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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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Fanlo-Zarazaga A, Echevarría JI, Pinilla J, Alejandre A, Pérez-Roche T, Gutiérrez D, Ortín M, Pueyo V. Validation of a New Digital and Automated Color Perception Test. Diagnostics (Basel) 2024; 14:396. [PMID: 38396435 PMCID: PMC10888327 DOI: 10.3390/diagnostics14040396] [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: 12/15/2023] [Revised: 01/21/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Although color vision deficiencies are very prevalent, there are no ideal methods for assessing color vision in all environments. We compared a new digital and automated method that quantifies color perception for the three protan, deutan, and tritan axes with two of the most commonly used color tests in daily practice: the Ishihara 38 plates test and the Farnsworth-Munsell 100-Hue test. One hundred patients underwent a triple examination composed of the new DIVE Color Test, the Ishihara test, and the Farnsworth-Munsell 100-Hue test. The DIVE Color Test was performed twice in forty participants to assess its repeatability. In the trichromatic group, the mean age stood at 20.57 ± 9.22 years compared with 25.99 ± 15.86 years in the dyschromatic group. The DIVE and Ishihara tests exhibited excellent agreement in identifying participants with color deficiency (Cohen's kappa = 1.00), while it was 0.81 when comparing DIVE and Farnsworth. The correlation between the global perception values of Farnsworth (TES) and DIVE (GCS) was 0.80. The repeatability of the DIVE Color Test was high according to Bland-Altman analysis with an intraclass correlation coefficient of 0.83. According to Ishihara, the DIVE Color Test proved to be an effective and reproducible tool for red-green color vision deficiency detection, capable of determining the severity of the defect in each of the three axes faster and more accurately than both Ishihara and Farnsworth.
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Affiliation(s)
- Alvaro Fanlo-Zarazaga
- Ophthalmology Department, Miguel Servet University Hospital, Isabel la Católica, 3, 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), San Juan Bosco 13, 50009 Zaragoza, Spain
- DIVE Medical S.L., Paseo Miramón 170, 20014 San Sebastián, Spain
| | - José Ignacio Echevarría
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, María de Luna 1, 50018 Zaragoza, Spain
| | - Juan Pinilla
- Ophthalmology Department, Miguel Servet University Hospital, Isabel la Católica, 3, 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Adrián Alejandre
- DIVE Medical S.L., Paseo Miramón 170, 20014 San Sebastián, Spain
| | - Teresa Pérez-Roche
- Ophthalmology Department, Miguel Servet University Hospital, Isabel la Católica, 3, 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Diego Gutiérrez
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, María de Luna 1, 50018 Zaragoza, Spain
| | - Marta Ortín
- DIVE Medical S.L., Paseo Miramón 170, 20014 San Sebastián, Spain
| | - Victoria Pueyo
- Ophthalmology Department, Miguel Servet University Hospital, Isabel la Católica, 3, 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), San Juan Bosco 13, 50009 Zaragoza, Spain
- Department of Microbiology, Pediatrics, Radiology and Public Health, Faculty of Medicine, University of Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain
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Ocular and inflammatory markers associated with Gulf War illness symptoms. Sci Rep 2023; 13:3512. [PMID: 36864130 PMCID: PMC9981620 DOI: 10.1038/s41598-023-30544-9] [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: 12/11/2022] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
To examine the utility of ocular coherence tomography (OCT) metrics, in conjunction with systemic markers of inflammation, in identifying individuals with Gulf War Illness (GWI) symptoms. Prospective case-control study of 108 Gulf War Era veterans, split into 2 groups based on the presence of GWI symptoms, defined by the Kansas criteria. Information on demographics, deployment history, and co-morbidities were captured. 101 individuals underwent OCT imaging and 105 individuals provided a blood sample which was analyzed for inflammatory cytokines using an enzyme-linked immunosorbent assay-based chemiluminescent assay. The main outcome measure was predictors of GWI symptoms, examined with multivariable forward stepwise logistic regression analysis followed by receiver operating characteristic (ROC) analysis. The mean age of the population was 55 ± 4, 90.7% self-identified as male, 53.3% as White, and 54.3% as Hispanic. A multivariable model that considered demographics and co-morbidities found that a lower inferior temporal ganglion cell layer-inner plexiform layer (GCL‒IPL) thickness, higher temporal nerve fiber layer (NFL) thickness, lower interleukin (IL)-1β levels, higher IL-1α levels, and lower tumor necrosis factor-receptor I levels correlated with GWI symptoms. ROC analysis demonstrated an area under the curve of 0.78 with the best cut-off value for the prediction model having a sensitivity of 83% and specificity of 58%. RNFL and GCL‒IPL measures, namely increased temporal thickness and decreased inferior temporal thickness, respectively, in conjunction with a number of inflammatory cytokines, had a reasonable sensitivity for the diagnosis of GWI symptoms in our population.
