and meta-analysis. Sci Rep 2024; 14:9643. [PMID: 38670997 PMCID: PMC11053039 DOI: 10.1038/s41598-024-54306-3] [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: 12/01/2023] [Accepted: 02/11/2024] [Indexed: 04/28/2024] Open
Abstract
Optical coherence tomography angiography (OCTA) is widely used for non-invasive retinal vascular imaging, but the OCTA methods used to assess retinal perfusion vary. We evaluated the different methods used to assess retinal perfusion between OCTA studies. MEDLINE and Embase were searched from 2014 to August 2021. We included prospective studies including ≥ 50 participants using OCTA to assess retinal perfusion in either global retinal or systemic disorders. Risk of bias was assessed using the National Institute of Health quality assessment tool for observational cohort and cross-sectional studies. Heterogeneity of data was assessed by Q statistics, Chi-square test, and I2 index. Of the 5974 studies identified, 191 studies were included in this evaluation. The selected studies employed seven OCTA devices, six macula volume dimensions, four macula subregions, nine perfusion analyses, and five vessel layer definitions, totalling 197 distinct methods of assessing macula perfusion and over 7000 possible combinations. Meta-analysis was performed on 88 studies reporting vessel density and foveal avascular zone area, showing lower retinal perfusion in patients with diabetes mellitus than in healthy controls, but with high heterogeneity. Heterogeneity was lowest and reported vascular effects strongest in superficial capillary plexus assessments. Systematic review of OCTA studies revealed massive heterogeneity in the methods employed to assess retinal perfusion, supporting calls for standardisation of methodology.
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Affiliation(s)
- Ella Courtie
- Neuroscience and Ophthalmology Research Group, University of Birmingham, Birmingham, UK
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
- Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Matthew Taylor
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Livia Faes
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Ann Logan
- Axolotl Consulting Ltd., Droitwich, Worcestershire, UK
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tonny Veenith
- Neuroscience and Ophthalmology Research Group, University of Birmingham, Birmingham, UK
- Critical Care Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Trauma Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Richard J Blanch
- Neuroscience and Ophthalmology Research Group, University of Birmingham, Birmingham, UK.
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK.
- Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
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21
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Cordano C, Werneburg S, Abdelhak A, Bennett DJ, Beaudry-Richard A, Duncan GJ, Oertel FC, Boscardin WJ, Yiu HH, Jabassini N, Merritt L, Nocera S, Sin JH, Samana IP, Condor Montes SY, Ananth K, Bischof A, Nourbakhsh B, Hauser SL, Cree BAC, Emery B, Schafer DP, Chan JR, Green AJ. Synaptic injury in the inner plexiform layer of the retina is associated with progression in multiple sclerosis. Cell Rep Med 2024; 5:101490. [PMID: 38574736 PMCID: PMC11031420 DOI: 10.1016/j.xcrm.2024.101490] [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: 07/24/2023] [Revised: 02/01/2024] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
While neurodegeneration underlies the pathological basis for permanent disability in multiple sclerosis (MS), predictive biomarkers for progression are lacking. Using an animal model of chronic MS, we find that synaptic injury precedes neuronal loss and identify thinning of the inner plexiform layer (IPL) as an early feature of inflammatory demyelination-prior to symptom onset. As neuronal domains are anatomically segregated in the retina and can be monitored longitudinally, we hypothesize that thinning of the IPL could represent a biomarker for progression in MS. Leveraging our dataset with over 800 participants enrolled for more than 12 years, we find that IPL atrophy directly precedes progression and propose that synaptic loss is predictive of functional decline. Using a blood proteome-wide analysis, we demonstrate a strong correlation between demyelination, glial activation, and synapse loss independent of neuroaxonal injury. In summary, monitoring synaptic injury is a biologically relevant approach that reflects a potential driver of progression.
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Affiliation(s)
- Christian Cordano
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sebastian Werneburg
- Department of Neurobiology, Brudnik Neuropsychiatric Research Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Ophthalmology & Visual Sciences, Michigan Neuroscience Institute, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA
| | - Ahmed Abdelhak
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel J Bennett
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Alexandra Beaudry-Richard
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Greg J Duncan
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Frederike C Oertel
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - W John Boscardin
- Department of Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Hao H Yiu
- Department of Biology, University of Maryland, College Park, MD, USA
| | - Nora Jabassini
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren Merritt
- Department of Neurobiology, Brudnik Neuropsychiatric Research Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sonia Nocera
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jung H Sin
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Isaac P Samana
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Shivany Y Condor Montes
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kirtana Ananth
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Antje Bischof
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Ben Emery
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Dorothy P Schafer
- Department of Neurobiology, Brudnik Neuropsychiatric Research Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jonah R Chan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Ari J Green
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
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22
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Alba-Arbalat S, Solana E, Lopez-Soley E, Camos-Carreras A, Martinez-Heras E, Vivó F, Pulido-Valdeolivas I, Andorra M, Sepulveda M, Cabrera JM, Fonseca E, Calvi A, Alcubierre R, Dotti-Boada M, Saiz A, Martinez-Lapiscina EH, Villoslada P, Blanco Y, Sanchez-Dalmau B, Llufriu S. Predictive value of retinal atrophy for cognitive decline across disease duration in multiple sclerosis. J Neurol Neurosurg Psychiatry 2024; 95:419-425. [PMID: 37989566 DOI: 10.1136/jnnp-2023-332332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND We investigated the association between changes in retinal thickness and cognition in people with MS (PwMS), exploring the predictive value of optical coherence tomography (OCT) markers of neuroaxonal damage for global cognitive decline at different periods of disease. METHOD We quantified the peripapillary retinal nerve fibre (pRFNL) and ganglion cell-inner plexiform (GCIPL) layers thicknesses of 207 PwMS and performed neuropsychological evaluations. The cohort was divided based on disease duration (≤5 years or >5 years). We studied associations between changes in OCT and cognition over time, and assessed the risk of cognitive decline of a pRFNL≤88 µm or GCIPL≤77 µm and its predictive value. RESULTS Changes in pRFNL and GCIPL thickness over 3.2 years were associated with evolution of cognitive scores, in the entire cohort and in patients with more than 5 years of disease (p<0.01). Changes in cognition were related to less use of disease-modifying drugs, but not OCT metrics in PwMS within 5 years of onset. A pRFNL≤88 µm was associated with earlier cognitive disability (3.7 vs 9.9 years) and higher risk of cognitive deterioration (HR=1.64, p=0.022). A GCIPL≤77 µm was not associated with a higher risk of cognitive decline, but a trend was observed at ≤91.5 µm in PwMS with longer disease (HR=1.81, p=0.061). CONCLUSIONS The progressive retinal thinning is related to cognitive decline, indicating that cognitive dysfunction is a late manifestation of accumulated neuroaxonal damage. Quantifying the pRFNL aids in identifying individuals at risk of cognitive dysfunction.
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Affiliation(s)
- Salut Alba-Arbalat
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Elisabeth Solana
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Elisabet Lopez-Soley
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | | | - Eloy Martinez-Heras
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Francesc Vivó
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Magi Andorra
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Maria Sepulveda
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Jose María Cabrera
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Elianet Fonseca
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
- Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alberto Calvi
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Rafel Alcubierre
- Ophthalmology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marina Dotti-Boada
- Ophthalmology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Albert Saiz
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | - Pablo Villoslada
- Department of Neurosciences, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Yolanda Blanco
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
| | | | - Sara Llufriu
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Fundacio Recerca Clinic Barcelona -IDIBAPS, Barcelona, Spain
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23
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Pan R, Ye C, Zhang Z, Kwapong WR, Wang R, Lu K, Liao L, Yan Y, Yang T, Cao L, Jiang S, Zhang X, Liu J, Tao W, Wu B. Distinct alterations of retinal structure between thalamic and extra-thalamic subcortical infarction patients: A cross-sectional and longitudinal study. CNS Neurosci Ther 2024; 30:e14543. [PMID: 38018655 PMCID: PMC11017429 DOI: 10.1111/cns.14543] [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: 07/27/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
AIMS Cerebrovascular lesions in the primary visual cortex, the lateral geniculate nucleus, and the optic tract have been associated with retinal neurodegeneration via the retrograde degeneration (RD) mechanism. We aimed to use optical coherence tomography (OCT) to assess the effects of the strategic single subcortical infarction (SSI) location on retinal neurodegeneration and its longitudinal impacts. METHODS Patients with SSI were enrolled and stratified by lesion location on cerebral MRI into the thalamic infarction group and extra-thalamic infarction group. Healthy controls from the native communities were also recruited. Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) were quantified using OCT. Generalized estimating equation (GEE) models were used for cross-sectional analyses and linear mixed models for longitudinal analyses. P < 0.05 was considered statistically significant. RESULTS We included a total of 283 eyes from 149 SSI patients. Of these, 115 eyes of 60 patients with follow-up were included in the longitudinal analyses. Cross-sectionally, thalamic-infarction patients had reduced retinal thickness compared with extra-thalamic infarction patients after adjustment for age, gender, disease duration, and vascular risk factors (p = 0.026 for RNFL, and p = 0.026 for GCIPL). Longitudinally, SSI patients showed greater retinal thinning compared with healthy controls over time (p = 0.040 for RNFL, and p < 0.001 for GCIPL), and thalamic infarction patients exhibited faster rates of GCIPL thinning in comparison with extra-thalamic infarction patients (p < 0.001). CONCLUSION Our study demonstrates a distinct effect of subcortical infarction lesion site on the retina both at the early stage of disease and at the 1-year follow-up time. These results present evidence of significant associations between strategic infarction locations and retinal neurodegeneration. It may provide novel insights for further research on RD in stroke patients and ultimately facilitate individualized recovery therapeutic strategy.
