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Bennett JL, Grove NC, Johnson RK, Mizenko C, DuPont JC, Wagner BD, Lynch AM, Frohman TC, Shindler KS, Frohman EM. A Randomized Prospective Trial Comparing Repository Corticotropin Injection and Intravenous Methylprednisolone for Neuroprotection in Acute Optic Neuritis. J Neuroophthalmol 2023; 43:323-329. [PMID: 37261907 PMCID: PMC10414149 DOI: 10.1097/wno.0000000000001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Repository corticotrophin injection (RCI, Acthar Gel) and intravenous methylprednisolone (IVMP) improve the rate but not the extent of visual recovery following acute optic neuritis. RCI has adrenal-stimulating and melanocortin receptor-stimulating properties that may endow it with unique anti-inflammatory properties relative to IVMP. METHODS Individuals with acute optic neuritis of less than 2 weeks duration were prospectively enrolled and randomized 1:1 to receive either RCI or IVMP. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell plus inner plexiform layer thickness (GC + IPL) were serially evaluated by OCT. In addition, patient-reported outcomes (PROs) for changes in fatigue, mood, visual function, depression, and quality of life (QOL) were measured, and high and low contrast visual acuity were recorded. RESULTS Thirty-seven subjects were enrolled (19 RCI; 18 IVMP); the average time from symptom to treatment was 8.8 days. At 6 months, there was no difference in the primary outcome: loss of average pRNFL thickness in the affected eye (RCI vs IVMP: -13.1 vs -11.7 µm, P = 0.88) 6 months after randomization. Additional outcomes also showed no difference between treatment groups: 6-month attenuation of GC + IPL thickness (RCI vs IVMP: -13.8 vs -12.0 µm, P = 0.58) and frequency of pRNFL swelling at 1 month (RCI vs IVMP: 63% vs 72%, P = 0.73) and 3 months (RCI vs IVMP: 26% vs 31%, P = 0.99). Both treatments resulted in improvement in visual function and PROs. CONCLUSIONS Treatment of acute optic neuritis with RCI or IVMP produced no clinically meaningful differences in optic nerve structure or visual function.
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Di Stadio A, De Luca P, Koohi N, Kaski D, Ralli M, Giesemann A, Hartung HP, Altieri M, Messineo D, Warnecke A, Frohman T, Frohman EM. Neuroinflammatory disorders of the brain and inner ear: a systematic review of auditory function in patients with migraine, multiple sclerosis, and neurodegeneration to support the idea of an innovative 'window of discovery'. Front Neurol 2023; 14:1204132. [PMID: 37662038 PMCID: PMC10471191 DOI: 10.3389/fneur.2023.1204132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background Hearing can be impaired in many neurological conditions and can even represent a forme fruste of specific disorders. Auditory function can be measured by either subjective or objective tests. Objective tests are more useful in identifying which auditory pathway (superior or inferior) is most affected by disease. The inner ear's perilymphatic fluid communicates with the cerebrospinal fluid (CSF) via the cochlear aqueduct representing a window from which pathological changes in the contents of the CSF due to brain inflammation could, therefore, spread to and cause inflammation in the inner ear, damaging inner hair cells and leading to hearing impairment identifiable on tests of auditory function. Methods A systematic review of the literature was performed, searching for papers with case-control studies that analyzed the hearing and migraine function in patients with neuro-inflammatory, neurodegenerative disorders. With data extracted from these papers, the risk of patients with neurological distortion product otoacoustic emission (DPOAE) was then calculated. Results Patients with neurological disorders (headache, Parkinson's disease, and multiple sclerosis) had a higher risk of having peripheral auditory deficits when compared to healthy individuals. Conclusion Existing data lend credence to the hypothesis that inflammatory mediators transmitted via fluid exchange across this communication window, thereby represents a key pathobiological mechanism capable of culminating in hearing disturbances associated with neuroimmunological and neuroinflammatory disorders of the nervous system.