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Barreiro-González A, Sanz MT, Carratalà-Boscà S, Pérez-Miralles F, Alcalá C, España-Gregori E, Casanova B. Dyschromatopsia in multiple sclerosis reflects diffuse chronic neurodegeneration beyond anatomical landmarks. Acta Neurol Belg 2021; 121:1767-1775. [PMID: 33044738 DOI: 10.1007/s13760-020-01516-x] [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: 04/16/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
To formulate and validate a dyschromatopsia linear regression model in patients with multiple sclerosis (MS). 64 MS patients (50 to formulate the model and 14 for its validation) underwent neurological (Expanded Disability Status Scale, EDSS), color vision (Farnsworth D15 test), and peripapillary retinal nerve fiber layer (pRNFL) and retinal evaluation with spectral-domain optical coherence tomography (SD-OCT). Neuroradiological examination permitted to obtain brain parenchymal fraction (BPF) and cervical spinal cord volume (SC). Ophthalmic parameters were calculated as the average of both non-optic neuritis (ON) eyes, and in case the patient had previous ON, the value of the fellow non-ON eye was taken. The influence of sex, age, disease duration, and history of disease-modifying treatment (first- or second-line DMT) was tested as covariables that could influence color perception. Color confusion index (log CCI) correlated with pRNFL (r = - 0.322, p = 0.009), ganglion cell layer (GCL, r = - 0.321, p = 0.01), BPF (r = - 0.287, p = 0.021), SC volume (r = - 0.33, p = 0.008), patients' age (r = 0.417, p = 0.001), disease duration (r = 0.371, p = 0.003), and EDSS (r = 0.44, p = 0.001). The following CCI equation was obtained: log (CCI) = 0.316-0.224 BPF - 0.187 SC volume (mm3) + 0.226 age (years) + 0.012 disease duration (years) - 0.372 GCL (µm). CCI correlates with MS clinical and paraclinical established biomarkers suggesting chronic diffuse neurodegeneration in MS operates at brain, SC, and retina linking all three compartments. Color vision outcome can be calculated through the aforementioned variables for clinical and research purposes.
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Affiliation(s)
- Antonio Barreiro-González
- Ophthalmology Department, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - Maria T Sanz
- Departamento de Didáctica de La Matemática, Universidad de Valencia, Valencia, Spain
| | - Sara Carratalà-Boscà
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Carmen Alcalá
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Enrique España-Gregori
- Ophthalmology Department, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
- Surgery Department, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Bonaventura Casanova
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
- Medicine Department, Faculty of Medicine, University of Valencia, Valencia, Spain
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Barreiro-González A, Sanz MT, Carratalà-Boscà S, Pérez-Miralles F, Alcalá C, Carreres-Polo J, España-Gregori E, Casanova B. Design and Validation of an Expanded Disability Status Scale Model in Multiple Sclerosis. Eur Neurol 2021; 85:112-121. [PMID: 34788755 DOI: 10.1159/000519772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to develop and validate an Expanded Disability Status Scale (EDSS) model through clinical, optical coherence tomography (OCT), and magnetic resonance imaging (MRI) measures. METHODS Sixty-four multiple sclerosis (MS) patients underwent peripapillary retinal nerve fiber layer and segmented macular layers evaluation through OCT (Spectralis, Heidelberg Engineering). Brain parenchymal fraction was quantified through Freesurfer, while cervical spinal cord (SC) volume was assessed manually guided by Spinal Cord Toolbox software analysis. EDSS, neuroradiological, and OCT assessment were carried out within 3 months. OCT parameters were calculated as the average of both nonoptic neuritis (ON) eyes, and in case the patient had previous ON, the value of the fellow non-ON eye was taken. Brain lesion volume, sex, age, disease duration, and history of disease-modifying treatment (1st or 2nd line disease-modifying treatments) were tested as covariables of the EDSS score. RESULTS EDSS values correlated with patient's age (r = 0.543, p = 0.001), SC volume (r = -0.301, p = 0.034), and ganglion cell layer (GCL, r = -0.354, p = 0.012). Using these correlations, an ordinal regression model to express probability of diverse EDSS scores were designed, the highest of which was the most probable (Nagelkerke R2 = 43.3%). Using EDSS cutoff point of 4.0 in a dichotomous model, compared to a cutoff of 2.0, permits the inclusion of GCL as a disability predictor, in addition to age and SC. CONCLUSIONS MS disability measured through EDSS is an age-dependent magnitude that is partly conditioned by SC and GCL. Further studies assessing paraclinical disability predictors are needed.
