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Zhang Y, Qiu Y, Chen L, Guo T, Xu X, Liu X, Fu Y, Liu K, Li X, Ren X, Xiao Z, Chen S, Yang H. Subclinical damage to the contralateral eye in unilateral optic neuritis: A longitudinal study. Mult Scler Relat Disord 2023; 78:104923. [PMID: 37562198 DOI: 10.1016/j.msard.2023.104923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Early detection of subclinical injuries can lead to a correct diagnosis and help control the advancement of the condition. This study aims to investigate the presence of subclinical damage and silent progression to the contralateral eye's visual function and structure in patients experiencing their first episode of unilateral optic neuritis (ON). METHODS Fifty patients with first-onset unilateral ON were enrolled in this study. Based on etiology, they were classified as having neuromyelitis optica spectrum disorder-related ON (NMOSD-ON), myelin oligodendrocyte glycoprotein antibody-associated ON (MOG-ON), idiopathic ON (IDON), or multiple sclerosis-related ON (MS-ON). These cases were followed up for one year to determine whether there was any silent progression of visual function and structure in the contralateral non-ON (NON) eye. A gender- and age-matched healthy control (HC) group was included to compare the differences in visual function and structure between the patients with NON eyes and the HC group. RESULTS Within two weeks of onset, best-corrected visual acuity (BCVA; P = 0.008), mean deviation (MD) of the visual field (VF) (P = 0.001), and peripapillary retinal nerve fiber layer (pRNFL; P = 0.019) thickness were significantly worse in the NMOSD-NON patients than those in the HC group, while there were no differences in the pRNFL and the ganglion cell-inner plexiform layer (GCIPL) thicknesses and quadrant thicknesses (P > 0.05) of the groups. IDON-NON only showed subclinical damage in VF (P = 0.001) and temporal pRNFL (P = 0.042), while the BCVA, VF, and optic nerve structure (pRNFL, GCIPL) of the MOG-NON patients showed no subclinical damage (P > 0.05). In addition, the one-year follow-up of each NON eye type showed that there was no silent progression in NMOSD-NON, MOG-NON, or IDON-NON. A pairwise comparison of the different types of NON eyes revealed no statistical differences (P > 0.05). CONCLUSION Among the patients with unilateral ON, NMOSD-NON and IDON-NON resulted in subclinical damage to the visual function and structure of the contralateral eye within two weeks of onset, whereas MOG-NON did not show any subclinical damage to visual function or structure. Furthermore, these subclinical damages did not show any silent progression during the one-year follow-up period.
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Affiliation(s)
- Yurong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Yao Qiu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Leyan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Taimin Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Xiaoyu Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Xiaoning Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Yue Fu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Kaiqun Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Xinnan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Xin Ren
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Zhiqiang Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Siqi Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
| | - Hui Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University.
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Ayoubi NKE, Moussa H, Younes A, Haddad R, Khoury SJ. Use of retinal optical coherence tomography to differentiate suspected neuromyelitis optica spectrum disorder from multiple sclerosis: A cross-sectional study. Mult Scler Relat Disord 2022; 68:104160. [PMID: 36113276 DOI: 10.1016/j.msard.2022.104160] [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: 06/28/2022] [Revised: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Retinal optical coherence tomography (OCT) can differentiate definite NMOSD (dNMOSD) from multiple sclerosis (MS), but has not been evaluated in patients with a high clinical suspicion of NMOSD and not fulfilling the current consensus diagnostic criteria, referred in this paper as "potential" NMOSD (pNMOSD). AIM To compare the retinal OCT measurements between patients with pNMOSD, dNMOSD, MS, and reference healthy controls (HC). MATERIAL AND METHODS In this cross-sectional study, clinical and demographic characteristics, as well as OCT measurements of peripapillary retinal nerve fiber layer (pRNFL), inner nuclear layer (INL), macular retinal nerve fiber layer (mRNFL), outer nuclear layer (ONL) ganglion cell/inner plexiform layer (GCIPL), and macular volume (MV) were compared between groups. Mixed-effects regression models adjusting for within-patient inter-eye correlations, controlling for age, gender, disease duration and history of optic neuritis per eye were explored. Subgroup analyses were performed on eyes with previous optic neuritis. RESULTS 234 eyes (20 pNMOSD, 33 dNMOSD, 138 MS, and 43 HC) were included. Controlling for age, gender, disease duration, and history of optic neuritis per eye, pNMOSD eyes showed decreased GCIPL, pRNFL, mRNFL and MV thicknesses, similar to eyes with dNMOSD, but significantly thinner than MS and HC subjects' eyes. Similar results were obtained for the pRNFL, mRNFL, GCIPL, INL and MV thickness in the subgroup analysis exploring only eyes with history of optic neuritis (12 pNMOSD, 15 dNMOSD, and 27 MS). CONCLUSION Retinal OCT measurements in patients with pNMOSD were similar to dNMOSD, but significantly lower than patients with MS and healthy controls. This suggests that retinal OCT measures could be helpful markers supportive of NMOSD diagnosis and should be explored in larger studies as a valuable addition to the current consensus diagnostic criteria.