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Affiliation(s)
- Arianna Di Stadio
- GF Ingrassia Department, University of Catania, Catania, Italy
- IRCCS Santa Lucia, Rome, Italy
| | - Pietro De Luca
- Head and Neck Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Nehzat Koohi
- The UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Diego Kaski
- The UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Massimo Ralli
- Department of Sense Organs, University Sapienza, Rome, Italy
| | - Anja Giesemann
- Department of Interventional Neuroradiologie, Hannover Medical School, Hannover, Germany
| | - Hans-Peter Hartung
- Klinik für Neurologie UKD Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Marta Altieri
- Department of Neurology, University Sapienza, Rome, Italy
| | - Daniela Messineo
- Department of Radiology and Pathology, University Sapienza, Rome, Italy
| | - Athanasia Warnecke
- Department of Otolaryngology-Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | - Teresa Frohman
- Distinguished Senior Fellows (Sabbatical), Laboratory of Neuroimmunology of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Elliot M. Frohman
- Distinguished Senior Fellows (Sabbatical), Laboratory of Neuroimmunology of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA, United States
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Mohammadi S, Gouravani M, Salehi MA, Arevalo JF, Galetta SL, Harandi H, Frohman EM, Frohman TC, Saidha S, Sattarnezhad N, Paul F. Optical coherence tomography angiography measurements in multiple sclerosis: a systematic review and meta-analysis. J Neuroinflammation 2023; 20:85. [PMID: 36973708 PMCID: PMC10041805 DOI: 10.1186/s12974-023-02763-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/11/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent literature on multiple sclerosis (MS) demonstrates the growing implementation of optical coherence tomography-angiography (OCT-A) to discover potential qualitative and quantitative changes in the retina and optic nerve. In this review, we analyze OCT-A studies in patients with MS and examine its utility as a surrogate or precursor to changes in central nervous system tissue. METHODS PubMed and EMBASE were systematically searched to identify articles that applied OCT-A to evaluate the retinal microvasculature measurements in patients with MS. Quantitative data synthesis was performed on all measurements which were evaluated in at least two unique studies with the same OCT-A devices, software, and study population compared to controls. A fixed-effects or random-effects model was applied for the meta-analysis based on the heterogeneity level. RESULTS The study selection process yielded the inclusion of 18 studies with a total of 1552 evaluated eyes in 673 MS-associated optic neuritis (MSON) eyes, 741 MS without optic neuritis (MSNON eyes), and 138 eyes without specification for the presence of optic neuritis (ON) in addition to 1107 healthy control (HC) eyes. Results indicated that MS cases had significantly decreased whole image superficial capillary plexus (SCP) vessel density when compared to healthy control subjects in the analyses conducted on Optovue and Topcon studies (both P < 0.0001). Likewise, the whole image vessel densities of deep capillary plexus (DCP) and radial peripapillary capillary (RPC) were significantly lower in MS cases compared to HC (all P < 0.05). Regarding optic disc area quadrants, MSON eyes had significantly decreased mean RPC vessel density compared to MSNON eyes in all quadrants except for the inferior (all P < 0.05). Results of the analysis of studies that used prototype Axsun machine revealed that MSON and MSNON eyes both had significantly lower ONH flow index compared to HC (both P < 0.0001). CONCLUSIONS This systematic review and meta-analysis of the studies reporting OCT-A measurements of people with MS confirmed the tendency of MS eyes to exhibit reduced vessel density in the macular and optic disc areas, mainly in SCP, DCP, and RPC vessel densities.
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Affiliation(s)
- Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Mohammad Amin Salehi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran.
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Steven L Galetta
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Hamid Harandi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Elliot M Frohman
- Laboratory of Neuroimmunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Teresa C Frohman
- Laboratory of Neuroimmunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Neda Sattarnezhad
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, Stanford Multiple Sclerosis Center, Stanford University, Stanford, USA
| | - Friedemann Paul
- Department of Neurology, Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
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Hurtubise B, Frohman EM, Galetta S, Balcer LJ, Frohman TC, Lisak RP, Newsome SD, Graves JS, Zamvil SS, Amezcua L. MOG Antibody-Associated Disease and Thymic Hyperplasia: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200077. [PMID: 36517233 PMCID: PMC9753285 DOI: 10.1212/nxi.0000000000200077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described CNS inflammatory disorder that may manifest with optic neuritis, myelitis, seizures, and/or acute disseminated encephalomyelitis. While MOG-specific antibodies in patients with MOGAD are IgG1, a T-cell-dependent antibody isotype, immunologic mechanisms of this disease are not fully understood. Thymic hyperplasia can be associated with certain autoimmune diseases. In this report we describe a case of MOGAD associated with thymic hyperplasia in a young adult.
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Affiliation(s)
- Brigitte Hurtubise
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Elliot M Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Steven Galetta
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Laura J Balcer
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Teresa C Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Robert P Lisak
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott D Newsome
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Jennifer S Graves
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco.
| | - Lilyana Amezcua
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
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Pimentel Maldonado DA, Lisak R, Galetta S, Balcer L, Varkey T, Goodman A, Graves J, Racke M, Zamvil SS, Newsome S, Frohman EM, Frohman TC. Recurrent Optic Neuritis and Perineuritis Followed by an Unexpected Discovery. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/1/e200051. [DOI: 10.1212/nxi.0000000000200051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
We describe a woman with a history of relapsing acute optic neuritis and perineuritis. Testing failed to confirm a specific diagnosis; hence, she was diagnosed with seronegative neuromyelitis optica spectrum disorder and treated with the immunotherapy rituximab, later in conjunction with mycophenolate mofetil. She achieved a durable remission for 9 years until she presented with paresthesia affecting her left fifth digit, right proximal thigh, and left foot, while also reporting a 25-pound weight loss over the prior 3 months. New imaging demonstrated a longitudinally extensive and enhancing optic nerve, in conjunction with multifocal enhancing lesions within the spinal cord, in a skip-like distribution. The differential diagnosis is discussed.
