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Nguyen MNL, Zhu C, Kolbe SC, Butzkueven H, White OB, Fielding J, Kilpatrick TJ, Egan GF, Klistorner A, van der Walt A. Early predictors of visual and axonal outcomes after acute optic neuritis. Front Neurol 2022; 13:945034. [PMID: 36158958 PMCID: PMC9493016 DOI: 10.3389/fneur.2022.945034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background Predicting long-term visual outcomes and axonal loss following acute optic neuritis (ON) is critical for choosing treatment. Predictive models including all clinical and paraclinical measures of optic nerve dysfunction following ON are lacking. Objectives Using a prospective study method, to identify 1 and 3 months predictors of 6 and 12 months visual outcome (low contrast letter acuity 2.5%) and axonal loss [retinal nerve fiber layer thickness and multifocal evoked potential (mfVEP) amplitude] following acute ON. Methods In total, 37 patients of acute ON onset were evaluated within 14 days using between-eye asymmetry of visual acuity, color vision (Ishihara plates), optical coherence tomography, mfVEP, and optic nerve magnetic resonance imaging [magnetic transfer ratio (MTR) and diffusion tensor imaging (DTI)]. Results Visual outcome at 6 and 12 months was best predicted by Ishihara asymmetry at 1 and 3 months following ON onset. Axonal loss at 6 and 12 months was reliably predicted by Ishihara asymmetry at 1 month. Optic nerve MTR and DTI at 3 months post-acute ON could predict axonal loss at 6 and 12 months. Conclusions Simple Ishihara asymmetry testing 1 month after acute ON onset can best predict visual outcome and axonal loss at 6 and 12 months in a clinical or research setting.
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Affiliation(s)
- Minh N. L. Nguyen
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Chao Zhu
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Scott C. Kolbe
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Owen B. White
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
| | | | - Gary F. Egan
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| | | | - Anneke van der Walt
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
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The Evaluation of Optic Nerves Using 7 Tesla "Silent" Zero Echo Time Imaging in Patients with Leber's Hereditary Optic Neuropathy with or without Idebenone Treatment. J Clin Med 2020; 9:jcm9041112. [PMID: 32295018 PMCID: PMC7230870 DOI: 10.3390/jcm9041112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022] Open
Abstract
Magnetic Resonance Imaging (MRI) of the Optic Nerve is difficult due to the fine extended nature of the structure, strong local magnetic field distortions induced by anatomy, and large motion artefacts associated with eye movement. To address these problems we used a Zero Echo Time (ZTE) MRI sequence with an Adiabatic SPectral Inversion Recovery (ASPIR) fat suppression pulse which also imbues the images with Magnetisation Transfer contrast. We investigated an application of the sequence for imaging the optic nerve in subjects with Leber's hereditary optic neuropathy (LHON). Of particular note is the sequence's near-silent operation, which can enhance image quality of the optic nerve by reducing the occurrence of involuntary saccades induced during Magnetic Resonance (MR) scanning.
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Visual Evoked Potentials as a Biomarker in Multiple Sclerosis and Associated Optic Neuritis. J Neuroophthalmol 2020; 38:350-357. [PMID: 30106802 DOI: 10.1097/wno.0000000000000704] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
: ABSTRACT:: Multiple sclerosis (MS) is an inflammatory, degenerative disease of the central nervous system (CNS) characterized by progressive neurological decline over time. The need for better "biomarkers" to more precisely capture and track the effects of demyelination, remyelination, and associated neuroaxonal injury is a well-recognized challenge in the field of MS. To this end, visual evoked potentials (VEPs) have a role in assessing the extent of demyelination along the optic nerve, as a functionally eloquent CNS region. Moreover, VEPs testing can be used to predict the extent of recovery after optic neuritis (ON) and capture disabling effects of clinical and subclinical demyelination events in the afferent visual pathway. In this review, the evolving role of VEPs in the diagnosis of patients with ON and MS and the utility of VEPs testing in determining therapeutic benefits of emerging MS treatments is discussed.