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Affiliation(s)
- Ruosu Pan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Chen Ye
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Zhimeng Zhang
- West China School of MedicineSichuan UniversityChengduChina
| | | | - Ruilin Wang
- Department of OphthalmologyWest China Hospital, Sichuan UniversityChengduChina
| | - Kun Lu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Lanhua Liao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Yuying Yan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Tang Yang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Le Cao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Shuai Jiang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Xuening Zhang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Junfeng Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Wendan Tao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Bo Wu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
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24
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Bayas A, Mansmann U, Ön BI, Hoffmann VS, Berthele A, Mühlau M, Kowarik MC, Krumbholz M, Senel M, Steuerwald V, Naumann M, Hartberger J, Kerschensteiner M, Oswald E, Ruschil C, Ziemann U, Tumani H, Vardakas I, Albashiti F, Kramer F, Soto-Rey I, Spengler H, Mayer G, Kestler HA, Kohlbacher O, Hagedorn M, Boeker M, Kuhn K, Buchka S, Kohlmayer F, Kirschke JS, Behrens L, Zimmermann H, Bender B, Sollmann N, Havla J, Hemmer B. Prospective study validating a multidimensional treatment decision score predicting the 24-month outcome in untreated patients with clinically isolated syndrome and early relapsing-remitting multiple sclerosis, the ProVal-MS study. Neurol Res Pract 2024; 6:15. [PMID: 38449051 PMCID: PMC10918966 DOI: 10.1186/s42466-024-00310-x] [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: 09/21/2023] [Accepted: 01/16/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION In Multiple Sclerosis (MS), patients´ characteristics and (bio)markers that reliably predict the individual disease prognosis at disease onset are lacking. Cohort studies allow a close follow-up of MS histories and a thorough phenotyping of patients. Therefore, a multicenter cohort study was initiated to implement a wide spectrum of data and (bio)markers in newly diagnosed patients. METHODS ProVal-MS (Prospective study to validate a multidimensional decision score that predicts treatment outcome at 24 months in untreated patients with clinically isolated syndrome or early Relapsing-Remitting-MS) is a prospective cohort study in patients with clinically isolated syndrome (CIS) or Relapsing-Remitting (RR)-MS (McDonald 2017 criteria), diagnosed within the last two years, conducted at five academic centers in Southern Germany. The collection of clinical, laboratory, imaging, and paraclinical data as well as biosamples is harmonized across centers. The primary goal is to validate (discrimination and calibration) the previously published DIFUTURE MS-Treatment Decision score (MS-TDS). The score supports clinical decision-making regarding the options of early (within 6 months after study baseline) platform medication (Interferon beta, glatiramer acetate, dimethyl/diroximel fumarate, teriflunomide), or no immediate treatment (> 6 months after baseline) of patients with early RR-MS and CIS by predicting the probability of new or enlarging lesions in cerebral magnetic resonance images (MRIs) between 6 and 24 months. Further objectives are refining the MS-TDS score and providing data to identify new markers reflecting disease course and severity. The project also provides a technical evaluation of the ProVal-MS cohort within the IT-infrastructure of the DIFUTURE consortium (Data Integration for Future Medicine) and assesses the efficacy of the data sharing techniques developed. PERSPECTIVE Clinical cohorts provide the infrastructure to discover and to validate relevant disease-specific findings. A successful validation of the MS-TDS will add a new clinical decision tool to the armamentarium of practicing MS neurologists from which newly diagnosed MS patients may take advantage. Trial registration ProVal-MS has been registered in the German Clinical Trials Register, `Deutsches Register Klinischer Studien` (DRKS)-ID: DRKS00014034, date of registration: 21 December 2018; https://drks.de/search/en/trial/DRKS00014034.
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Affiliation(s)
- Antonios Bayas
- Department of Neurology and Clinical Neurophysiology, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
| | - Ulrich Mansmann
- Institute of Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Begum Irmak Ön
- Institute of Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Verena S Hoffmann
- Institute of Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Markus C Kowarik
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Markus Krumbholz
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Makbule Senel
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | - Verena Steuerwald
- Department of Neurology and Clinical Neurophysiology, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Markus Naumann
- Department of Neurology and Clinical Neurophysiology, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Julia Hartberger
- Department of Neurology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Martin Kerschensteiner
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Eva Oswald
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christoph Ruschil
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | | | | | - Fady Albashiti
- Medical Data Integration Center, University Hospital, LMU Munich, Munich, Germany
| | - Frank Kramer
- IT-Infrastructure for Translational Medical Research, University of Augsburg, Augsburg, Germany
| | - Iñaki Soto-Rey
- Medical Data Integration Center, Institute of Digital Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Helmut Spengler
- Medical Data Integration Center, Medical Center rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Gerhard Mayer
- Heidelberg Institute for Theoretical Studies (HITS), Heidelberg, Germany
| | | | - Oliver Kohlbacher
- Institute for Translational Bioinformatics, University Hospital Tübingen, Tübingen, Germany
- Department of Computer Science, University of Tübingen, Tübingen, Germany
- Institute for Bioinformatics and Medical Informatics, University of Tübingen, Tübingen, Germany
| | - Marlien Hagedorn
- Medical Data Integration Center, University Hospital, LMU Munich, Munich, Germany
| | - Martin Boeker
- Institute for Artificial Intelligence and Informatics in Medicine, Medical Center rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Kuhn
- Institute for Artificial Intelligence and Informatics in Medicine, Medical Center rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Buchka
- Institute of Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | | | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lars Behrens
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Hanna Zimmermann
- Institute of Neuroradiology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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25
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Andorra M, Freire A, Zubizarreta I, de Rosbo NK, Bos SD, Rinas M, Høgestøl EA, de Rodez Benavent SA, Berge T, Brune-Ingebretse S, Ivaldi F, Cellerino M, Pardini M, Vila G, Pulido-Valdeolivas I, Martinez-Lapiscina EH, Llufriu S, Saiz A, Blanco Y, Martinez-Heras E, Solana E, Bäcker-Koduah P, Behrens J, Kuchling J, Asseyer S, Scheel M, Chien C, Zimmermann H, Motamedi S, Kauer-Bonin J, Brandt A, Saez-Rodriguez J, Alexopoulos LG, Paul F, Harbo HF, Shams H, Oksenberg J, Uccelli A, Baeza-Yates R, Villoslada P. Predicting disease severity in multiple sclerosis using multimodal data and machine learning. J Neurol 2024; 271:1133-1149. [PMID: 38133801 PMCID: PMC10896787 DOI: 10.1007/s00415-023-12132-z] [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: 06/24/2023] [Revised: 10/28/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Multiple sclerosis patients would benefit from machine learning algorithms that integrates clinical, imaging and multimodal biomarkers to define the risk of disease activity. METHODS We have analysed a prospective multi-centric cohort of 322 MS patients and 98 healthy controls from four MS centres, collecting disability scales at baseline and 2 years later. Imaging data included brain MRI and optical coherence tomography, and omics included genotyping, cytomics and phosphoproteomic data from peripheral blood mononuclear cells. Predictors of clinical outcomes were searched using Random Forest algorithms. Assessment of the algorithm performance was conducted in an independent prospective cohort of 271 MS patients from a single centre. RESULTS We found algorithms for predicting confirmed disability accumulation for the different scales, no evidence of disease activity (NEDA), onset of immunotherapy and the escalation from low- to high-efficacy therapy with intermediate to high-accuracy. This accuracy was achieved for most of the predictors using clinical data alone or in combination with imaging data. Still, in some cases, the addition of omics data slightly increased algorithm performance. Accuracies were comparable in both cohorts. CONCLUSION Combining clinical, imaging and omics data with machine learning helps identify MS patients at risk of disability worsening.