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Goldschmidt C, Galetta SL, Lisak RP, Balcer LJ, Hellman A, Racke MK, Lovett-Racke AE, Cruz R, Parsons MS, Sattarnezhad N, Steinman L, Zamvil SS, Frohman EM, Frohman TC. Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200037. [PMID: 36270950 PMCID: PMC9673749 DOI: 10.1212/nxi.0000000000200037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
A woman presented at age 18 years with partial myelitis and diplopia and experienced multiple subsequent relapses. Her MRI demonstrated T2 abnormalities characteristic of multiple sclerosis (MS) (white matter ovoid lesions and Dawson fingers), and CSF demonstrated an elevated IgG index and oligoclonal bands restricted to the CSF. Diagnosed with clinically definite relapsing-remitting MS, she was treated with various MS disease-modifying therapies and eventually began experiencing secondary progression. At age 57 years, she developed an acute longitudinally extensive transverse myelitis and was found to have AQP4 antibodies by cell-based assay. Our analysis of the clinical course, radiographic findings, molecular diagnostic methods, and treatment response characteristics support the hypothesis that our patient most likely had 2 CNS inflammatory disorders: MS, which manifested as a teenager, and neuromyelitis optica spectrum disorder, which evolved in her sixth decade of life. This case emphasizes a key principle in neurology practice, which is to reconsider whether the original working diagnosis remains tenable, especially when confronted with evidence (clinical and/or paraclinical) that raises the possibility of a distinctively different disorder.
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Affiliation(s)
- Carolyn Goldschmidt
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Steven L Galetta
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Robert P Lisak
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Laura J Balcer
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Andrew Hellman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Michael K Racke
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Amy E Lovett-Racke
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Roberto Cruz
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Matthew S Parsons
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Neda Sattarnezhad
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Lawrence Steinman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Scott S Zamvil
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Elliot M Frohman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA.
| | - Teresa C Frohman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
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7
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Kenney R, Liu M, Hasanaj L, Joseph B, Al-Hassan AA, Balk L, Behbehani R, Brandt AU, Calabresi PA, Frohman EM, Frohman T, Havla J, Hemmer B, Jiang H, Knier B, Korn T, Leocani L, Martínez-Lapiscina EH, Papadopoulou A, Paul F, Petzold A, Pisa M, Villoslada P, Zimmermann H, Ishikawa H, Schuman JS, Wollstein G, Chen Y, Saidha S, Thorpe LE, Galetta SL, Balcer LJ. Normative Data and Conversion Equation for Spectral-Domain Optical Coherence Tomography in an International Healthy Control Cohort. J Neuroophthalmol 2022; 42:442-453. [PMID: 36049213 PMCID: PMC10350791 DOI: 10.1097/wno.0000000000001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Spectral-domain (SD-) optical coherence tomography (OCT) can reliably measure axonal (peripapillary retinal nerve fiber layer [pRNFL]) and neuronal (macular ganglion cell + inner plexiform layer [GCIPL]) thinning in the retina. Measurements from 2 commonly used SD-OCT devices are often pooled together in multiple sclerosis (MS) studies and clinical trials despite software and segmentation algorithm differences; however, individual pRNFL and GCIPL thickness measurements are not interchangeable between devices. In some circumstances, such as in the absence of a consistent OCT segmentation algorithm across platforms, a conversion equation to transform measurements between devices may be useful to facilitate pooling of data. The availability of normative data for SD-OCT measurements is limited by the lack of a large representative world-wide sample across various ages and ethnicities. Larger international studies that evaluate the effects of age, sex, and race/ethnicity on SD-OCT measurements in healthy control participants are needed to provide normative values that reflect these demographic subgroups to provide comparisons to MS retinal degeneration. METHODS Participants were part of an 11-site collaboration within the International Multiple Sclerosis Visual System (IMSVISUAL) consortium. SD-OCT was performed by a trained technician for healthy control subjects using Spectralis or Cirrus SD-OCT devices. Peripapillary pRNFL and GCIPL thicknesses were measured on one or both devices. Automated segmentation protocols, in conjunction with manual inspection and correction of lines delineating retinal layers, were used. A conversion equation was developed using structural equation modeling, accounting for clustering, with healthy control data from one site where participants were scanned on both devices