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Pihl-Jensen G, Schmidt MF, Frederiksen JL. Multifocal visual evoked potentials in optic neuritis and multiple sclerosis: A review. Clin Neurophysiol 2017; 128:1234-1245. [PMID: 28531809 DOI: 10.1016/j.clinph.2017.03.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/21/2022]
Abstract
Multifocal visual evoked potential (mf-VEP) represents a new approach to the classical full field (ff-)VEP with separate responses from up to 60 sectors of the visual field. A thorough literature survey of the use of mf-VEP in optic neuritis (ON) and multiple sclerosis (MS) is presented (38 published studies were retrieved). Mf-VEP provides direct topographical information of specific lesions and facilitates investigations on structural-functional correlations thus providing new methods for exploring the interplay between demyelination, atrophy and remyelination in MS. Good correlation was shown between mf-VEP and OCT, ff-VEP, MRI (MTR, DTI), 30-2 standard automated perimetry and low-contrast-visual acuity. All but one study showed superior sensitivity and specificity compared to ff-VEP, especially with regards to small, peripheral lesions or lesions of the upper visual field. Mf-VEP has shown superior sensitivity and specificity than established methods in diagnosing optic nerve lesions and tracking functional recovery following lesions. Abnormal mf-VEP responses in the fellow, non-ON afflicted eye may predict MS risk in ON patients. No standardization currently exists and no direct comparisons in ON and MS between at least 5 different commercially available mf-VEP systems have so far been published. Despite these limitations, mf-VEP is a promising new tool of diagnostic and prognostic value of mf-VEP in ON and MS.
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Affiliation(s)
- Gorm Pihl-Jensen
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
| | - Mathias Falck Schmidt
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
| | - Jette Lautrup Frederiksen
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
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Galetta SL, Villoslada P, Levin N, Shindler K, Ishikawa H, Parr E, Cadavid D, Balcer LJ. Acute optic neuritis: Unmet clinical needs and model for new therapies. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e135. [PMID: 26236761 PMCID: PMC4516397 DOI: 10.1212/nxi.0000000000000135] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/13/2015] [Indexed: 01/22/2023]
Abstract
Idiopathic demyelinating optic neuritis (ON) most commonly presents as acute unilateral vision loss and eye pain and is frequently associated with multiple sclerosis. Although emphasis is often placed on the good recovery of high-contrast visual acuity, persistent deficits are frequently observed in other aspects of vision, including contrast sensitivity, visual field testing, color vision, motion perception, and vision-related quality of life. Persistent and profound structural and functional changes are often revealed by imaging and electrophysiologic techniques, including optical coherence tomography, visual-evoked potentials, and nonconventional MRI. These abnormalities can impair patients' abilities to perform daily activities (e.g., driving, working) so they have important implications for patients' quality of life. In this article, we review the sequelae from ON, including clinical, structural, and functional changes and their interrelationships. The unmet needs in each of these areas are considered and the progress made toward meeting those needs is examined. Finally, we provide an overview of past and present investigational approaches for disease modification in ON.
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Affiliation(s)
- Steven L Galetta
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Pablo Villoslada
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Netta Levin
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Kenneth Shindler
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Hiroshi Ishikawa
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Edward Parr
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Diego Cadavid
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Laura J Balcer
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
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Berg S, Kaschka I, Utz KS, Huhn K, Lämmer A, Lämmer R, Waschbisch A, Kloska S, Lee DH, Doerfler A, Linker RA. Baseline magnetic resonance imaging of the optic nerve provides limited predictive information on short-term recovery after acute optic neuritis. PLoS One 2015; 10:e0113961. [PMID: 25635863 PMCID: PMC4312052 DOI: 10.1371/journal.pone.0113961] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 11/03/2014] [Indexed: 11/29/2022] Open
Abstract
Background In acute optic neuritis, magnetic resonance imaging (MRI) may help to confirm the diagnosis as well as to exclude alternative diagnoses. Yet, little is known on the value of optic nerve imaging for predicting clinical symptoms or therapeutic outcome. Purpose To evaluate the benefit of optic nerve MRI for predicting response to appropriate therapy and recovery of visual acuity. Methods Clinical data as well as visual evoked potentials (VEP) and MRI results of 104 patients, who were treated at the Department of Neurology with clinically definite optic neuritis between December 2010 and September 2012 were retrospectively reviewed including a follow up within 14 days. Results Both length of the Gd enhancing lesion (r = -0.38; p = 0.001) and the T2 lesion (r = -0.25; p = 0.03) of the optic nerve in acute optic neuritis showed a medium correlation with visual acuity after treatment. Although visual acuity pre-treatment was little but nonsignificantly lower if Gd enhancement of the optic nerve was detected via orbital MRI, improvement of visual acuity after adequate therapy was significantly better (0.40 vs. 0.24; p = 0.04). Intraorbitally located Gd enhancing lesions were associated with worse visual improvement compared to canalicular, intracranial and chiasmal lesions (0.35 vs. 0.54; p = 0.02). Conclusion Orbital MRI is a broadly available, valuable tool for predicting the improvement of visual function. While the accurate individual prediction of long-term outcomes after appropriate therapy still remains difficult, lesion length of Gd enhancement and T2 lesion contribute to its prediction and a better short-term visual outcome may be associated with detection and localization of Gd enhancement along the optic nerve.