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Affiliation(s)
- Nabil K El Ayoubi
- Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon
| | - Hussein Moussa
- Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Antoine Younes
- Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon
| | - Ribal Haddad
- Department of Neurology, the University of Chicago, Chicago, IL, USA
| | - Samia J Khoury
- Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon.
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Sguigna PV, Tardo LM, Blackburn KM, Horton LA, Conger DL, Hogan RN, McCreary MC, Greenberg BM. Application of the International Interocular Difference Thresholds into Practice: Localising the Patient Experience. Neuroophthalmology 2022; 46:375-382. [PMID: 36544583 PMCID: PMC9762821 DOI: 10.1080/01658107.2022.2109687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 06/30/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
Demyelinating diseases of the central nervous system (CNS) often have neuro-ophthalmological manifestations, and retinal examination can be helpful in making the diagnosis. The latest iteration of optical coherence tomography (OCT)-based criteria for optic neuritis in multiple sclerosis has been developed in the research realm, but its application to clinical practice, and to the more uncommon demyelinating diseases requires further study. The ability to use OCT data to distinguish between various CNS demyelinating disorders could provide additional paraclinical tools to accurately diagnose patients. Furthermore, neuro-ophthalmological testing can define the extent of inflammatory damage in the CNS, independent of patient-reported history. New referrals for OCT at a tertiary multiple sclerosis and neuro-immunology referral centre (n = 167) were analysed retrospectively for the self-reporting of optic neuritis, serological test results, and diagnosis. Only approximately 30% of patients with a clinical history of unilateral optic neuritis solely had a unilateral optic neuropathy, nearly 40% of those subjects actually having evidence of bilateral optic neuropathies. Roughly 30% of patients reporting a history of bilateral optic neuritis did not have any evidence of structural disease, with 20% of these patients having a separate, intervenable diagnosis noted on macular scans. OCT is a useful adjunct diagnostic tool in the evaluation of demyelinating disease and has the ability to aid in a more accurate diagnosis for patients. Application of the international interocular difference thresholds to a clinical patient population generally reproduces the original results, emphasising their appropriateness. The analysis distinguishing the demyelinating diseases needs to be replicated in a blinded, multi-centre setting.
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Affiliation(s)
- Peter V. Sguigna
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Lauren M. Tardo
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Kyle M. Blackburn
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Lindsay A. Horton
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Darrel L. Conger
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - R. Nick Hogan
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Ophthalmology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Pathology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Morgan C. McCreary
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Benjamin M. Greenberg
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
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Fu J, Tan S, Peng C, Zhou H, Wei S. A comparative study of alteration in retinal layer segmentation alteration by SD-OCT in neuromyelitis optica spectrum disorders: A systematic review and meta-analysis. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2021; 1:100007. [PMID: 37846392 PMCID: PMC10577872 DOI: 10.1016/j.aopr.2021.100007] [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: 08/16/2021] [Revised: 09/05/2021] [Accepted: 09/25/2021] [Indexed: 10/18/2023]
Abstract
Background To evaluate the feature of different retinal layer segmentation in neuromyelitis optica spectrum disorders (NMOSD) with spectral-domain optical coherence tomography (SD-OCT) and to compare it with that in multiple sclerosis (MS), healthy controls (HC), and idiopathic optic neuritis (ION). Methods We retrieved four electronic databases, including Pubmed, Embase, Cochrane Library, and Web of Science from inception to September 1st, 2021. A meta-analysis was performed to compare different retinal layer segmentation thicknesses between patients with or without a history of optic neuritis (ON) in NMOSD and the control group, including patients with MS, HC, and ION. Results Forty-two studies were included and the interval between the last ON onset and examination was greater than 3 months. Compared with that in HC eyes, the loss of retinal nerve fiber layer (RNFL) and macular ganglion cell and inner plexiform layer (GC-IPL) was serious in NMOSD eye especially after ON. Moreover, compared with that in ION eyes or MS-related-ON eyes, the injury to the peripapillary retinal nerve fiber layer (pRNFL) was severe in NMOSD-related-ON eyes. In addition, the correlation coefficient between pRNFL and prognostic visual acuity was 0.43. However, the one-arm study revealed the inner nuclear layer (INL) was thickened in NMOSD-related-ON eyes compared with HC eyes. Conclusions Inclusion of the RNFL and macular GC-IPL is recommended for monitoring disease progression and attention should be paid to changes in the INL.