on the same day. Normative values were evaluated, with the entire cohort, for pRNFL and GCIPL thicknesses for each decade of age, by sex, and across racial groups using generalized estimating equation (GEE) models, accounting for clustering and adjusting for within-patient, intereye correlations. Change-point analyses were performed to determine at what age pRNFL and GCIPL thicknesses exhibit accelerated rates of decline. RESULTS The healthy control cohort (n = 546) was 54% male and had a wide distribution of ages, ranging from 18 to 87 years, with a mean (SD) age of 39.3 (14.6) years. Based on 346 control participants at a single site, the conversion equation for pRNFL was Cirrus = -5.0 + (1.0 × Spectralis global value). Based on 228 controls, the equation for GCIPL was Cirrus = -4.5 + (0.9 × Spectralis global value). Standard error was 0.02 for both equations. After the age of 40 years, there was a decline of -2.4 μm per decade in pRNFL thickness ( P < 0.001, GEE models adjusting for sex, race, and country) and -1.4 μm per decade in GCIPL thickness ( P < 0.001). There was a small difference in pRNFL thickness based on sex, with female participants having slightly higher thickness (2.6 μm, P = 0.003). There was no association between GCIPL thickness and sex. Likewise, there was no association between race/ethnicity and pRNFL or GCIPL thicknesses. CONCLUSIONS A conversion factor may be required when using data that are derived between different SD-OCT platforms in clinical trials and observational studies; this is particularly true for smaller cross-sectional studies or when a consistent segmentation algorithm is not available. The above conversion equations can be used when pooling data from Spectralis and Cirrus SD-OCT devices for pRNFL and GCIPL thicknesses. A faster decline in retinal thickness may occur after the age of 40 years, even in the absence of significant differences across racial groups.
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Affiliation(s)
- Rachel Kenney
- Departments of Neurology (RK, LH, BJ, SLG, LJB) and Population Health (RK, ML, YC, LET, LJB), New York University Grossman School of Medicine, New York, New York; Al-Bahar Ophthalmology Center (AAA-H, RB), Ibn Sina Hospital, Kuwait City, Kuwait; Centre for Research on Sports in Society (LB), Mulier Institute, Utrecht, Netherlands; Experimental and Clinical Research Center (AUB, AP, FP, HZ), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology (AUB), University of California, Irvine, California; Department of Neurology (PAC, SS), Johns Hopkins University, Baltimore, Maryland; Laboratory of Neuroimmunology (EMF, TF), Stanford University School of Medicine, Palo Alto, California; Institute of Clinical Neuroimmunology (JH), LMU Hospital, Ludwig Maximilians Universität München, Munich, Germany; Data Integration for Future Medicine consortium (DIFUTURE) (JH), Ludwig-Maximilians University, Munich, Germany; Department of Neurology (BH, BK, TK), Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy) (BH, TK), Munich, Germany; Department of Neurology (HJ), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Vita-Salute University & Hospital San Raffaele (LL, MP), Milano, Italy; Center of Neuroimmunology and Department of Neurology (EHM-L, PV), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Neurologic Clinic and Policlinic (AP), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (FP, HZ), Charité-Universitätsmedizin Berlin, Berlin, Germany; Moorfields Eye Hospital (AP), London, United Kingdom ; The National Hospital for Neurology and Neurosurgery (AP), Queen Square, UCL Institute of Neurology, London, United Kingdom; Dutch Neuro-Ophthalmology Expertise Centre (AP), Amsterdam UMC, Amsterdam, the Netherlands; Oregon Health and Science University (HI), Portland, Oregon; Department of Ophthalmology (JSS, GW, SLG, LJB), New York University Grossman School of Medicine, New York, New York; Departments of Biomedical Engineering and Electrical and Computer Engineering (JSS), Tandon School of Engineering, New York University, Brooklyn, New York; Center for Neural Science (JSS), NYU, New York, New York; and Neuroscience Institute (JSS), NYU Langone Health, New York, New York
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8
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Racke MK, Frohman EM, Frohman T. Pain in Multiple Sclerosis: Understanding Pathophysiology, Diagnosis, and Management Through Clinical Vignettes. Front Neurol 2022; 12:799698. [PMID: 35095742 PMCID: PMC8794582 DOI: 10.3389/fneur.2021.799698] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Neuropathic pain and other pain syndromes occur in the vast majority of patients with multiple sclerosis at some time during their disease course. Pain can become chronic and paroxysmal. In this review, we will utilize clinical vignettes to describe various pain syndromes associated with multiple sclerosis and their pathophysiology. These syndromes vary from central neuropathic pain or Lhermitte's phenomenon associated with central nervous system lesions to trigeminal neuralgia and optic neuritis pain associated with nerve lesions. Muscular pain can also arise due to spasticity. In addition, we will discuss strategies utilized to help patients manage these symptoms.