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Affiliation(s)
- Sebastian Berg
- Department of Neurology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Iris Kaschka
- Department of Neuroradiology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Kathrin S. Utz
- Department of Neurology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Konstantin Huhn
- Department of Neurology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexandra Lämmer
- Department of Neurology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Robert Lämmer
- Department of Ophthalmology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Anne Waschbisch
- Department of Neurology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephan Kloska
- Department of Neuroradiology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - De-Hyung Lee
- Department of Neurology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf A. Linker
- Department of Neurology, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
- * E-mail:
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Balcer LJ, Miller DH, Reingold SC, Cohen JA. Vision and vision-related outcome measures in multiple sclerosis. Brain 2015; 138:11-27. [PMID: 25433914 PMCID: PMC4285195 DOI: 10.1093/brain/awu335] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/14/2014] [Accepted: 10/29/2014] [Indexed: 12/22/2022] Open
Abstract
Visual impairment is a key manifestation of multiple sclerosis. Acute optic neuritis is a common, often presenting manifestation, but visual deficits and structural loss of retinal axonal and neuronal integrity can occur even without a history of optic neuritis. Interest in vision in multiple sclerosis is growing, partially in response to the development of sensitive visual function tests, structural markers such as optical coherence tomography and magnetic resonance imaging, and quality of life measures that give clinical meaning to the structure-function correlations that are unique to the afferent visual pathway. Abnormal eye movements also are common in multiple sclerosis, but quantitative assessment methods that can be applied in practice and clinical trials are not readily available. We summarize here a comprehensive literature search and the discussion at a recent international meeting of investigators involved in the development and study of visual outcomes in multiple sclerosis, which had, as its overriding goals, to review the state of the field and identify areas for future research. We review data and principles to help us understand the importance of vision as a model for outcomes assessment in clinical practice and therapeutic trials in multiple sclerosis.
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Affiliation(s)
- Laura J Balcer
- 1 Departments of Neurology, Ophthalmology and Population Health, New York University School of Medicine, NY 10016, USA
| | - David H Miller
- 2 Queen Square MS Centre, UCL Institute of Neurology, London, WC1N 3BG, UK
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Rossi S, Motta C, Studer V, Rocchi C, Macchiarulo G, Barbieri F, Marfia GA, Furlan R, Martino G, Mancino R, Centonze D. Interleukin-8 is associated with acute and persistent dysfunction after optic neuritis. Mult Scler 2014; 20:1841-50. [DOI: 10.1177/1352458514537365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Acute optic neuritis is often in association with multiple sclerosis (MS). Proinflammatory cytokines trigger neuronal damage in neuroinflammatory disorders but their role in optic neuritis is poorly investigated. Objective: The objective of this work is to investigate the associations of intrathecal contents of proinflammatory cytokines with transient and persistent dysfunctions after optic neuritis. Methods: In 50 MS patients followed for up to six months, cerebrospinal fluid (CSF) levels of IL-1β, TNF and IL-8 were determined, along with clinical, neurophysiological and morphological measures of optic neuritis severity. Results: Visual impairment, measured by high- and low-contrast visual acuity, and delayed visual-evoked potential (VEP) latencies were significantly correlated to IL-8 levels during optic neuritis. IL-8 at the time of optic neuritis was also associated with persistent demyelination and final axonal loss, inferred by VEP and optical coherence tomography measures, respectively. Contents of IL-8 were correlated to functional visual outcomes, being higher among patients with incomplete recovery. Multivariate analysis confirmed that IL-8 significantly predicted final visual acuity, at equal values of demographics and baseline visual scores. Conclusion: Our study points to IL-8 as the main inflammatory cytokine associated with demyelination and secondary neurodegeneration in the optic nerve after optic neuritis.