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Affiliation(s)
- Magi Andorra
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Ana Freire
- School of Management, Pompeu Fabra University, Barcelona, Spain
- UPF Barcelona School of Management, Balmes 132, 08008, Barcelona, Spain
| | - Irati Zubizarreta
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Nicole Kerlero de Rosbo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Steffan D Bos
- University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | - Melanie Rinas
- Institute for Computational Biomedicine, Heidelberg University Hospital, and Heidelberg University, Heidelberg, Germany
| | - Einar A Høgestøl
- University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | | | - Tone Berge
- Oslo University Hospital, Oslo, Norway
- Oslo Metropolitan University, Oslo, Norway
| | | | - Federico Ivaldi
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Matteo Pardini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gemma Vila
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Albert Saiz
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Eloy Martinez-Heras
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | - Elisabeth Solana
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS) and Hospital Clinic Barcelona, Barcelona, Spain
| | | | | | | | - Susanna Asseyer
- Charité Universitaetsmedizin Berlin, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | - Claudia Chien
- Charité Universitaetsmedizin Berlin, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Hanna Zimmermann
- Charité Universitaetsmedizin Berlin, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | | | - Alex Brandt
- Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Julio Saez-Rodriguez
- Institute for Computational Biomedicine, Heidelberg University Hospital, and Heidelberg University, Heidelberg, Germany
| | - Leonidas G Alexopoulos
- ProtATonce Ltd, Athens, Greece
- School of Mechanical Engineering, National Technical University of Athens, Zografou, Greece
| | - Friedemann Paul
- Charité Universitaetsmedizin Berlin, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Hanne F Harbo
- University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | - Hengameh Shams
- Department of Neurology, University of California, San Francisco, USA
| | - Jorge Oksenberg
- Department of Neurology, University of California, San Francisco, USA
| | - Antonio Uccelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Pablo Villoslada
- Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain.
- Hospital del Mar Research Institute, Barcelona, Spain.
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26
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Terravecchia C, Mostile G, Chisari CG, Rascunà C, Terranova R, Cicero CE, Giuliano L, Donzuso G, Sciacca G, Luca A, Preux PM, Jankovic J, Zappia M, Nicoletti A. Retinal Thickness in Essential Tremor and Early Parkinson Disease: Exploring Diagnostic Insights. J Neuroophthalmol 2024; 44:35-40. [PMID: 37523235 PMCID: PMC10855993 DOI: 10.1097/wno.0000000000001959] [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: 08/01/2023]
Abstract
BACKGROUND Essential tremor (ET) represents a heterogeneous condition which may overlap with Parkinson disease (PD) even at early stages, by sharing some subtle clinical aspects. Longstanding ET demonstrated also higher risk of developing PD, especially with a Tremor-dominant (TD-PD) phenotype. Therefore, differential diagnosis between ET and early PD could be quite challenging. Optical coherence tomography (OCT) has been recognized as a reliable tool to assess the retina as a proxy of neurodegeneration. We aimed to explore the possible role of retinal assessment in differential diagnosis between ET and early PD. METHODS Macular layers and peripapillary retinal nerve fiber layer (RNFL) thickness among ET, early PD, and healthy controls (HCs) were assessed using OCT. RESULTS Forty-two eyes from 23 ET, 41 eyes from 21 early PD, and 33 eyes from 17 HCs were analyzed. Macular RNFL, ganglion cell layer, inner plexiform layer, and inner nuclear layer were thinner in PD as compared with ET and even more in HCs. Differences between ET and PD were more evident when considering the TD-PD subgroup, especially for RNFL. Among ET patients, thickness of the inner macular layers showed negative linear relationship with both age at onset and disease duration. Peripapillary temporal quadrant thinning was found in ET compared with HCs. CONCLUSIONS Macular inner retina was thinner in patients with ET and early PD compared with HCs. These findings suggest that the retinal assessment may have a utility in the differential diagnosis between ET and PD.
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27
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Friedel EBN, Tebartz van Elst L, Schäfer M, Maier S, Runge K, Küchlin S, Reich M, Lagrèze WA, Kornmeier J, Ebert D, Endres D, Domschke K, Nickel K. Retinal Thinning in Adults with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:1143-1156. [PMID: 36550331 PMCID: PMC10907434 DOI: 10.1007/s10803-022-05882-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Since the retina shares its embryological origin with the central nervous system, optical coherence tomography (OCT), an imaging technique frequently employed in ophthalmology to analyze the macula and intraretinal layer thicknesses and volumes, has recently become increasingly important in psychiatric research. We examined 34 autistic and 31 neurotypical adults (NT) using OCT. Autistic adults had reduced overall macular and outer nuclear layer (ONL) thickness and volume compared to NT. Both macular and ONL thickness showed significant inverse associations with the severity of autistic symptoms measured with the Social Responsiveness Scale 2 (SRS-2). Longitudinal studies across different age groups are required to clarify whether retinal changes may represent a possible trait marker.
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Affiliation(s)
- Evelyn B N Friedel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam Schäfer
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kimon Runge
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Küchlin
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Reich
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Kornmeier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
| | - Dieter Ebert
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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28
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Raghib MF, Bao F, Elkhooly M, Bernitsas E. Choroid plexus volume as a marker of retinal atrophy in relapsing remitting multiple sclerosis. J Neurol Sci 2024; 457:122884. [PMID: 38237367 DOI: 10.1016/j.jns.2024.122884] [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: 05/30/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To evaluate choroid plexus (CP) volume as a biomarker for predicting clinical disability and retinal layer atrophy in relapsing remitting multiple sclerosis (RRMS). METHODS Ninety-five RRMS patients and 26 healthy controls (HCs) underwent 3 T whole brain MRI, expanded disability status scale (EDSS) and optical coherence tomography (OCT). Fully automated intra-retinal segmentation was performed to obtain the volumes of the retinal nerve fiber layer (RNFL), combined ganglion cell layer -inner plexiform layer (GCIPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), total macular volume (TMV) and papillomacular bundle (PMB). Automated segmentation of the CP within the lateral ventricles was performed and the choroid plexus volume (CPV) was normalized by total intracranial volume (TIV). Linear regression analysis and generalized estimating equation (GEE) models were applied to evaluate relationships between nCPV and EDSS, T2 lesion volume, disease duration, and retinal layer volumes, followed by Bonferroni correction analysis for multiple comparisons. RESULTS RRMS patients had larger tChPV compared to HCs (p < 0.001). After Bonferroni correction, there was a significant positive correlation between tChPV and EDSS (r2 = 0.25, p = 0.0002), disease duration (r2 = 0.30, p = 0.01), and T2 lesion volume (r2 = 0.39, p = 0.0000). A robust negative correlation was found between tChPV and RNFL (p < 0.001), GCIPL (p = 0.003), TMV (p = 0.0185), PMB (p < 0.0001), G (p = 0.04), T(p = 0.0001). CONCLUSIONS Our findings support the association of tChPV with disability and altered retinal integrity in RRMS.
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Affiliation(s)
- Muhammad F Raghib
- Department of Neurology, Wayne State University School of Medicine, United States of America
| | - Fen Bao
- Department of Neurology, Wayne State University School of Medicine, United States of America
| | - Mahmoud Elkhooly
- Department of Neurology, Wayne State University School of Medicine, United States of America; Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, United States of America; Department of Neurology and Psychiatry, Minia University, Minia, Egypt
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University School of Medicine, United States of America; Detroit Medical Center, Detroit, MI, United States of America.
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29
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Oertel FC, Casillas D, Cobigo Y, Condor Montes S, Heuer HW, Chapman M, Beaudry-Richard A, Reinsberg H, Abdelhak A, Cordano C, Boeve BF, Dickerson BC, Grossman M, Huey E, Irwin DJ, Litvan I, Pantelyat A, Tartaglia MC, Vandevrede L, Boxer A, Green AJ. Scientific commentary on: "Phosphorylated tau in the retina correlates with tau pathology in the brain in Alzheimer's disease and primary tauopathies". Acta Neuropathol 2024; 147:30. [PMID: 38308717 PMCID: PMC10838223 DOI: 10.1007/s00401-023-02656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 02/05/2024]
Affiliation(s)
- Frederike C Oertel
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
| | - Daniel Casillas
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
| | - Yann Cobigo
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
- UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Shivany Condor Montes
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
| | - Hilary W Heuer
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
- UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Makenna Chapman
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
| | - Alexandra Beaudry-Richard
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
| | - Henriette Reinsberg
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
| | - Ahmed Abdelhak
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
| | - Christian Cordano
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Huey
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
- Department of Psychiatry and New York Psychiatric Institute, Columbia University Medical Center, New York, USA
| | - David J Irwin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, San Diego, CA, 92093, USA
| | - Alexander Pantelyat
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Lawren Vandevrede
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
- UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Adam Boxer
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA
- UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Sandler Neurosciences Building, San Francisco, CA, USA.
- Department of Ophthalmology, School of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.
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30
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Hopf S, Tüscher O, Schuster AK. [Retinal OCT biomarkers and neurodegenerative diseases of the central nervous system beyond Alzheimer's disease]. DIE OPHTHALMOLOGIE 2024; 121:93-104. [PMID: 38263475 DOI: 10.1007/s00347-023-01974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Optical coherence tomography (OCT) biomarkers are increasingly used by neurologists, psychiatrists, and ophthalmologists for the diagnosis, prognosis, and follow-up of neurodegenerative diseases. Long-term data on OCT biomarkers of selected primary and secondary neurodegenerative diseases of the central nervous system (CNS), such as multiple sclerosis (MS) or Parkinson's disease, are already available in part. In addition, there are rare neurodegenerative diseases with early disease onset that may show OCT abnormalities. METHODS A literature review on the association of OCT biomarkers with neurodegenerative diseases of the CNS beyond Alzheimer's disease is presented. Parkinson's disease, MS, Friedreich's ataxia, Huntington's disease, spinocerebellar ataxia, and lysosomal storage diseases are addressed. RESULTS Relevant OCT biomarkers of neurodegenerative diseases are the macular ganglion cell inner plexiform layer (GCIPL) and the peripapillary retinal nerve fiber layer (pRNFL) thickness. Different sectors may be affected depending on the disease entity in addition to global pRFNL reduction. OCT‑angiography (OCT-A) is also increasingly used as a biomarker in neurodegenerative diseases. CONCLUSION Optical coherence tomography biomarkers are used in an interdisciplinary context. Retinal pathologies should be excluded by an ophthalmologist. While OCT biomarkers are increasingly used clinically in MS, the benefit in other neurodegenerative diseases, especially the rare ones, is less well documented. Further longitudinal studies are required.