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Affiliation(s)
- Michael K Racke
- Department of Medical Affairs, Quest Diagnostics, Secaucus, NJ, United States
| | - Elliot M Frohman
- Neuroimmunology Laboratory of Lawrence Steinman, Stanford University School of Medicine, Stanford, CA, United States
| | - Teresa Frohman
- Neuroimmunology Laboratory of Lawrence Steinman, Stanford University School of Medicine, Stanford, CA, United States
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9
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Frohman EM, Villemarette-Pittman NR, Rodriguez A, Glanzman R, Rugheimer S, Komogortsev O, Zamvil SS, Cruz RA, Varkey TC, Frohman AN, Frohman AR, Parsons MS, Konkle EH, Frohman TC. Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease. J Neurol Sci 2021; 426:117463. [PMID: 33971376 PMCID: PMC8055502 DOI: 10.1016/j.jns.2021.117463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
The COVID-19 pandemic has devastated individuals, families, and institutions throughout the world. Despite the breakneck speed of vaccine development, the human population remains at risk of further devastation. The decision to not become vaccinated, the protracted rollout of available vaccine, vaccine failure, mutational forms of the SARS virus, which may exhibit mounting resistance to our molecular strike at only one form of the viral family, and the rapid ability of the virus(es) to hitch a ride on our global transportation systems, means that we are will likely continue to confront an invisible, yet devastating foe. The enemy targets one of our human physiology's most important and vulnerable life-preserving body tissues, our broncho-alveolar gas exchange apparatus. Notwithstanding the fear and the fury of this microbe's potential to raise existential questions across the entire spectrum of human endeavor, the application of an early treatment intervention initiative may represent a crucial tool in our defensive strategy. This strategy is driven by evidence-based medical practice principles, those not likely to become antiquated, given the molecular diversity and mutational evolution of this very clever "world traveler".
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Affiliation(s)
- Elliot M Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
| | | | - Adriana Rodriguez
- Department of Emergency Medicine, Cook Children's Medical Center, Ft. Worth, TX, United States of America
| | - Robert Glanzman
- Clene Nanomedicine, Inc., Salt Lake City, UT 84121, United States of America.
| | - Sarah Rugheimer
- Department of Physics, University Oxford, Oxford OX1 3PU, UK.
| | - Oleg Komogortsev
- Department of Computer Sciences, Texas State University, San Marcos, TX, United States of America.
| | - Scott S Zamvil
- Department of Neurology and Program in Immunology, University of California San Francisco, San Francisco, CA, United States of America.
| | - Roberto Alejandro Cruz
- Department of Neurology, Doctor's Health at Renaissance Health Neurology Institute, United States of America; Department of Neurology, University of Texas Rio Grande Valley School of Medicine, United States of America.
| | - Thomas C Varkey
- Dell Medical School, University of Texas at Austin, United States of America.
| | | | | | - Matthew S Parsons
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, United States of America; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States of America.
| | | | - Teresa C Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
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10
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Zarghami Esfanhani N, Wundes A, Varkey T, Lisak RP, Goodman A, Graves J, Zamvil SS, Frohman EM, Frohman TC, Newsome SD. Encephalitis and Myelitis in a Young Woman: Overlap Syndrome, Thyroiditis, and Occult Tumor From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/5/e1026. [PMID: 34162741 PMCID: PMC8223881 DOI: 10.1212/nxi.0000000000001026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Neda Zarghami Esfanhani
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Annette Wundes
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Thomas Varkey
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Robert P Lisak
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Andrew Goodman
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Jennifer Graves
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Scott S Zamvil
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Elliot M Frohman
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Teresa C Frohman
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Scott D Newsome
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD.
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Anadani N, Hyland M, Cruz RA, Lisak R, Costello K, Major EO, Jassam Y, Meltzer E, Varkey TC, Parsons MS, Goodman AD, Graves JS, Newsome S, Zamvil SS, Frohman EM, Frohman TC. Treating MS after surviving PML: Discrete strategies for rescue, remission, and recovery patient 1: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2020; 8:8/1/e929. [PMID: 33411672 PMCID: PMC7803340 DOI: 10.1212/nxi.0000000000000929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Nidhiben Anadani
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Megan Hyland
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Roberto Alejandro Cruz
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Robert Lisak
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Kathleen Costello
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Eugene O Major
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Yasir Jassam
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Ethan Meltzer
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Thomas C Varkey
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Matthew S Parsons
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Andrew D Goodman
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Jennifer S Graves
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Scott Newsome
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Scott S Zamvil
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Elliot M Frohman
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin.
| | - Teresa C Frohman
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin.