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Affiliation(s)
- Junxia Fu
- Department of Ophthalmology, The Chinese People's Liberation Army General Hospital & the Chinese People's Liberation Army Medical School, Beijing, China
| | - Shaoying Tan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chunxia Peng
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Huanfen Zhou
- Department of Ophthalmology, The Chinese People's Liberation Army General Hospital & the Chinese People's Liberation Army Medical School, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, The Chinese People's Liberation Army General Hospital & the Chinese People's Liberation Army Medical School, Beijing, China
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5
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Lo C, Vuong LN, Micieli JA. Recent advances and future directions on the use of optical coherence tomography in neuro-ophthalmology. Taiwan J Ophthalmol 2021; 11:3-15. [PMID: 33767951 PMCID: PMC7971436 DOI: 10.4103/tjo.tjo_76_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022] Open
Abstract
Optical coherence tomography (OCT) is a noninvasive imaging technique used to qualitatively and quantitatively analyze various layers of the retina. OCT of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) is particularly useful in neuro-ophthalmology for the evaluation of patients with optic neuropathies and retrochiasmal visual pathway disorders. OCT allows for an objective quantification of edema and atrophy of the RNFL and GCIPL, which may be evident before obvious clinical signs and visual dysfunction develop. Enhanced depth imaging OCT allows for visualization of deep structures of the optic nerve and has emerged as the gold standard for the detection of optic disc drusen. In the evaluation of compressive optic neuropathies, OCT RNFL and GCIPL thicknesses have been established as the most important visual prognostic factor. There is increasing evidence that inclusion of OCT as part of the diagnostic criteria for multiple sclerosis (MS) increases its sensitivity. Moreover, OCT of the RNFL and GCIPL may be helpful in the early detection and monitoring the treatment of conditions such as MS and Alzheimer's disease. OCT is an important aspect of the neuro-ophthalmologic assessment and its use is likely to increase moving forward.
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Affiliation(s)
- Cody Lo
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laurel N Vuong
- The New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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Wang Y, Kwapong WR, Tu Y, Xia Y, Tang J, Miao H, Liu X, Lu Y, Yan Z. Altered resting-state functional connectivity density in patients with neuromyelitis optica-spectrum disorders. Mult Scler Relat Disord 2020; 43:102187. [PMID: 32480345 DOI: 10.1016/j.msard.2020.102187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune, demyelinating disorder, accompanied by abnormal spontaneous activity of the brain and impairment of the retina and optic nerve. Functional connectivity density (FCD) map, a graph theory method, was applied to explore the functional connectivity alterations of brian in NMOSD patients and investigate the alterations of FCD to the structural and microvascular changes around the optic nerve head (ONH). METHODS Nineteen NMOSD patients and 22 healthy controls (HCs) were included in our study. All participants underwent resting-state functional magnetic resonance imaging (fMRI) scans of the brain, and ophthalmological examinations included optical coherence tomographic angiography (OCT-A) imaging, visual acuity (VA), and intraocular pressure (IOP). The long- and short-range FCD was calculated by the fMRI graph theory method and two-sample t-tests were performed to compare the discrepancy of FCD between NMOSD and HCs. OCT-A imaging was used to obtain the structure (peripapillary retinal nerve fiber layer, pRNFL) and microvessels (radial peripapillary capillary, RPC) details around the ONH. The association between the long- and short-range FCD values with the structural and microvascular variation around the ONH were evaluated using Spearman's correlation. RESULTS Significantly decreased (corrected p < 0.05) long-range FCD was seen in the right superior parietal gyrus (SPG) in patients with NMOSD when compared to HCs. Increased long-range FCD was seen in the right fusiform gyrus (FFG), left orbital part of superior frontal orbital gyrus (ORBsup) and left anterior cingulum and paracingulate gyri (ACG) in NMOSD patients (corrected p < 0.05). The regions with reduced short-range FCD in NMOSD were the left angular gyrus (ANG) and right SPG (corrected p < 0.05). Increased short-range FCD was shown (corrected p < 0.05) in the right FFG of NMOSD. The pRNFL thickness and RPC density in all participants were negatively correlated with the long-range FCD values in the right FFG, left ORBsup, and left ACG as well as short-range FCD values in the right FFG, besides, both were positively correlated with the long-range FCD values in the right SPG and short-range FCD values in the left ANG and right SPG (p < 0.05). CONCLUSION Our study demonstrates that patients with NMOSD have widespread brain dysfunction after optic neuritis attacks which shows as impairment of widespread spatial distribution in long- and short-range FCD. Structural and microvascular changes around the ONH are associated with neural changes in the brain.