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Affiliation(s)
- Susanne Hopf
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
| | - Oliver Tüscher
- Zentrum für seltene Erkrankungen des Nervensystems (ZSEN) Mainz und Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Alexander K Schuster
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
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31
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Murueta-Goyena A, Romero-Bascones D, Teijeira-Portas S, Urcola JA, Ruiz-Martínez J, Del Pino R, Acera M, Petzold A, Wagner SK, Keane PA, Ayala U, Barrenechea M, Tijero B, Gómez Esteban JC, Gabilondo I. Association of retinal neurodegeneration with the progression of cognitive decline in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:26. [PMID: 38263165 PMCID: PMC10805713 DOI: 10.1038/s41531-024-00637-x] [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: 09/15/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
Retinal thickness may serve as a biomarker in Parkinson's disease (PD). In this prospective longitudinal study, we aimed to determine if PD patients present accelerated thinning rate in the parafoveal ganglion cell-inner plexiform layer (pfGCIPL) and peripapillary retinal nerve fiber layer (pRNFL) compared to controls. Additionally, we evaluated the relationship between retinal neurodegeneration and clinical progression in PD. A cohort of 156 PD patients and 72 controls underwent retinal optical coherence tomography, visual, and cognitive assessments between February 2015 and December 2021 in two Spanish tertiary hospitals. The pfGCIPL thinning rate was twice as high in PD (β [SE] = -0.58 [0.06]) than in controls (β [SE] = -0.29 [0.06], p < 0.001). In PD, the progression pattern of pfGCIPL atrophy depended on baseline thickness, with slower thinning rates observed in PD patients with pfGCIPL below 89.8 µm. This result was validated with an external dataset from Moorfields Eye Hospital NHS Foundation Trust (AlzEye study). Slow pfGCIPL progressors, characterized by older at baseline, longer disease duration, and worse cognitive and disease stage scores, showed a threefold increase in the rate of cognitive decline (β [SE] = -0.45 [0.19] points/year, p = 0.021) compared to faster progressors. Furthermore, temporal sector pRNFL thinning was accelerated in PD (βtime x group [SE] = -0.67 [0.26] μm/year, p = 0.009), demonstrating a close association with cognitive score changes (β [SE] = 0.11 [0.05], p = 0.052). This study suggests that a slower pattern of pfGCIPL tissue loss in PD is linked to more rapid cognitive decline, whereas changes in temporal pRNFL could track cognitive deterioration.
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Affiliation(s)
- Ane Murueta-Goyena
- Neurodegenerative Diseases Group, Biobizkaia Health Research Institute, Barakaldo, Spain.
- Department of Neurosciences, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Spain.
| | - David Romero-Bascones
- Biomedical Engineering Department, Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Mondragón, Spain
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, EC1V 2PD, London, UK
| | - Sara Teijeira-Portas
- Neurodegenerative Diseases Group, Biobizkaia Health Research Institute, Barakaldo, Spain
| | - J Aritz Urcola
- Department of Ophthalmology, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Javier Ruiz-Martínez
- Department of Neurology, Donostia University Hospital, Donostia, Spain
- Biogipuzkoa Health Research Institute, Donostia, Spain
- CIBERNED, Institute of Health Carlos III, Madrid, Spain
| | - Rocío Del Pino
- Neurodegenerative Diseases Group, Biobizkaia Health Research Institute, Barakaldo, Spain
| | - Marian Acera
- Neurodegenerative Diseases Group, Biobizkaia Health Research Institute, Barakaldo, Spain
| | - Axel Petzold
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, EC1V 2PD, London, UK
- Queen Square Institute of Neurology, University College London, London, UK
- The National Hospital for Neurology and Neurosurgery, London, UK
- Departments of Neurology and Ophthalmology, Amsterdam UMC, Amsterdam, Netherlands
| | - Siegfried Karl Wagner
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, EC1V 2PD, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Pearse Andrew Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, EC1V 2PD, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Unai Ayala
- Biomedical Engineering Department, Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Mondragón, Spain
| | - Maitane Barrenechea
- Biomedical Engineering Department, Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Mondragón, Spain
| | - Beatriz Tijero
- Neurodegenerative Diseases Group, Biobizkaia Health Research Institute, Barakaldo, Spain
- Neurology Department, Cruces University Hospital, Barakaldo, Spain
| | - Juan Carlos Gómez Esteban
- Neurodegenerative Diseases Group, Biobizkaia Health Research Institute, Barakaldo, Spain
- Department of Neurosciences, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Spain
- Neurology Department, Cruces University Hospital, Barakaldo, Spain
| | - Iñigo Gabilondo
- Neurodegenerative Diseases Group, Biobizkaia Health Research Institute, Barakaldo, Spain
- Neurology Department, Cruces University Hospital, Barakaldo, Spain
- IKERBASQUE, The Basque Foundation for Science, Bilbao, Spain
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Rezende Filho FM, Jurkute N, de Andrade JBC, Marianelli BF, de Lima FD, França MC, Sallum JMF, Yu-Wai-Man P, Barsottini OGP, Pedroso JL. Optic Disc and Retinal Architecture Changes in Patients with Spinocerebellar Ataxia Type 2. Mov Disord 2024; 39:203-209. [PMID: 38037516 DOI: 10.1002/mds.29675] [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: 08/22/2023] [Revised: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND ATXN2 is the causative gene of spinocerebellar ataxia type 2 (SCA2) and has been implicated in glaucoma pathogenesis. Therefore, studying ocular changes in SCA2 could uncover clinically relevant changes. OBJECTIVE The aim was to investigate optic disc and retinal architecture in SCA2. METHODS We evaluated 14 patients with SCA2 and 26 controls who underwent intraocular pressure measurement, fundoscopy, and macular and peripapillary spectral domain optical coherence tomography (SD-OCT). We compared SD-OCT measurements in SCA2 and controls, and the frequency of glaucomatous changes among SCA2, controls, and 76 patients with other SCAs (types 1, 3, 6, and 7). RESULTS The macula, peripapillary retinal nerve fiber and inner plexiform layers were thinner in SCA2 than in controls. Increased cup-to-disc ratio was more frequent in SCA2 than in controls and other SCAs. CONCLUSIONS Ocular changes are part of SCA2 phenotype. Future studies should further investigate retinal and optic nerve architecture in this disorder.
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Affiliation(s)
- Flávio Moura Rezende Filho
- Division of General Neurology and Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Neringa Jurkute
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - João Brainer Clares de Andrade
- Division of General Neurology and Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | - Fabrício Diniz de Lima
- Department of Neurology, School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil
| | | | | | - Patrick Yu-Wai-Man
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Department of Clinical Neurosciences, Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, United Kingdom
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Orlando G P Barsottini
- Division of General Neurology and Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - José Luiz Pedroso
- Division of General Neurology and Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, Sao Paulo, Brazil
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Ye C, Kwapong WR, Tang B, Liu J, Tao W, Lu K, Pan R, Wang A, Liao L, Yang T, Cao L, Wang Y, Jiang S, Zhang X, Liu M, Wu B. Association between functional network connectivity, retina structure and microvasculature, and visual performance in patients after thalamic stroke: An exploratory multi-modality study. Brain Behav 2024; 14:e3385. [PMID: 38376035 PMCID: PMC10794127 DOI: 10.1002/brb3.3385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/06/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Neuro-ophthalmologic symptoms and retinal changes have been increasingly observed following thalamic stroke, and there is mounting evidence indicating distinct alterations occurring in the vision-related functional network. However, the intrinsic correlations between these changes are not yet fully understood. Our objective was to explore the altered patterns of functional network connectivity and retina parameters, and their correlations with visual performance in patients with thalamic stroke. METHODS We utilized resting-state functional MRI to obtain multi-modular functional connectivity (FC), and optical coherence tomography-angiography to measure various retina parameters, such as the retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), superficial vascular complex (SVC), and deep vascular complex. Visual acuity (VA) was used as a metric for visual performance. RESULTS We included 46 patients with first-ever unilateral thalamic stroke (mean age 59.74 ± 10.02 years, 33 males). Significant associations were found between FC of attention-to-default mode and SVC, RNFL, and GCIPL, as well as between FC of attention-to-visual and RNFL (p < .05). Both RNFL and GCIPL exhibited significant associations with FC of visual-to-visual (p < .05). Only GCIPL showed an association with VA (p = .038). Stratified analysis based on a disease duration of 6 months revealed distinct and significant linking patterns in multi-modular FC and specific retina parameters, with varying correlations with VA in each subgroup. CONCLUSION These findings provide valuable insight into the neural basis of the associations between brain network dysfunction and impaired visual performance in patients with thalamic stroke. Our novel findings have the potential to inform future targeted and individualized therapies. However, further comprehensive studies are necessary to validate our results.