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Cruz RA, Hogan N, Sconzert J, Sconzert M, Major EO, Lisak RP, Melamed E, Varkey TC, Meltzer E, Goodman A, Komogortsev O, Parsons MS, Costello K, Graves JS, Newsome S, Zamvil SS, Frohman EM, Frohman TC. Treating MS after surviving PML: Discrete strategies for rescue, remission, and recovery patient 2: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2020; 8:8/1/e930. [PMID: 33434885 PMCID: PMC7803334 DOI: 10.1212/nxi.0000000000000930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Roberto Alejandro Cruz
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Nick Hogan
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Jayne Sconzert
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Megan Sconzert
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Eugene O Major
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Robert P Lisak
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Esther Melamed
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Thomas C Varkey
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Ethan Meltzer
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Andrew Goodman
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Oleg Komogortsev
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Matthew S Parsons
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Kathleen Costello
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Jennifer S Graves
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Scott Newsome
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Scott S Zamvil
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Elliot M Frohman
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin.
| | - Teresa C Frohman
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin.
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Meltzer E, Campbell S, Ehrenfeld B, Cruz RA, Steinman L, Parsons MS, Zamvil SS, Frohman EM, Frohman TC. Mitigating alemtuzumab-associated autoimmunity in MS: A "whack-a-mole" B-cell depletion strategy. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/6/e868. [PMID: 32769201 PMCID: PMC7643549 DOI: 10.1212/nxi.0000000000000868] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 07/06/2020] [Indexed: 12/17/2022]
Abstract
Objective To determine whether the punctuated administration of low-dose rituximab,
temporally linked to B-cell hyperrepopulation (defined when the return of
CD19+ B cells approximates 40%–50% of baseline
levels as measured before alemtuzumab treatment inception), can mitigate
alemtuzumab-associated secondary autoimmunity. Methods In this hypothesis-driven pilot study, 10 patients received low-dose
rituximab (50–150 mg/m2), a chimeric anti-CD20 monoclonal
antibody, after either their first or second cycles of alemtuzumab. These
patients were then routinely assessed for the development of autoimmune
disorders and safety signals related to the use of dual monoclonal antibody
therapy. Results Five patients received at least 1 IV infusion of low-dose rituximab,
following alemtuzumab therapy, with a mean follow-up of 41 months. None of
the 5 patients developed secondary autoimmune disorders. An additional 5
patients with follow-up over less than 24 months received at least 1
infusion of low-dose rituximab treatment following alemtuzumab treatment. No
secondary autoimmune diseases were observed. Conclusions An anti-CD20 “whack-a-mole” B-cell depletion strategy may serve
to mitigate alemtuzumab-associated secondary autoimmunity in MS by reducing
the imbalance in B- and T-cell regulatory networks during immune
reconstitution. We believe that these observations warrant further
investigation. Classification of evidence This study provides Class IV evidence that for people with MS, low-dose
rituximab following alemtuzumab treatment decreases the risk of
alemtuzumab-associated secondary autoimmune diseases.
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Affiliation(s)
- Ethan Meltzer
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Sarah Campbell
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Benjamin Ehrenfeld
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Roberto A Cruz
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Lawrence Steinman
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Matthew S Parsons
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Scott S Zamvil
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Elliot M Frohman
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin.
| | - Teresa C Frohman
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin.