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Affiliation(s)
| | - Maria T Sanz
- Department of Mathematics Teaching, University of Valencia, Valencia, Spain
| | - Sara Carratalà-Boscà
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Carmen Alcalá
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Joan Carreres-Polo
- Radiology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Enrique España-Gregori
- Opthalmology Department, University and Polytechnic Hospital La Fe, Valencia, Spain.,Surgery Department, University of Valencia, Valencia, Spain
| | - Bonaventura Casanova
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain.,Medicine Department, University of Valencia, Valencia, Spain
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Krishna Priya R, Chacko S. Improved particle swarm optimized deep convolutional neural network with super-pixel clustering for multiple sclerosis lesion segmentation in brain MRI imaging. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3506. [PMID: 34181310 DOI: 10.1002/cnm.3506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 02/09/2021] [Accepted: 03/12/2021] [Indexed: 06/13/2023]
Abstract
A central nervous system (CNS) disease affecting the insulating myelin sheaths around the brain axons is called multiple sclerosis (MS). In today's world, MS is extensively diagnosed and monitored using the MRI, because of the structural MRI sensitivity in dissemination of white matter lesions with respect to space and time. The main aim of this study is to propose Multiple Sclerosis Lesion Segmentation in Brain MRI imaging using Optimized Deep Convolutional Neural Network and Super-pixel Clustering. Three stages included in the proposed methodology are: (a) preprocessing, (b) segmentation of super-pixel, and (c) classification of super-pixel. In the first stage, image enhancement and skull stripping is done through performing a preprocessing step. In the second stage, the MS lesion and Non-MS lesion regions are segmented through applying SLICO algorithm over each slice of the volume. In the fourth stage, a CNN training and classification is performed using this segmented lesion and non-lesion regions. To handle this complex task, a newly developed Improved Particle Swarm Optimization (IPSO) based optimized convolutional neural network classifier is applied. On clinical MS data, the approach exhibits a significant increase in the accuracy segmenting of WM lesions when compared with the rest of evaluated methods.
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Affiliation(s)
- R Krishna Priya
- Department of Electrical and Communication Engineering, National University of Science and Technology, Oman
| | - Susamma Chacko
- Department of Quality Enhancement and Assurance, National University of Science and Technology, Oman
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Gil-Casas A, Piñero DP, Molina-Martin A. Are near visual signs and symptoms in multiple sclerosis compatible with convergence insufficiency? Clin Exp Optom 2021; 105:631-636. [PMID: 34406109 DOI: 10.1080/08164622.2021.1961566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Optometric management of neurodegenerative diseases is essential since visual signs, such as double vision, visual acuity reduction, or oculomotricity dysfunctions, are usually present in these subjects over the course of the disease. The present paper can guide clinicians in better managing their patients with multiple sclerosis. BACKGROUND Patients with multiple sclerosis present near vision symptoms that may be related to binocular anomalies, but these symptoms have not been investigated and related to specific signs. The aim of the present study was to evaluate the binocular vision in subjects with multiple sclerosis, and to analyse if the near visual signs and symptoms observed are compatible with those found in convergence insufficiency, as occurs in other neurodegenerative diseases. METHODS A total of 57 multiple sclerosis patients and 26 healthy controls were examined and classified as potentially compatible with convergence insufficiency according to the signs and symptoms. Clinical diagnosis of convergence insufficiency was established when subjects met the following criteria: NPC breakpoint more than 6 cm, PFV ≤ than 15Δ (base-out), and exophoria greater at near than at distance at least 4Δ. Convergence Insufficiency Symptom Survey (CISS) was administered to assess the symptomatology considering a score ≥16 as positive. RESULTS According to the CISS score, 54,4% of the multiple sclerosis subjects revised showed a suspect of convergence insufficiency, with a median score of 27 (IQR 9), whereas only one subject from control group (3.8%) showed this suspect. According to the diagnostic criteria based on signs, only 15.8% of multiple sclerosis patients had a real diagnosis of convergence insufficiency. CONCLUSION Multiple sclerosis patients showed symptomatology compatible with convergence insufficiency, but this was not supported by the signs which showed a more esophoric tendency. The discrepancies between the signs and symptoms could be due to the questionnaire used including items that are also related to the cognitive function and other ocular abnormalities.