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Affiliation(s)
- Chen Ye
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - William Robert Kwapong
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Biqiu Tang
- Department of Radiology, Huaxi MR Research Center (HMRRC)West China Hospital, Sichuan UniversityChengduChina
| | - Junfeng Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Wendan Tao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Kun Lu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Ruosu Pan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Anmo Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Lanhua Liao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Tang Yang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Le Cao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Youjie Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Shuai Jiang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Xuening Zhang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Ming Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Bo Wu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
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Chen Y, Wang H, Wang B, Li W, Ye P, Xu W, Liu P, Chen X, Cen Z, Ouyang Z, Wu S, Dou X, Liao Y, Zhang H, Tian M, Luo W. Retinal Thinning as a Marker of Disease Severity in Progressive Supranuclear Palsy. J Mov Disord 2024; 17:55-63. [PMID: 37748923 PMCID: PMC10846978 DOI: 10.14802/jmd.23102] [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: 05/21/2023] [Revised: 08/18/2023] [Accepted: 09/25/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Progressive supranuclear palsy (PSP) involves a variety of visual symptoms that are thought to be partially caused by structural abnormalities of the retina. However, the relationship between retinal structural changes, disease severity, and intracranial alterations remains unknown. We investigated distinct retinal thinning patterns and their relationship with clinical severity and intracranial alterations in a PSP cohort. METHODS We enrolled 19 patients with PSP (38 eyes) and 20 age-matched healthy controls (40 eyes). All of the participants underwent peripapillary and macular optical coherence tomography. Brain 11C-2β-carbomethoxy-3β-(4-fluorophenyl) tropane (11C-CFT) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography imaging were also performed in patients with PSP. We investigated the association between retinal thickness changes and clinical features, striatal dopamine transporter availability, and cerebral glucose metabolism. RESULTS The peripapillary retinal nerve fiber layer (pRNFL) and macula were significantly thinner in patients with PSP than in controls. The thickness of the superior sector of the pRNFL demonstrated a significant negative relationship with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III and Hoehn and Yahr staging scale scores. A significant negative correlation was found between outer inferior macular thickness and disease duration. Outer temporal macular thickness was positively correlated with Montreal Cognitive Assessment scores. In PSP, lower outer temporal macular thickness was also positively correlated with decreased dopamine transporter binding in the caudate. CONCLUSION The pRNFL and macular thinning may be candidate markers for monitoring disease severity. Additionally, macular thinning may be an in vivo indicator of nigrostriatal dopaminergic cell degeneration in PSP patients.
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Affiliation(s)
- Yueting Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Haotian Wang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bo Wang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenbo Li
- Department of Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China
| | - Panpan Ye
- Department of Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China
| | - Wen Xu
- Department of Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China
| | - Peng Liu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinhui Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhidong Cen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhiyuan Ouyang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Sheng Wu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaofeng Dou
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi Liao
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hong Zhang
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, Zhejiang, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mei Tian
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Huashan Hospital and Human Phenome Institute, Fudan University, Shanghai, China
| | - Wei Luo
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Liang K, Li X, Guo Q, Ma J, Yang H, Fan Y, Yang D, Shi X, She Z, Qi X, Gu Q, Chen S, Zheng J, Li D. Structural changes in the retina and serum HMGB1 levels are associated with decreased cognitive function in patients with Parkinson's disease. Neurobiol Dis 2024; 190:106379. [PMID: 38104911 DOI: 10.1016/j.nbd.2023.106379] [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: 10/05/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Cognitive impairment is a serious nonmotor symptom in patients with Parkinson's disease (PD). Currently, there are few studies investigating the relationship of serum markers and retinal structural changes with cognitive function in PD. OBJECTIVE To investigate the relationship between retinal structural changes, serum high mobility group box-1 (HMGB1) levels and cognitive function and motor symptoms in PD patients. METHODS Eighty-nine participants, including 47 PD patients and 42 healthy subjects, were enrolled. PD patients were divided into Parkinson's disease with normal cognitive (PD-NC), Parkinson's disease with mild cognitive impairment (PD-MCI), and Parkinson's disease with dementia (PDD) groups. The motor and nonmotor symptoms of PD patients were evaluated with clinical scale. Serum HMGB1 levels were detected by enzyme-linked immunosorbent assay (ELISA), and ganglion cell-inner plexiform layer complex (GCIPL) thickness changes in the macula were quantitatively analyzed by swept source optical coherence tomography (SS-OCT) in all patients. RESULTS Compared with the control group, the macular GCIPL (t = -2.308, P = 0.023) was thinner and serum HMGB1 (z = -2.285, P = 0.022) was increased in PD patients. Macular GCIPL thickness in patients with PD-MCI and PDD were significantly lower than that in PD-NC patients, but there were no significant difference between the PD-MCI and PDD groups. Serum HMGB1 levels in patients with PD-MCI and PDD were significantly higher than those in PD-NC patients, and serum HMGB1 levels in PDD patients were higher than those in PD-MCI patients. Correlation analysis showed that serum HMGB1 levels in PD patients were positively correlated with disease duration, HY stage, UPDRS-I score, UPDRS-III score, and UPDRS total score and negatively correlated with MOCA score. Macular GCIPL thickness was negatively correlated with HY stage and positively correlated with MOCA score, and macular GCIPL thickness was negatively correlated with serum HMGB1 level. Logistic regression analysis showed that elevated serum HMGB1 level, thinner macular GCIPL thickness, and higher HY stage were independent risk factors for Parkinson's disease with cognitive impairment (PD-CI). The areas under the receiver operating characteristic curve (AUC) for the serum HMGB1 level and macular GCIPL thickness-based diagnosis of PD-MCI, PDD and PD-CI based on in patients with PD were 0.786 and 0.825, 0.915 and 0.856, 0.852 and 0.841, respectively. The AUC for the diagnosis of PD-MCI, PDD and PD-CI with serum HMGB1 level and GCIPL thickness combined were 0.869, 0.967 and 0.916, respectively. CONCLUSION The macular GCIPL thickness and serum HMGB1 level are potential markers of cognitive impairment in PD patients, and their combination can significantly improve the accuracy of the diagnosis of cognitive impairment in PD.
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Affiliation(s)
- Keke Liang
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiaohuan Li
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Qingge Guo
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jianjun Ma
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China.
| | - Hongqi Yang
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China.
| | - Yongyan Fan
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Dawei Yang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xiaoxue Shi
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Zonghan She
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xuelin Qi
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Qi Gu
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Siyuan Chen
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jinhua Zheng
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Dongsheng Li
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
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Stulova AN, Semenova NS, Akopyan VS. [Terminology of quantitative optical coherence tomography angiography metrics]. Vestn Oftalmol 2024; 140:117-124. [PMID: 38962987 DOI: 10.17116/oftalma2024140031117] [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: 07/05/2024]
Abstract
This review is devoted to the English- and Russian-language terminology of quantitative metrics that are used in the evaluation of images obtained by optical coherence tomography angiography (OCT-A). The paper presents an analysis of the use of terms characterizing intraretinal blood flow (vascular density, perfusion density, skeletonized density, etc.), area and shape of the foveal avascular zone, and choriocapillaris blood flow. The factors causing the heterogeneity of OCT-A terminology are described, including the lack of a unified international nomenclature for OCT-A, features of their Russian translation, inconsistency of the parameters in optical coherence tomography systems of different manufacturers. The article also considers ways to standardize the terminology.