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Nguyen J, Rothman A, Gonzalez N, Avornu A, Ogbuokiri E, Balcer LJ, Galetta SL, Frohman EM, Frohman T, Crainiceanu C, Calabresi PA, Saidha S. Macular Ganglion Cell and Inner Plexiform Layer Thickness Is More Strongly Associated With Visual Function in Multiple Sclerosis Than Bruch Membrane Opening-Minimum Rim Width or Peripapillary Retinal Nerve Fiber Layer Thicknesses. J Neuroophthalmol 2020; 39:444-450. [PMID: 30921169 DOI: 10.1097/wno.0000000000000768] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) measurements of ganglion cell + inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses are associated with visual function (VF) and disability in multiple sclerosis (MS). However, the value of measuring Bruch membrane opening-minimum rim width (BMO-MRW) thickness in MS remains unclear. METHODS Sixty-eight patients with MS and 22 healthy controls (HCs) underwent spectral domain OCT, 100%-contrast visual acuity (VA), 2.5%- and 1.25%-contrast letter acuity (LA), and Expanded Disability Status Scale (EDSS) testing. Mixed-effects linear regression models, accounting for within-subject, intereye correlations, were used to assess relationships. RESULTS The MS cohort exhibited significantly lower BMO-MRW (P = 0.01), pRNFL at 3.7-, 4.1-, and 4.7-mm diameters surrounding the optic disc (P < 0.001 for all), and GCIPL (P < 0.001) thicknesses than HCs. BMO-MRW thickness was associated with 100%-VA (P < 0.001, R = 0.08), 2.5%-LA (P < 0.001; R = 0.13), and 1.25%-LA (P = 0.002; R = 0.11). All measured pRNFL thicknesses were associated with high- and low-contrast VF (all: P < 0.001). GCIPL thickness was more strongly associated with 100%-VA (P < 0.001; R = 0.23), 2.5%-LA (P < 0.001; R = 0.27), and 1.25%-LA (P < 0.001; R = 0.21) than the other OCT measures assessed. All OCT measures were significantly, but weakly, associated with EDSS scores. CONCLUSIONS BMO-MRW and pRNFL thicknesses are reduced and associated with VF and disability in MS, but GCIPL thickness is a stronger marker of visual impairment. Our findings corroborate the utility of OCT in providing valuable information regarding the MS disease process.
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Affiliation(s)
- James Nguyen
- Department of Neurology (JN, AR, NG, AA, EO, PAC, and SS), Johns Hopkins University School of Medicine, Baltimore, Maryland; Departments of Neurology (LJB and SLG), Population Health (LJB and SLG), and Ophthalmology (LJB and SLG), New York University School of Medicine, New York, New York; Departments of Neurology (EMF and TF) and Ophthalmology (EMF and TF), Dell Medical School, University of Texas at Austin, Austin, Texas; and Department of Biostatistics (CC), Johns Hopkins University, Baltimore, Maryland
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15
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Murphy OC, Kwakyi O, Iftikhar M, Zafar S, Lambe J, Pellegrini N, Sotirchos ES, Gonzalez-Caldito N, Ogbuokiri E, Filippatou A, Risher H, Cowley N, Feldman S, Fioravante N, Frohman EM, Frohman TC, Balcer LJ, Prince JL, Channa R, Calabresi PA, Saidha S. Alterations in the retinal vasculature occur in multiple sclerosis and exhibit novel correlations with disability and visual function measures. Mult Scler 2020; 26:815-828. [PMID: 31094280 PMCID: PMC6858526 DOI: 10.1177/1352458519845116] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The retinal vasculature may be altered in multiple sclerosis (MS), potentially acting as a biomarker of disease processes. OBJECTIVE To compare retinal vascular plexus densities in people with MS (PwMS) and healthy controls (HCs), and examine correlations with visual function and global disability. METHODS In this cross-sectional study, 111 PwMS (201 eyes) and 50 HCs (97 eyes) underwent optical coherence tomography angiography (OCTA). Macular superficial vascular plexus (SVP) and deep vascular plexus (DVP) densities were quantified, and poor quality images were excluded according to an artifact-rating protocol. RESULTS Mean SVP density was 24.1% (SD = 5.5) in MS eyes (26.0% (SD = 4.7) in non-optic neuritis (ON) eyes vs. 21.7% (SD = 5.5) in ON eyes, p < 0.001), as compared to 29.2% (SD = 3.3) in HC eyes (p < 0.001 for all MS eyes and multiple sclerosis optic neuritis (MSON) eyes vs. HC eyes, p = 0.03 for MS non-ON eyes vs. HC eyes). DVP density did not differ between groups. In PwMS, lower SVP density was associated with higher levels of disability (expanded disability status scale (EDSS): R2 = 0.26, p = 0.004; multiple sclerosis functional composite (MSFC): R2 = 0.27, p = 0.03) and lower letter acuity scores (100% contrast: R2 = 0.29; 2.5% contrast: R2 = 0.40; 1.25% contrast: R2 = 0.31; p < 0.001 for all). CONCLUSIONS Retinal SVP density measured by OCTA is reduced across MS eyes, and correlates with visual function, EDSS, and MSFC scores.