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Affiliation(s)
- Amparo Gil-Casas
- Optometry Clinic, Fundació Lluís Alcanyís, University of Valencia, Valencia, Spain
| | - David P Piñero
- Optics and Visual Perception Group, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Ainhoa Molina-Martin
- Optics and Visual Perception Group, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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Application of Blue Filters Increases the Usefulness of Moreland Test in Anomaloscopic Color Vision Assessment for Blue-Green Color Range. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147654. [PMID: 34300104 PMCID: PMC8305414 DOI: 10.3390/ijerph18147654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022]
Abstract
The effect of blue light filters on the anomaloscopic examination was analyzed. Thirty subjects (18–43 y, 20 female, 10 male) without color vision disorders were examined in 4 filter conditions: no filter (F-0), Blue Control Hoya (F-BC), Med-1 JZO (F-Med1) and 450 Eschenbach (F-450). Both Rayleigh test (red–green axis) and Moreland test (blue–green axis) were performed. Application of F-BC filter shows negligible effect on color vision perception in both tests. Contrary to this, the application of strong F-450 filter causes significant shift in Moreland test towards tritanopy and the decrease in correlations of Moreland parameters with Rayleigh test parameters. The application of medium strong F-Med1 filter causes the slight shift in Moreland test towards the center of the Moreland scale and increases the Spearman correlations between Moreland and Rayleigh test parameters. This observation suggests that the about 15–40% reduction of blue diode intensity in the Moreland test may be beneficial in detecting mild changes in color vision perception in the blue-green axis and may improve its usefulness in evaluating the color vision perception disorders accompanying different illnesses, such as diabetes, glaucoma, neuritis optica, or cataract. The discussion concerning the modifications of Moreland test construction is also presented.
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Roberts BWR, Atkinson DA, Manson GA, Markley R, Kaldis T, Britz GW, Horner PJ, Vette AH, Sayenko DG. Transcutaneous spinal cord stimulation improves postural stability in individuals with multiple sclerosis. Mult Scler Relat Disord 2021; 52:103009. [PMID: 34023772 DOI: 10.1016/j.msard.2021.103009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/09/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Widespread demyelination in the central nervous system can lead to progressive sensorimotor impairments following multiple sclerosis, with compromised postural stability during standing being a common consequence. As such, clinical strategies are needed to improve postural stability following multiple sclerosis. The objective of this study was therefore to investigate the effect of non-invasive transcutaneous spinal stimulation on postural stability during upright standing in individuals with multiple sclerosis. METHODS Center of pressure displacement and electromyograms from the soleus and tibialis anterior were recorded in seven individuals with multiple sclerosis during standing without and with transcutaneous spinal stimulation. Center of pressure and muscle activity measures were calculated and compared between no stimulation and transcutaneous spinal stimulation conditions. The relationship between the center of pressure displacement and electromyograms was quantified using cross-correlation analysis. RESULTS For transcutaneous spinal stimulation, postural stability was significantly improved during standing with eyes closed: the time- and frequency-domain measures obtained from the anterior-posterior center of pressure fluctuation decreased and increased, respectively, and the tibialis anterior activity was lower compared to no stimulation. Conversely, no differences were found between no stimulation and transcutaneous spinal stimulation when standing with eyes open. CONCLUSION Following multiple sclerosis, transcutaneous spinal stimulation improved postural stability during standing with eyes closed, presumably by catalyzing proprioceptive function. Future work should confirm underlying mechanisms and explore the clinical value of transcutaneous spinal stimulation for individuals with multiple sclerosis.