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Affiliation(s)
- A N Stulova
- Lomonosov Moscow State University, Moscow, Russia
| | - N S Semenova
- Lomonosov Moscow State University, Moscow, Russia
| | - V S Akopyan
- Lomonosov Moscow State University, Moscow, Russia
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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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Liu J, Tao W, Li D, Kwapong WR, Cao L, Zhang X, Ye C, Chen S, Liu M. Characterization of retinal microvasculature and structure in atrial fibrillation. Front Cardiovasc Med 2023; 10:1229881. [PMID: 38152608 PMCID: PMC10751341 DOI: 10.3389/fcvm.2023.1229881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/17/2023] [Indexed: 12/29/2023] Open
Abstract
Background and objective Quantitative changes in retinal microvasculature are associated with subclinical cardiac alterations and clinical cardiovascular diseases (i.e., heart failure and coronary artery disease). Nonetheless, very little is known about the retinal vascular and structural changes in patients with atrial fibrillation (AF). Our study aims to characterize the microvasculature and structure of the retina in AF patients and explore their differences in different types of AF (paroxysmal and sustained AF). Methods This cross-sectional study was conducted at the Departments of Neurology and Cardiology in West China Hospital, Chengdu, China. Individuals aged 40 years or older with a diagnosis of AF were eligible for inclusion and underwent an evaluation and diagnosis confirmation before enrollment. Control individuals aged 40 years or older and without a history of AF, ocular abnormalities/disease, or any significant systemic illness were recruited. The retinal vascular and structural parameters were assessed using swept-source optical coherence tomography (SS-OCT)/SS-OCT angiography. Echocardiographic data of left atrium (LA) diameter were collected in patients with AF at the time of inclusion. Results A total of 242 eyes of 125 participants [71 men (56.8%); mean (SD) age, 61.98 (8.73) years] with AF and 219 eyes of 111 control participants [53 men (47.7%); mean (SD) age, 62.31 (6.47) years] were analyzed. In our AF cohort, 71 patients with paroxysmal AF and 54 patients with sustained AF (i.e., persistent/permanent AF) were included. Decreased retinal microvascular perfusion (β coefficient = -0.08; 95% CI, -0.14 to -0.03) and densities (β coefficient = -1.86; 95% CI, -3.11 to -0.60) in superficial vascular plexus (SVC) were found in the eyes of the participants with AF. In regard to retinal structures, thinner ganglion cell-inner plexiform layer (GCIPL; β coefficient = -2.34; 95% CI, -4.32 to -0.36) and retinal nerve fiber layer (RNFL) thicknesses (β coefficient = -0.63; 95% CI, -2.09 to -0.18) were observed in the eyes of the participants with AF. The retinal parameters did not significantly differ between paroxysmal and sustained AF (all P > 0.05). However, significant interactions were observed between LA diameter and AF subtypes with the perfusion and densities in SVC (P < 0.05). Conclusion This study found that individuals with AF had decreased retinal vascular densities and perfusion in SVC, as well as thinner GCIPL and RNFL thickness compared with age- and sex-matched control participants. The differences of the retinal microvasculature in SVC between paroxysmal and sustained AF depend on the LA diameter. Given our findings, further longitudinal studies with our participants are of interest to investigate the natural history of retinal microvascular and structural changes in individuals across the clinical process of AF and AF subtypes.
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Affiliation(s)
- Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wendan Tao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dayan Li
- Cardiac Ultrasound Office, Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Le Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoling Zhang
- Cardiac Ultrasound Office, Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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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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Wang H, Cao L, Kwapong WR, Liu G, Wang R, Liu J, Wu B. Optic Nerve Head Changes Measured by Swept Source Optical Coherence Tomography and Angiography in Patients with Intracranial Hypertension. Ophthalmol Ther 2023; 12:3295-3305. [PMID: 37792243 PMCID: PMC10640446 DOI: 10.1007/s40123-023-00822-w] [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: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION This study explored the structural and microvascular changes in the optic nerve head (ONH) of patients with intracranial hypertension (IH) by using swept-source optical coherence tomography (SS-OCT)/OCT angiography (OCTA) and evaluated their association with clinical features. METHODS The optic disc morphology, peripapillary retinal nerve fiber layer (pRNFL), ganglion cell-inner plexiform layer (GCIPL), and microvascular densities of the nerve fiber layer plexus (NFLP), superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP) were measured by the SS-OCT/OCTA tool. Frisen score, visual acuity, and intracranial pressure were assessed and recorded in patients with IH. RESULTS Sixty-one patients with IH and 65 controls were included in this study. Patients with IH showed thicker pRNFL and GCIPL thickness with larger ONH rim area when compared to controls (P < 0.001). Microvascular densities were increased in NFLP while densities were reduced in SVP, ICP, and DCP when compared to controls (P < 0.001). Structural thickness and microvascular densities were significantly correlated with Frisen scores (P < 0.05) and intracranial pressure (P < 0.05) in patients with IH. CONCLUSION Structural and microvasculature variations of the ONH were found in patients with IH compared to controls. Importantly, we showed that structural and microvascular changes in the ONH were correlated with their Frisen score and intracranial pressure in patients with IH.
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Affiliation(s)
- Hang Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Le Cao
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - William Robert Kwapong
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Guina Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Ruilin Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
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Kwapong WR, Cao L, Pan R, Wang H, Ye C, Tao W, Liu J, Wu B. Retinal microvascular and structural changes in intracranial hypertension patients correlate with intracranial pressure. CNS Neurosci Ther 2023; 29:4093-4101. [PMID: 37287365 PMCID: PMC10651994 DOI: 10.1111/cns.14298] [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: 01/23/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
AIMS We aimed to evaluate the retinal microvascular and structural changes in intracranial hypertension (IH) patients compared with an age- and sex-matched control group. We also investigated the association between clinical parameters and retinal changes in IH patients. METHODS Intracranial hypertension patients were divided into eyes with papilledema (IH-P) and eyes without papilledema (IH-WP). IH patients underwent lumbar puncture to measure intracranial pressure (ICP); visual acuity was performed using the Snellen chart. Optical coherence tomography (OCT) was used to image and measure the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) while OCT angiography was used to image and measure the superficial vascular complex (SVC) and deep vascular complex (DVC). RESULTS Intracranial hypertension patients showed reduced microvascular densities and thinner retinal thicknesses compared with the control group (all p < 0.001). Compared with the control group, IH-P showed reduced microvascular densities and thinner retinal thicknesses (all p < 0.001). IH-P showed reduced SVC density and thinner retinal thicknesses when compared with IH-WP (p = 0.008 for SVC, p = 0.025 for RNFL, and p = 0.018 for GCIPL). ICP correlated with the microvascular densities and GCIPL thickness in IH patients (p = 0.025 for GCIPL, p = 0.004 for SVC, and p = 0.002 for DVC). A significant association of ICP with SVC (p = 0.010) and DVC (p = 0.005) densities were also found in IH-P. CONCLUSIONS Given the observed differences in these noninvasive retinal imaging markers, further research into their clinical utility in IH is needed.
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Affiliation(s)
| | - Le Cao
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Ruosu Pan
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Hang Wang
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Chen Ye
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Wendan Tao
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Junfeng Liu
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Bo Wu
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
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Romahn EF, Wiltgen T, Bussas M, Aly L, Wicklein R, Noll C, Berthele A, Dehmelt V, Mardin C, Zimmer C, Korn T, Hemmer B, Kirschke JS, Mühlau M, Knier B. Association of retinal vessel pathology and brain atrophy in relapsing-remitting multiple sclerosis. Front Immunol 2023; 14:1284986. [PMID: 38090586 PMCID: PMC10715309 DOI: 10.3389/fimmu.2023.1284986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Background Optical coherence tomography angiography (OCTA) allows non-invasive assessment of retinal vessel structures. Thinning and loss of retinal vessels is evident in eyes of patients with multiple sclerosis (MS) and might be associated with a proinflammatory disease phenotype and worse prognosis. We investigated whether changes of the retinal vasculature are linked to brain atrophy and disability in MS. Material and methods This study includes one longitudinal observational cohort (n=79) of patients with relapsing-remitting MS. Patients underwent annual assessment of the expanded disability status scale (EDSS), timed 25-foot walk, symbol digit modalities test (SDMT), retinal optical coherence tomography (OCT), OCTA, and brain MRI during a follow-up duration of at least 20 months. We investigated intra-individual associations between changes in the retinal architecture, vasculature, brain atrophy and disability. Eyes with a history of optic neuritis (ON) were excluded. Results We included 79 patients with a median disease duration of 12 (interquartile range 2 - 49) months and a median EDSS of 1.0 (0 - 2.0). Longitudinal retinal axonal and ganglion cell loss were linked to grey matter atrophy, cortical atrophy, and volume loss of the putamen. We observed an association between vessel loss of the superficial vascular complex (SVC) and both grey and white matter atrophy. Both observations were independent of retinal ganglion cell loss. Moreover, patients with worsening of the EDSS and SDMT revealed a pronounced longitudinal rarefication of the SVC and the deep vascular complex. Discussion ON-independent narrowing of the retinal vasculature might be linked to brain atrophy and disability in MS. Our findings suggest that retinal OCTA might be a new tool for monitoring neurodegeneration during MS.
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Affiliation(s)
- Eva Feodora Romahn
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Tun Wiltgen
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Matthias Bussas
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christina Noll
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Vera Dehmelt
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christian Mardin
- Department of Ophthalmology, University Hospital of Erlangen-Nuremberg, Erlangen, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Jan S. Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Wang R, Wu X, Zhang Z, Cao L, Kwapong WR, Wang H, Tao W, Ye C, Liu J, Wu B. Retinal ganglion cell-inner plexiform layer, white matter hyperintensities, and their interaction with cognition in older adults. Front Aging Neurosci 2023; 15:1240815. [PMID: 38035269 PMCID: PMC10685347 DOI: 10.3389/fnagi.2023.1240815] [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: 06/15/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose We explored the interaction of optical coherence tomography (OCT) parameters and white matter hyperintensities with cognitive measures in our older adult cohort. Methods This observational study enrolled participants who underwent a comprehensive neuropsychological battery, structural 3-T brain magnetic resonance imaging (MRI), visual acuity examination, and OCT imaging. Cerebral small vessel disease (CSVD) markers were read on MR images; lacune, cerebral microbleeds (CMB), white matter hyperintensities (WMH), and enlarged perivascular spaces (EPVS), were defined according to the STRIVE standards. Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thicknesses (μm) were measured on the OCT tool. Results Older adults with cognitive impairment (CI) showed lower RNFL (p = 0.001), GCIPL (p = 0.009) thicknesses, and lower hippocampal volume (p = 0.004) when compared to non-cognitively impaired (NCI). RNFL (p = 0.006) and GCIPL thicknesses (p = 0.032) correlated with MoCA scores. GCIPL thickness (p = 0.037), total WMH (p = 0.003), PWMH (p = 0.041), and DWMH (p = 0.001) correlated with hippocampal volume in our older adults after adjusting for covariates. With hippocampal volume as the outcome, a significant interaction (p < 0.05) between GCIPL and PWMH and total WMH was observed in our older adults. Conclusion Both GCIPL thinning and higher WMH burden (especially PWMH) are associated with hippocampal volume and older adults with both pathologies are more susceptible to subclinical cognitive decline.
