[Optic neuropathy after retrobulbar neuritis in multiple sclerosis: are optical coherence tomography and magnetic resonance imaging useful and necessary follow-up parameters?]

BACKGROUND

This study evaluated whether progressive optic neuropathy (ON) is commonly found after retrobulbar neuritis and whether optical coherence tomography (OCT) is a useful tool for follow-up of patients with multiple sclerosis (MS).

METHODS

An observational study of 86 MS patients (currently treated with immunomodulation) with a past medical history of ON was carried out. Patients were assessed in 2010 and 2012 using the expanded disability status scale (EDSS), visual acuity, visual evoked potentials (VEP) and OCT but magnetic resonance imaging (MRI) was performed only in 2012.

RESULTS

In this study 16 men and 70 women with a mean age of 41.6 and 43.8 years, respectively, were evaluated (28 patients post bilateral and 58 patients post unilateral ON including 114 eyes post-ON and 58 eyes without previous ON). Visual acuity and VEPs improved or remained the same over the study period. Visual acuity, VEPs, retinal nerve fiber layer (RNFL) thickness and macular volume were significantly worse in eyes post-ON compared to eyes without previous ON. The RNFL significantly decreased over the study period in eyes post-ON from an average of 79.9 ± 13.3 μm to 77.0 ± 12.9 μm (p < 0.0001) and eyes without previous ON from 89.5 ± 12.9 μm to 86.0 ± 12.5 μm (p < 0.0001). The number of VEPs and RNFL thickness were significantly correlated with visual acuity in all eyes. In patients after unilateral ON the brain atrophy parameters corpus callosum index (CCI) and cella media index (CMI) were negatively correlated with the EDSS.

CONCLUSION

Initially MS often begins with an episode of ON which can be stabilized by immunomodulation. A mild progressive ON was generally detectable in this study but severe progressive ON was rarely observed. The OCT measurements showed no better correlation than the VEPs with visual acuity; however, OCT can be applied for confirmation of atypical ON. The corpus callosum index seems to be best associated with the degree of disability while, as already described in the literature, the number of T2 lesions is not well correlated with disability, probably due to the small-world network function of the brain and the position of the lesions in areas with no clinical relevance.

Health care situation of patients with relapsing-remitting multiple sclerosis receiving immunomodulatory therapy: a retrospective survey of more than 9000 German patients with MS

BACKGROUND AND PURPOSE

First-line immunomodulatory treatment with interferon-beta or glatiramer acetate is accepted as effective basic therapy in patients with relapsing-remitting multiple sclerosis (RRMS). However, a considerable portion of patients does not benefit from treatment.

METHOD

To test basic immunomodulatory treatment under real-life conditions, we retrospectively analyzed clinical and subclinical disease activity within the last 12 months in a cohort of 9916 patients with RRMS, of which 7896 patients were receiving immunomodulatory treatment. In addition, factors associated with treating physicians' consideration of a switch of current treatment were assessed.

RESULTS

The majority of treated patients (approximately 66%) experienced no relapse during the last 12 months. However, in line with common clinical study findings, about one-third (approximately 34%) of patients had relapses. When MRI data were taken into account, approximately one-quarter (24%) of patients would qualify for therapy escalation to monoclonal antibody natalizumab. Relapse rate in the preceding year (the year directly prior to the start of retrospective data collection) was strongly associated with considering a switch of current treatment. In addition, therapy switch was more often considered in younger patients. The relationship between MRI findings in the absence of clinical symptoms and consideration of a treatment switch was not as clear.

CONCLUSIONS

This analysis confirms that disease progression occurs in a considerable proportion of patients with RRMS. These patients should be considered for therapy escalation.

Maturation of hepatosomal mono-oxygenation and glucuronidation activities in pre- and full-term infants as studied using the [15N]methacetin urine test

The non-distressing [15N]methacetin liver function test was modified and applied to newborn healthy infants in order to measure both the total [15N]methacetin metabolites excreted in the urine (total elimination capacity) and the proportion of glucuronated metabolite. By studying pre- and full-term normotrophic neonates 3-168 days old, the age-dependent maturation of the two developing liver function processes can be compared on the basis of either postnatal or postmenstrual age. When solely considering postnatal age, no significant differences between the pre- and full-term infants were observed in the development of the total elimination capacity. However, when postmenstrual age was considered, it became apparent that this development starts earlier in pre-term infants and continues at the same rate as their full-term counterparts, up to the postmenstrual age of approximately 280 days. This increase subsequently diminishes in the pre-terms. In the same study group, the proportion of glucuronidation, another indicator of the hepatic detoxification system, appears to develop at a lower rate in pre-term than in full-term infants. When postmenstrual age is taken into consideration, glucuronidation development is also observed to begin earlier in pre-term infants and the slower maturation is more pronounced. Although these results are not generally applicable, they contribute to a better interpretation of the [15N]methacetin liver function test--for instance when estimating effects due to environmental exposure or accurately calculating age-related drug dosage for neonates.