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Affiliation(s)
- Brad W R Roberts
- Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, Alberta, T6G 1H9, Canada.
| | - Darryn A Atkinson
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, 5401 La Crosse Avenue, Austin, TX, 78739, United States.
| | - Gerome A Manson
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX, 77030, United States.
| | - Rachel Markley
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX, 77030, United States.
| | - Teresa Kaldis
- Department of Physical Medicine and Rehabilitation, Center for Neuroregeneration, Houston Methodist Research Institute, 6560 Fannin Street, Houston, TX, 77030, United States.
| | - Gavin W Britz
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX, 77030, United States.
| | - Philip J Horner
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX, 77030, United States.
| | - Albert H Vette
- Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, Alberta, T6G 1H9, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta, T5G 0B7, Canada; Neuroscience and Mental Health Institute, University of Alberta, 87 Avenue & 112 Street, Edmonton, Alberta, T6G 2E1, Canada.
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX, 77030, United States.
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Uzunköprü C, Yüceyar N, Yilmaz SG, Afrashi F, Ekmekçi Ö, Taşkiran D. Retinal Nerve Fiber Layer Thickness Correlates with Serum and Cerebrospinal Fluid Neurofilament Levels and is Associated with Current Disability in Multiple Sclerosis. ACTA ACUST UNITED AC 2021; 58:34-40. [PMID: 33795950 DOI: 10.29399/npa.27355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
Introduction The main purpose of the present study is to confirm Peripapillary Retinal Nerve Fiber Layer (pRNFL) thickness is a biomarker of axonal degeneration in patients with Multiple Sclerosis (MS) and to evaluate its relationship with Neurofilament heavy chain (NfH) and Nitrotyrosine (NT). Method We quantified serum (s) and/or cerebrospinal fluid (CSF) NfH and NT levels in 30 relapsing-remitting MS patients (RRMS), 16 secondary progressive MS (SPMS) patients and in 29 control subjects matched for age and gender. Optical coherence tomography (OCT) measurements of pRNFL were performed in all subjects. Clinical outcomes were tested by Multiple Sclerosis Functional Composite (MSFC) and Expanded Disability Status Scale (EDSS). Results RRMS patients exhibited significantly higher NfH/NT levels (99 pg/mL, 107.52 nM respectively) than controls (74 pg/mL, 48.72 nM) in CSF (p<0.0001), but not in sera. SPMS patients had significantly higher s NfH/NT values (111.25 pg/mL, 1251.77 nM respectively) and lower mean pRNFL thickness (79 µm) than patients with RRMS (98.50 µm) and controls (108 µm) (p<0.0001). pRNFL thickness was significantly correlated with all clinical disability measurements (EDSS, Trail Making test, 9-Hole Peg Test, and PASAT) in both RRMS and SPMS (p<0.001, p=0.02, p=0.03, p=0.02 respectively). A positive correlation was also found between serum and/or CSF NfH levels and EDSS scores in RRMS and SPMS (p<0.001, p=0.02 respectively). The pRNFL thickness was also correlated significantly with serum and/or CSF NfH levels but not with s/CSF NT levels in both clinical forms of MS (p<0.01, p<0.001 respectively). Conclusion The current study demonstrated that both pRNFL and s/CSF NfH are reliable and quantitative biomarkers that correlate with current disease course and cross-sectional measure of disability in patients with MS.
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Affiliation(s)
- Cihat Uzunköprü
- İzmir Katip Çelebi University, Department of Neurology, İzmir, Turkey
| | - Nur Yüceyar
- Ege University Faculty of Medicine, Department of Neurology, İzmir, Turkey
| | - Suzan Güven Yilmaz
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Filiz Afrashi
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Özgül Ekmekçi
- Ege University Faculty of Medicine, Department of Neurology, İzmir, Turkey
| | - Dilek Taşkiran
- Ege University Faculty of Medicine, Department of Physiology İzmir, Turkey
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Villoslada P, Sanchez-Dalmau B, Galetta S. Optical coherence tomography: A useful tool for identifying subclinical optic neuropathy in diagnosing multiple sclerosis. Neurology 2020; 95:239-240. [PMID: 32723803 DOI: 10.1212/wnl.0000000000009840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Pablo Villoslada
- From Stanford University (P.V.), CA; Hospital Clinic (P.V., B.S.-D.), University of Barcelona, Spain; and NYU Langone Health (S.G.), New York.