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Affiliation(s)
- Ruilin Wang
- Ophthalmology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Xinmao Wu
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Zengyi Zhang
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Le Cao
- Ophthalmology Department, West China Hospital, Sichuan University, Chengdu, China
| | | | - Hang Wang
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Wendan Tao
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Junfeng Liu
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
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Wicklein R, Yam C, Noll C, Aly L, Banze N, Romahn EF, Wolf E, Hemmer B, Oertel FC, Zimmermann H, Albrecht P, Ringelstein M, Baumann C, Feucht N, Penkava J, Havla J, Gernert JA, Mardin C, Vasileiou ES, Van Der Walt A, Al-Louzi O, Cabello S, Vidal-Jordana A, Krämer J, Wiendl H, Preiningerova JL, Ciccarelli O, Garcia-Martin E, Kana V, Calabresi PA, Paul F, Saidha S, Petzold A, Toosy AT, Knier B. The OSCAR-MP Consensus Criteria for Quality Assessment of Retinal Optical Coherence Tomography Angiography. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200169. [PMID: 37813596 PMCID: PMC10574825 DOI: 10.1212/nxi.0000000000200169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Optical coherence tomography angiography (OCTA) is a noninvasive high-resolution imaging technique for assessing the retinal vasculature and is increasingly used in various ophthalmologic, neuro-ophthalmologic, and neurologic diseases. To date, there are no validated consensus criteria for quality control (QC) of OCTA. Our study aimed to develop criteria for OCTA quality assessment. METHODS To establish criteria through (1) extensive literature review on OCTA artifacts and image quality to generate standardized and easy-to-apply OCTA QC criteria, (2) application of OCTA QC criteria to evaluate interrater agreement, (3) identification of reasons for interrater disagreement, revision of OCTA QC criteria, development of OCTA QC scoring guide and training set, and (4) validation of QC criteria in an international, interdisciplinary multicenter study. RESULTS We identified 7 major aspects that affect OCTA quality: (O) obvious problems, (S) signal strength, (C) centration, (A) algorithm failure, (R) retinal pathology, (M) motion artifacts, and (P) projection artifacts. Seven independent raters applied the OSCAR-MP criteria to a set of 40 OCTA scans from people with MS, Sjogren syndrome, and uveitis and healthy individuals. The interrater kappa was substantial (κ 0.67). Projection artifacts were the main reason for interrater disagreement. Because artifacts can affect only parts of OCTA images, we agreed that prior definition of a specific region of interest (ROI) is crucial for subsequent OCTA quality assessment. To enhance artifact recognition and interrater agreement on reduced image quality, we designed a scoring guide and OCTA training set. Using these educational tools, 23 raters from 14 different centers reached an almost perfect agreement (κ 0.92) for the rejection of poor-quality OCTA images using the OSCAR-MP criteria. DISCUSSION We propose a 3-step approach for standardized quality control: (1) To define a specific ROI, (2) to assess the occurrence of OCTA artifacts according to the OSCAR-MP criteria, and (3) to evaluate OCTA quality based on the occurrence of different artifacts within the ROI. OSCAR-MP OCTA QC criteria achieved high interrater agreement in an international multicenter study and is a promising QC protocol for application in the context of future clinical trials and studies.
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Affiliation(s)
- Rebecca Wicklein
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Charmaine Yam
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Christina Noll
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Lilian Aly
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Nicolas Banze
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Eva Feodora Romahn
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Elisabeth Wolf
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Bernhard Hemmer
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Frederike C Oertel
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Hanna Zimmermann
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Philipp Albrecht
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Marius Ringelstein
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Carmen Baumann
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Nikolaus Feucht
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Josef Penkava
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Joachim Havla
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Jonathan A Gernert
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Christian Mardin
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Eleni S Vasileiou
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Anneke Van Der Walt
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Omar Al-Louzi
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Sergio Cabello
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Angela Vidal-Jordana
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Julia Krämer
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Heinz Wiendl
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Jana Lizrova Preiningerova
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Olga Ciccarelli
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Elena Garcia-Martin
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Veronika Kana
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Peter A Calabresi
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Friedemann Paul
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Shiv Saidha
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Axel Petzold
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Ahmed T Toosy
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Benjamin Knier
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands.
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Bostan M, Li C, Sim YC, Bujor I, Wong D, Tan B, Ismail MB, Garhöfer G, Tiu C, Pirvulescu R, Schmetterer L, Popa-Cherecheanu A, Chua J. Combining retinal structural and vascular measurements improves discriminative power for multiple sclerosis patients. Ann N Y Acad Sci 2023; 1529:72-83. [PMID: 37656135 DOI: 10.1111/nyas.15060] [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] [Indexed: 09/02/2023]
Abstract
Data on how retinal structural and vascular parameters jointly influence the diagnostic performance of detection of multiple sclerosis (MS) patients without optic neuritis (MSNON) are lacking. To investigate the diagnostic performance of structural and vascular changes to detect MSNON from controls, we performed a cross-sectional study of 76 eyes from 51 MS participants and 117 eyes from 71 healthy controls. Retinal macular ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) thicknesses, and capillary densities from the superficial (SCP) and deep capillary plexuses (DCP) were obtained from the Cirrus AngioPlex. The best structural parameter for detecting MS was compensated RNFL from the optic nerve head (AUC = 0.85), followed by GCC from the macula (AUC = 0.79), while the best vascular parameter was the SCP (AUC = 0.66). Combining structural and vascular parameters improved the diagnostic performance for MS detection (AUC = 0.90; p<0.001). Including both structure and vasculature in the joint model considerably improved the discrimination between MSNON and normal controls compared to each parameter separately (p = 0.027). Combining optical coherence tomography (OCT)-derived structural metrics and vascular measurements from optical coherence tomography angiography (OCTA) improved the detection of MSNON. Further studies may be warranted to evaluate the clinical utility of OCT and OCTA parameters in the prediction of disease progression.
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Affiliation(s)
- Mihai Bostan
- Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Ophthalmology Emergency Hospital, Bucharest, Romania
| | - Chi Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Computer Science and Engineering, Nanyang Technological University, Singapore
| | - Yin Ci Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Inna Bujor
- Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
| | - Munirah Binte Ismail
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Cristina Tiu
- Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurology, Emergency University Hospital, Bucharest, Romania
| | - Ruxandra Pirvulescu
- Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Alina Popa-Cherecheanu
- Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
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46
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Wagner SK, Romero-Bascones D, Cortina-Borja M, Williamson DJ, Struyven RR, Zhou Y, Patel S, Weil RS, Antoniades CA, Topol EJ, Korot E, Foster PJ, Balaskas K, Ayala U, Barrenechea M, Gabilondo I, Schapira AHV, Khawaja AP, Patel PJ, Rahi JS, Denniston AK, Petzold A, Keane PA. Retinal Optical Coherence Tomography Features Associated With Incident and Prevalent Parkinson Disease. Neurology 2023; 101:e1581-e1593. [PMID: 37604659 PMCID: PMC10585674 DOI: 10.1212/wnl.0000000000207727] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cadaveric studies have shown disease-related neurodegeneration and other morphological abnormalities in the retina of individuals with Parkinson disease (PD); however, it remains unclear whether this can be reliably detected with in vivo imaging. We investigated inner retinal anatomy, measured using optical coherence tomography (OCT), in prevalent PD and subsequently assessed the association of these markers with the development of PD using a prospective research cohort. METHODS This cross-sectional analysis used data from 2 studies. For the detection of retinal markers in prevalent PD, we used data from AlzEye, a retrospective cohort of 154,830 patients aged 40 years and older attending secondary care ophthalmic hospitals in London, United Kingdom, between 2008 and 2018. For the evaluation of retinal markers in incident PD, we used data from UK Biobank, a prospective population-based cohort where 67,311 volunteers aged 40-69 years were recruited between 2006 and 2010 and underwent retinal imaging. Macular retinal nerve fiber layer (mRNFL), ganglion cell-inner plexiform layer (GCIPL), and inner nuclear layer (INL) thicknesses were extracted from fovea-centered OCT. Linear mixed-effects models were fitted to examine the association between prevalent PD and retinal thicknesses. Hazard ratios for the association between time to PD diagnosis and retinal thicknesses were estimated using frailty models. RESULTS Within the AlzEye cohort, there were 700 individuals with prevalent PD and 105,770 controls (mean age 65.5 ± 13.5 years, 51.7% female). Individuals with prevalent PD had thinner GCIPL (-2.12 μm, 95% CI -3.17 to -1.07, p = 8.2 × 10-5) and INL (-0.99 μm, 95% CI -1.52 to -0.47, p = 2.1 × 10-4). The UK Biobank included 50,405 participants (mean age 56.1 ± 8.2 years, 54.7% female), of whom 53 developed PD at a mean of 2,653 ± 851 days. Thinner GCIPL (hazard ratio [HR] 0.62 per SD increase, 95% CI 0.46-0.84, p = 0.002) and thinner INL (HR 0.70, 95% CI 0.51-0.96, p = 0.026) were also associated with incident PD. DISCUSSION Individuals with PD have reduced thickness of the INL and GCIPL of the retina. Involvement of these layers several years before clinical presentation highlight a potential role for retinal imaging for at-risk stratification of PD.