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Affiliation(s)
- S Rossi
- Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy/Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Italy
| | - C Motta
- Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy/Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Italy
| | - V Studer
- Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy/Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Italy
| | - C Rocchi
- Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy
| | - G Macchiarulo
- Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy/Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Italy
| | - F Barbieri
- Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy/Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Italy
| | - GA Marfia
- Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy
| | - R Furlan
- Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - G Martino
- Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - R Mancino
- Clinica Oculistica, Dipartimento di Biopatologia, Università Tor Vergata, Italy
| | - D Centonze
- Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy/Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Italy
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van der Walt A, Kolbe SC, Wang YE, Klistorner A, Shuey N, Ahmadi G, Paine M, Marriott M, Mitchell P, Egan GF, Butzkueven H, Kilpatrick TJ. Optic nerve diffusion tensor imaging after acute optic neuritis predicts axonal and visual outcomes. PLoS One 2013; 8:e83825. [PMID: 24386285 PMCID: PMC3873392 DOI: 10.1371/journal.pone.0083825] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 11/08/2013] [Indexed: 11/30/2022] Open
Abstract
Background Early markers of axonal and clinical outcomes are required for early phase testing of putative neuroprotective therapies for multiple sclerosis (MS). Objectives To assess whether early measurement of diffusion tensor imaging (DTI) parameters (axial and radial diffusivity) within the optic nerve during and after acute demyelinating optic neuritis (ON) could predict axonal (retinal nerve fibre layer thinning and multi-focal visual evoked potential amplitude reduction) or clinical (visual acuity and visual field loss) outcomes at 6 or 12 months. Methods Thirty-seven patients presenting with acute, unilateral ON were studied at baseline, one, three, six and 12 months using optic nerve DTI, clinical and paraclinical markers of axonal injury and clinical visual dysfunction. Results Affected nerve axial diffusivity (AD) was reduced at baseline, 1 and 3 months. Reduced 1-month AD correlated with retinal nerve fibre layer (RNFL) thinning at 6 (R=0.38, p=0.04) and 12 months (R=0.437, p=0.008) and VEP amplitude loss at 6 (R=0.414, p=0.019) and 12 months (R=0.484, p=0.003). AD reduction at three months correlated with high contrast visual acuity at 6 (ρ = -0.519, p = 0.001) and 12 months (ρ = -0.414, p=0.011). The time-course for AD reduction for each patient was modelled using a quadratic regression. AD normalised after a median of 18 weeks and longer normalisation times were associated with more pronounced RNFL thinning and mfVEP amplitude loss at 12 months. Affected nerve radial diffusivity (RD) was unchanged until three months, after which time it remained elevated. Conclusions These results demonstrate that AD reduces during acute ON. One month AD reduction correlates with the extent of axonal loss and persistent AD reduction at 3 months predicts poorer visual outcomes. This suggests that acute ON therapies that normalise optic nerve AD by 3 months could also promote axon survival and improve visual outcomes.
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Affiliation(s)
- Anneke van der Walt
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neuro-ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Scott C. Kolbe
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Victoria, Australia
| | - Yejun E. Wang
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Neil Shuey
- Department of Neuro-ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Gelareh Ahmadi
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Paine
- Department of Neuro-ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Mark Marriott
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter Mitchell
- Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Gary F. Egan
- Monash University, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Trevor J. Kilpatrick
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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