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Affiliation(s)
- Yu Wang
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | | | - Yunhai Tu
- The Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Yikai Xia
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Jing Tang
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Hanpei Miao
- The Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xiaozheng Liu
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; China-USA Neuroimaging Research Institute, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Yi Lu
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China.
| | - Zhihan Yan
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China.
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Abstract
PURPOSE OF REVIEW To summarize recent developments in the classification, investigation and management of pediatric optic neuritis (PON). RECENT FINDINGS A recent surge in interest surrounding antibodies to myelin oligodendrocyte glycoprotein antibody (MOG-Ab) has instigated a paradigm shift in our assessment of children with PON. This serological marker is associated with a broad spectrum of demyelinating syndromes that are clinically and radiologically distinct from multiple sclerosis (MS) and aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (AQP4+NMOSD). Optic neuritis is the most common presenting phenotype of MOG-Ab positive-associated disease (MOG+AD). MOG-Ab seropositivity is much more common in the pediatric population and it predicts a better prognosis than MS or AQP4+NMOSD, except in the subset that exhibit a recurrent phenotype. SUMMARY A better grasp of MOG+AD features and its natural history has facilitated more accurate risk stratification of children after a presenting episode of PON. Consequently, the initial investigation of PON has broadened to include serology, along with neuroimaging and cerebrospinal fluid analysis. Acute treatment of PON and chronic immunotherapy is also becoming better tailored to the suspected or confirmed diagnoses of MS, AQP4+NMOSD and MOG+AD.
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Affiliation(s)
- Jane H. Lock
- Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Nancy J. Newman
- Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States
- Departments of Ophthalmology, Neurology, Emory University School of Medicine, Atlanta, Georgia, United States
- Departments of Ophthalmology, Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Valérie Biousse
- Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States
- Departments of Ophthalmology, Neurology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Jason H. Peragallo
- Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States
- Departments of Ophthalmology, Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
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Heckmann JG, Vachalova I, Lang CJG, Pitz S. Neuro-Ophthalmology at the Bedside: A Clinical Guide. J Neurosci Rural Pract 2019; 9:561-573. [PMID: 30271051 PMCID: PMC6126320 DOI: 10.4103/jnrp.jnrp_145_18] [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] [Indexed: 11/23/2022] Open
Abstract
Neuro-ophthalmological signs and symptoms are common in the emergency department but are a frequent source of diagnostic uncertainties. However, neuro-ophthalmological signs often allow a precise neuro-topographical localization of the clinical problem. A practical concept is presented how to perform a neuro-ophthalmological examination at the bedside and to interpret key findings under the aspect of emergency medicine with limited resources.
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Affiliation(s)
- Josef G Heckmann
- Department of Neurology, Municipal Hospital, Landshut, Bavaria, Germany
| | - Ivana Vachalova
- Department of Neurology, Municipal Hospital, Landshut, Bavaria, Germany
| | - Christoph J G Lang
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Susanne Pitz
- Orbital Center, Bürgerhospital, Frankfurt, Germany
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9
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Zarei S, Eggert J, Franqui-Dominguez L, Carl Y, Boria F, Stukova M, Avila A, Rubi C, Chinea A. Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico. Surg Neurol Int 2018; 9:242. [PMID: 30603227 PMCID: PMC6293609 DOI: 10.4103/sni.sni_224_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
Neuromyelitis optica (NMO) is an immune-mediated inflammatory disorder of the central nervous system. It is characterized by concurrent inflammation and demyelination of the optic nerve (optic neuritis [ON]) and the spinal cord (myelitis). Multiple studies show variations in prevalence, clinical, and demographic features of NMO among different populations. In addition, ethnicity and race are known as important factors on disease phenotype and clinical outcomes. There are little data on information about NMO patients in underserved groups, including Puerto Rico (PR). In this research, we will provide a comprehensive overview of all aspects of NMO, including epidemiology, environmental risk factors, genetic factors, molecular mechanism, symptoms, comorbidities and clinical differentiation, diagnosis, treatment, its management, and prognosis. We will also evaluate the demographic features and clinical phenotype of NMO patients in PR. This will provide a better understanding of NMO and establish a basis of knowledge that can be used to improve care. Furthermore, this type of population-based study can distinguish the clinical features variation among NMO patients and will provide insight into the potential mechanisms that cause these variations.