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Affiliation(s)
- Siegfried Karl Wagner
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom.
| | - David Romero-Bascones
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Mario Cortina-Borja
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Dominic J Williamson
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Robbert R Struyven
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Yukun Zhou
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Salil Patel
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Rimona S Weil
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Chrystalina A Antoniades
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Eric J Topol
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Edward Korot
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Paul J Foster
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Konstantinos Balaskas
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Unai Ayala
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Maitane Barrenechea
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Iñigo Gabilondo
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Anthony H V Schapira
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Anthony P Khawaja
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Praveen J Patel
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Jugnoo S Rahi
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Alastair K Denniston
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Axel Petzold
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Pearse Andrew Keane
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
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Wang X, Zhang Y, Ma Y, Kwapong WR, Ying J, Lu J, Ma S, Yan Q, Yi Q, Zhao Y. Automated evaluation of retinal hyperreflective foci changes in diabetic macular edema patients before and after intravitreal injection. Front Med (Lausanne) 2023; 10:1280714. [PMID: 37869163 PMCID: PMC10587607 DOI: 10.3389/fmed.2023.1280714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose Fast and automated reconstruction of retinal hyperreflective foci (HRF) is of great importance for many eye-related disease understanding. In this paper, we introduced a new automated framework, driven by recent advances in deep learning to automatically extract 12 three-dimensional parameters from the segmented hyperreflective foci in optical coherence tomography (OCT). Methods Unlike traditional convolutional neural networks, which struggle with long-range feature correlations, we introduce a spatial and channel attention module within the bottleneck layer, integrated into the nnU-Net architecture. Spatial Attention Block aggregates features across spatial locations to capture related features, while Channel Attention Block heightens channel feature contrasts. The proposed model was trained and tested on 162 retinal OCT volumes of patients with diabetic macular edema (DME), yielding robust segmentation outcomes. We further investigate HRF's potential as a biomarker of DME. Results Results unveil notable discrepancies in the amount and volume of HRF subtypes. In the whole retinal layer (WR), the mean distance from HRF to the retinal pigmented epithelium was significantly reduced after treatment. In WR, the improvement in central macular thickness resulting from intravitreal injection treatment was positively correlated with the mean distance from HRF subtypes to the fovea. Conclusion Our study demonstrates the applicability of OCT for automated quantification of retinal HRF in DME patients, offering an objective, quantitative approach for clinical and research applications.
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Affiliation(s)
- Xingguo Wang
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, China
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Yanyan Zhang
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
| | - Yuhui Ma
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | | | - Jianing Ying
- Health Science Center, Ningbo University, Ningbo, China
| | - Jiayi Lu
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, China
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Shaodong Ma
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Qifeng Yan
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Quanyong Yi
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
| | - Yitian Zhao
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, China
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
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Huang SC, Pisa M, Guerrieri S, Dalla Costa G, Comi G, Leocani L. Optical coherence tomography with voxel-based morphometry: a new tool to unveil focal retinal neurodegeneration in multiple sclerosis. Brain Commun 2023; 6:fcad249. [PMID: 38328398 PMCID: PMC10847824 DOI: 10.1093/braincomms/fcad249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/25/2023] [Accepted: 09/25/2023] [Indexed: 02/09/2024] Open
Abstract
Neurodegeneration is the main contributor to disability accumulation in multiple sclerosis. Previous studies in neuro-ophthalmology have revealed that neurodegeneration in multiple sclerosis also affects the neuro-retina. Optical coherence tomography has been used to measure thinning of retinal layers, which correlates with several other markers for axonal/neuronal loss in multiple sclerosis. However, the existing analytical tools have limitations in terms of sensitivity and do not provide topographical information. In this study, we aim to evaluate whether voxel-based morphometry can increase sensitivity in detecting neuroaxonal degeneration in the retina and offer topographical information. A total of 131 people with multiple sclerosis (41 clinically isolated syndrome, 53 relapsing-remitting and 37 progressive multiple sclerosis) and 50 healthy subjects were included. Only eyes with normal global peripapillary retinal nerve fibre layer thickness and no history of optic neuritis were considered. Voxel-based morphometry and voxel-wise statistical comparisons were performed on the following: (i) patients at different disease stages and 2) patients who experienced the first demyelination attack without subclinical optic neuritis, assessed by visual evoked potentials. Standard parameters failed to discern any differences; however, voxel-based morphometry-optical coherence tomography successfully detected focal macular atrophy of retinal nerve fibre layer and ganglion cell/inner plexiform layer, along with thickening of inner nuclear layer in patients who experienced the first demyelination attack (disease duration = 4.2 months). Notably, the atrophy pattern of the ganglion cell/inner plexiform layer was comparable across disease phenotypes. In contrast, the retinal nerve fibre layer atrophy spread from the optic nerve head to the fovea as the disease evolved towards the progressive phase. Furthermore, for patients who experienced the first neurological episode, the severity of retinal nerve fibre layer atrophy at entry could predict a second attack. Our results demonstrate that voxel-based morphometry-optical coherence tomography exhibits greater sensitivity than standard parameters in detecting focal retinal atrophy, even at clinical presentation, in eyes with no history of optic neuritis and with normal latency of visual evoked potentials. Thinning of the ganglion cell/inner plexiform layer primarily concentrated in nasal perifovea in all disease phenotypes, indicating selective vulnerability of retinal ganglion cells and their perifoveal axons. Conversely, the degree of retinal nerve fibre layer thinning seems to be related to the clinical course of multiple sclerosis. The findings suggest bidirectional neurodegeneration in the visual pathway. Voxel-based morphometry-optical coherence tomography shows potential as a valuable tool for monitoring neurodegeneration on a patient level and evaluating the efficacy of novel neuroprotective treatments.
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Affiliation(s)
- Su-Chun Huang
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan 20132, Italy
| | - Marco Pisa
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan 20132, Italy
| | - Simone Guerrieri
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan 20132, Italy
| | - Gloria Dalla Costa
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan 20132, Italy
| | - Giancarlo Comi
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan 20132, Italy
- Department of Neurorehabilitation Science, Casa di Cura Igea, Milan 20144, Italy
| | - Letizia Leocani
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan 20132, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan 20132, Italy
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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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Cao L, Wang H, Kwapong WR, Wang R, Liu J, Wu B. Length of Carotid Plaque Impacts Retinal Microvascular Densities of Carotid Artery Stenosis Patients. Transl Vis Sci Technol 2023; 12:3. [PMID: 37672253 PMCID: PMC10484014 DOI: 10.1167/tvst.12.9.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Purpose We explored the retinal microvascular changes in carotid artery stenosis (CAS) and their relationship with carotid plaque morphology. Methods All participants were diagnosed with carotid artery stenosis by a neurologist. Participants underwent digital subtraction angiography (DSA) and optical coherence tomography angiography (OCTA) imaging. The degree and length of carotid plaque were obtained from the DSA tool. OCTA tool measured the densities in the superficial vascular complex (SVC) and deep vascular complex (DVC). Results One hundred seventeen patients with CAS patients were included in our data analysis. Eyes with ipsilateral stenosis had reduced retinal microvascular densities when compared to contralateral eyes in patients with CAS (P = 0.016 for SVC, and P = 0.004 for DVC). Microvascular densities correlated with the length of carotid plaque (P = 0.015 for SVC, and P = 0.022 for DVC) in our CAS cohort, although they did not correlate with the degree of carotid plaque (P = 0.264 for SVC, and P = 0.298 for DVC). However, when stratified into moderate and severe subgroups, the degree of carotid plaque correlated with microvascular densities in patients with severe stenosis (P = 0.045 for SVC, and P = 0.038 for DVC). Conclusions Our study suggests that OCTA can noninvasively detect retinal microvascular changes in patients with CAS and that these changes correlated with the length of the stenosis, but future studies are required to confirm these findings. Translational Relevance Noninvasive and rapid acquisition of the OCTA image might have the potential to be used as a screening tool to detect microvascular changes in carotid artery stenosis.
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Affiliation(s)
- Le Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hang Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - William Robert Kwapong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruilin Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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