| | - Bernardo Sanchez-Dalmau
- From Stanford University (P.V.), CA; Hospital Clinic (P.V., B.S.-D.), University of Barcelona, Spain; and NYU Langone Health (S.G.), New York
| | - Steven Galetta
- From Stanford University (P.V.), CA; Hospital Clinic (P.V., B.S.-D.), University of Barcelona, Spain; and NYU Langone Health (S.G.), New York
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12
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Hidalgo de la Cruz M, Valsasina P, Gobbi C, Gallo A, Zecca C, Bisecco A, Tedeschi G, Filippi M, Rocca MA. Longitudinal cortical thinning progression differs across multiple sclerosis phenotypes and is clinically relevant: A multicentre study. Mult Scler 2020; 27:827-840. [DOI: 10.1177/1352458520940548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Longitudinal evolution of cortical thickness (CTh) in different MS phenotypes has been rarely studied. Aim: To investigate the regional pattern and 1-year progression of cortical thinning in relapsing-remitting (RR) and progressive (P) MS. Methods: 3T high-resolution T1-weighted magnetic resonance imaging (MRI) was obtained from 86 patients (75 RRMS, 11 PMS) and 34 healthy controls (HC) at three European sites at baseline and 1-year follow-up. Using FreeSurfer, baseline CTh between-group differences, longitudinal CTh changes and their correlations with clinical and MRI variables were assessed. Results: Baseline frontal, parietal and sensorimotor atrophy was found in MS versus HC. Such pattern was driven by RRMS, while PMS showed additional parietal, insular and sensorimotor cortical atrophy versus RRMS. At 1-year versus baseline, additional frontal and temporal cortical thinning was detected in RRMS patients, while a widespread CTh reduction was found in PMS patients (significant at time-by-group interaction vs RRMS). In MS, baseline fronto-parietal atrophy correlated with more severe disability and higher lesion volume. Baseline inferior parietal CTh decrease and 1-year temporal cortical thinning correlated with more severe disability. Conclusion: Parieto-temporal baseline CTh abnormalities and thinning pattern over time characterized the main MS clinical phenotypes and were associated with 1-year disability worsening.
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Affiliation(s)
- Milagros Hidalgo de la Cruz
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Gobbi
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland/Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Chiara Zecca
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland/Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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13
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Petzold A, Braithwaite T, van Oosten BW, Balk L, Martinez-Lapiscina EH, Wheeler R, Wiegerinck N, Waters C, Plant GT. Case for a new corticosteroid treatment trial in optic neuritis: review of updated evidence. J Neurol Neurosurg Psychiatry 2020; 91:9-14. [PMID: 31740484 PMCID: PMC6952848 DOI: 10.1136/jnnp-2019-321653] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/20/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Axel Petzold
- Expertise Centrum Neuro-ophthalmology, Departments of Neurology & Ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands .,Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Tasanee Braithwaite
- Neuro-ophthalmology, Moorfields Eye Hospital and The National Hospital for Neurology & Neurosurgery, London, UK
| | | | - Lisanne Balk
- Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Elena H Martinez-Lapiscina
- Center of Neuroimmunology and Service of Neurology, Clinic Barcelona Hospital University, Barcelona, Spain
| | | | - Nils Wiegerinck
- )Patient Organisation (Neuro-ophthalmology), Lisbon, Portugal
| | - Christiaan Waters
- Neuro-ophthalmologie Vereniging Nederland (KvK nummer 66260140), Amsterdam, Netherlands
| | - Gordon T Plant
- ,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, St. Thomas Hospital, Moorfields Eye Hospital, London, UK
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Sen MK, Mahns DA, Coorssen JR, Shortland PJ. Behavioural phenotypes in the cuprizone model of central nervous system demyelination. Neurosci Biobehav Rev 2019; 107:23-46. [PMID: 31442519 DOI: 10.1016/j.neubiorev.2019.08.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/01/2019] [Accepted: 08/12/2019] [Indexed: 12/14/2022]
Abstract
The feeding of cuprizone (CPZ) to animals has been extensively used to model the processes of demyelination and remyelination, with many papers adopting a narrative linked to demyelinating conditions like multiple sclerosis (MS), the aetiology of which is unknown. However, no current animal model faithfully replicates the myriad of symptoms seen in the clinical condition of MS. CPZ ingestion causes mitochondrial and endoplasmic reticulum stress and subsequent apoptosis of oligodendrocytes leads to central nervous system demyelination and glial cell activation. Although there are a wide variety of behavioural tests available for characterizing the functional deficits in animal models of disease, including that of CPZ-induced deficits, they have focused on a narrow subset of outcomes such as motor performance, cognition, and anxiety. The literature has not been systematically reviewed in relation to these or other symptoms associated with clinical MS. This paper reviews these tests and makes recommendations as to which are the most important in order to better understand the role of this model in examining aspects of demyelinating diseases like MS.