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Affiliation(s)
- Sara Zarei
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - James Eggert
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Yonatan Carl
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Fernando Boria
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Marina Stukova
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Cristina Rubi
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
| | - Angel Chinea
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
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10
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Zhao X, Qiu W, Zhang Y, Luo Y, Zhang X, Lu L, Yang H. A prospective case-control study comparing optical coherence tomography characteristics in neuromyelitis optica spectrum disorder- optic neuritis and idiopathic optic neuritis. BMC Ophthalmol 2018; 18:247. [PMID: 30217177 PMCID: PMC6137880 DOI: 10.1186/s12886-018-0902-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 08/28/2018] [Indexed: 12/31/2022] Open
Abstract
Background Neuromyelitis optica spectrum disorder-optic neuritis (NMOSD-ON) can now be distinguished from other types of ON as a specific disease by the Aquaporin-4 antibody (AQP4-Ab) test. NMOSD-ON can cause severe retinal nerve fiber layer (RNFL) damage. The optical coherence tomography (OCT) characteristics between NMOSD- ON and idiopathic optic neuritis (IDON) were seldom studied in Asians. Methods This prospective case-control study involved 152 eyes from 143 optic neuritis (ON) patients. All the patients were divided into either the NMOSD-ON group or the IDON group based on the AQP4-Ab test. The retinal nerve fiber layer thickness (RNFLT), retinal thickness (RT), and choroidal thickness (CT) were measured by spectral-domain OCT and compared to the 60 age- and gender-matched healthy controls. The association between RNFLT and best corrected visual acuity (BCVA) was examined. Results The RNFLT was significantly thinner in all ON patients than in healthy controls, while NMOSD-ON eyes were significantly more affected than IDON eyes in all quadrants (p < 0.01). NMOSD-ON patients had stronger visual function impairment than IDON patients (p < 0.01). RNFLT was related to BCVA in both the NMOSD-ON and IDON groups. Microcystic macular edema (MME) was identified in 28 patients (19.58%) and in 29 of 152 eyes (19.08%), including 20 of 40 eyes (50%) previously affected by ON. MME was more common in patients with NMOSD-ON (32.2%) than in those with IDON (10.75%) (p = 0.001). Conclusions The NMOSD-ON group had more pronounced RNFLT thinning and visual function impairment than the IDON group. MME prevalence was higher in NMOSD-ON and was associated with higher frequency of clinical relapses.
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Affiliation(s)
- Xiujuan Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No. 54 Xianlie South Road, Guangzhou, 510060, People's Republic of China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuxin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No. 54 Xianlie South Road, Guangzhou, 510060, People's Republic of China
| | - Yan Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No. 54 Xianlie South Road, Guangzhou, 510060, People's Republic of China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No. 54 Xianlie South Road, Guangzhou, 510060, People's Republic of China
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No. 54 Xianlie South Road, Guangzhou, 510060, People's Republic of China.
| | - Hui Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No. 54 Xianlie South Road, Guangzhou, 510060, People's Republic of China.
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Abstract
PURPOSE OF REVIEW Pediatric optic neuritis may be challenging to diagnose and treat. Significant clinical investigation of optic neuritis occurring in adults guides current clinical practices. Differences in presentation and prognosis exist for pediatric patients with optic neuritis when compared with adults including the risk of developing multiple sclerosis. The aim of this review is to provide an update on latest advances in the diagnosis, treatment and current research concerning pediatric optic neuritis. RECENT FINDINGS Limited case series and retrospective reviews constitute much of the data we know about patients with pediatric optic neuritis. Pediatric optic neuritis is included in the spectrum of neuroinflammatory diseases. Testing modalities (ocular coherence tomography and visual evoked potentials) and serologic testing (antibodies against aquaporin-4 and myelin oligodendrocyte glycoprotein) are being investigated for diagnostic and prognostic value. The low incidence of pediatric optic neuritis results in small sample sizes may contribute to conflicting results of different studies. SUMMARY Recent advances in diagnostic and serologic testing in pediatric neuritis may offer better diagnosis, treatment and prediction of prognosis. Validation requires well designed prospective research.
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