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Affiliation(s)
- Monokesh K Sen
- School of Medicine, Western Sydney University, New South Wales, Australia
| | - David A Mahns
- School of Medicine, Western Sydney University, New South Wales, Australia
| | - Jens R Coorssen
- Departments of Health Sciences and Biological Sciences, Faculties of Applied Health Sciences and Mathematics & Science, Brock University, Ontario, Canada.
| | - Peter J Shortland
- Science and Health, Western Sydney University, New South Wales, Australia.
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15
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Immune tolerance in multiple sclerosis and neuromyelitis optica with peptide-loaded tolerogenic dendritic cells in a phase 1b trial. Proc Natl Acad Sci U S A 2019; 116:8463-8470. [PMID: 30962374 PMCID: PMC6486735 DOI: 10.1073/pnas.1820039116] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Application of antigen-specific immune tolerance in autoimmune disease is a long-sought goal. We studied diseases with abundant information on the autoimmune target: in multiple sclerosis (MS), various myelin antigens are known targets of T cells and antibodies, whereas in neuromyelitis optica (NMO), the aquaporin-4 channel is attacked by T cells and antibodies. We tested whether engineered dendritic cells might induce a tolerogenic immune response in these two conditions. In this in-human clinical study, individual regulatory T cells, secreting IL-10, a key tolerogenic cytokine, were detected after treatment. These results might lead to more extensive trials with this approach in autoimmune conditions where the antigenic target has been identified, including MS, NMO, myasthenia gravis, and Graves disease. There are adaptive T-cell and antibody autoimmune responses to myelin-derived peptides in multiple sclerosis (MS) and to aquaporin-4 (AQP4) in neuromyelitis optica spectrum disorders (NMOSDs). Strategies aimed at antigen-specific tolerance to these autoantigens are thus indicated for these diseases. One approach involves induction of tolerance with engineered dendritic cells (tolDCs) loaded with specific antigens. We conducted an in-human phase 1b clinical trial testing increasing concentrations of autologous tolDCs loaded with peptides from various myelin proteins and from AQP4. We tested this approach in 12 patients, 8 with MS and 4 with NMOSD. The primary end point was the safety and tolerability, while secondary end points were clinical outcomes (relapses and disability), imaging (MRI and optical coherence tomography), and immunological responses. Therapy with tolDCs was well tolerated, without serious adverse events and with no therapy-related reactions. Patients remained stable clinically in terms of relapse, disability, and in various measurements using imaging. We observed a significant increase in the production of IL-10 levels in PBMCs stimulated with the peptides as well as an increase in the frequency of a regulatory T cell, known as Tr1, by week 12 of follow-up. In this phase 1b trial, we concluded that the i.v. administration of peptide-loaded dendritic cells is safe and feasible. Elicitation of specific IL-10 production by peptide-specific T cells in MS and NMOSD patients indicates that a key element in antigen specific tolerance is activated with this approach. The results warrant further clinical testing in larger trials.
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Ayhan Z, Yaman A. What Does Optical Coherence Tomography Offer for Evaluating Physical Disability in Patients with Multiple Sclerosis? ACTA ACUST UNITED AC 2019; 55:S37-S40. [PMID: 30692853 DOI: 10.29399/npa.23327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Visual dysfunction is one of the most common clinical manifestations of multiple sclerosis (MS). For example, optic neuritis is the onset symptom in 20% of patients with MS. Visual pathway impairment presents in most patients with MS, including patients who have not experienced optic neuritis. During the last decade, many clinical trials of MS have included visual outcomes. One tool used in these studies, optical coherence tomography, is a non-contact, noninvasive, high-resolution optical imaging technology that helps segmentation and measurement of specific retinal layers using computerized algorithms. Optical coherence tomography is used in various stages of MS from diagnosis to treatment of the disease. In this review, we summarize the use of optical coherence tomography in MS and study its usefulness for evaluating the physical disabilities of MS patients.
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Affiliation(s)
- Ziya Ayhan
- Dokuz Eylul University Faculty of Medicine, Eye Diseases, İzmir, Turkey
| | - Aylin Yaman
- Dokuz Eylul University Faculty of Medicine, Eye Diseases, İzmir, Turkey
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