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Affiliation(s)
- Olwen C. Murphy
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Ohemaa Kwakyi
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
| | - Jeffrey Lambe
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicole Pellegrini
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Elias S. Sotirchos
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Natalia Gonzalez-Caldito
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Esther Ogbuokiri
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Angeliki Filippatou
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Hunter Risher
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Norah Cowley
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Sydney Feldman
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicholas Fioravante
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Elliot M. Frohman
- Department of Neurology and Ophthalmology, University of
Texas Austin Dell Medical School, Austin, TX, United States
| | - Teresa C. Frohman
- Department of Neurology and Ophthalmology, University of
Texas Austin Dell Medical School, Austin, TX, United States
| | - Laura J. Balcer
- Department of Neurology, New York University Langone
Medical Center, New York, NY, United States
| | - Jerry L. Prince
- Department of Electrical and Computer Engineering, Johns
Hopkins University, Baltimore, MD, United States
| | - Roomasa Channa
- Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
- Department of Ophthalmology, Baylor College of Medicine,
Houston, TX, United States
| | - Peter A. Calabresi
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
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Frohman EM, Villemarette-Pittman NR, Melamed E, Cruz RA, Longmuir R, Varkey TC, Steinman L, Zamvil SS, Frohman TC. Part I. SARS-CoV-2 triggered 'PANIC' attack in severe COVID-19. J Neurol Sci 2020; 415:116936. [PMID: 32532449 PMCID: PMC7241348 DOI: 10.1016/j.jns.2020.116936] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has produced a world-wide collapse of social and economic infrastructure, as well as constrained our freedom of movement. This respiratory tract infection is nefarious in how it targets the most distal and highly vulnerable aspect of the human bronchopulmonary tree, specifically, the delicate yet irreplaceable alveoli that are responsible for the loading of oxygen upon red cell hemoglobin for use by all of the body's tissues. In most symptomatic individuals, the disease is a mild immune-mediated syndrome, with limited damage to the lung tissues. About 20% of those affected experience a disease course characterized by a cataclysmic set of immune activation responses that can culminate in the diffuse and irreversible obliteration of the distal alveoli, leading to a virtual collapse of the gas-exchange apparatus. Here, in Part I of a duology on the characterization and potential treatment for COVID-19, we define severe COVID-19 as a consequence of the ability of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to trigger what we now designate for the first time as a ‘Prolific Activation of a Network-Immune-Inflammatory Crisis’, or ‘PANIC’ Attack, in the alveolar tree. In Part II we describe an immunotherapeutic hypothesis worthy of the organization of a randomized clinical trial in order to ascertain whether a repurposed, generic, inexpensive, and widely available agent is capable of abolishing ‘PANIC’; thereby preventing or mitigating severe COVID-19, with monumental ramifications for world health, and the global pandemic that continues to threaten it.
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Affiliation(s)
- Elliot M Frohman
- Department of Neurology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America; Department of Neurosurgery, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America; Department of Ophthalmology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America.
| | | | - Esther Melamed
- Department of Neurology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America.
| | - Roberto Alejandro Cruz
- Department of Neurology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America.
| | - Reid Longmuir
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America; Veterans Affairs Medical Center, Nashville, TN, United States of America
| | - Thomas C Varkey
- Department of Neurology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America; Colangelo College of Business, Grand Canyon University Phoenix, AZ, United States of America
| | - Lawrence Steinman
- Department of Neurology, Stanford University School of Medicine, Palo Alto, California, United States of America.
| | - Scott S Zamvil
- Department of Neurology and Program in Immunology, University of California San Francisco, San Francisco, California, United States of America.
| | - Teresa C Frohman
- Department of Neurology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America; Department of Neurosurgery, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America; Department of Ophthalmology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America.
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17
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Frohman EM, Villemarette-Pittman NR, Cruz RA, Longmuir R, Rowe V, Rowe ES, Varkey TC, Steinman L, Zamvil SS, Frohman TC. Part II. high-dose methotrexate with leucovorin rescue for severe COVID-19: An immune stabilization strategy for SARS-CoV-2 induced 'PANIC' attack. J Neurol Sci 2020; 415:116935. [PMID: 32534807 PMCID: PMC7241359 DOI: 10.1016/j.jns.2020.116935] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/31/2022]
Abstract
Here, in Part II of a duology on the characterization and potential treatment for COVID-19, we characterize the application of an innovative treatment regimen for the prevention of the transition from mild to severe COVID-19, as well as detail an intensive immunotherapy intervention hypothesis. We propose as a putative randomized controlled trial that high-dose methotrexate with leucovorin (HDMTX-LR) rescue can abolish ‘PANIC’, thereby ‘left-shifting’ severe COVID-19 patients to the group majority of those infected with SARS-CoV-2, who are designated as having mild, even asymptomatic, disease. HDMTX-LR is endowed with broadly pleiotropic properties and is a repurposed, generic, inexpensive, and widely available agent which can be administered early in the course of severe COVID-19 thus rescuing the critical and irreplaceable gas-exchange alveoli. Further, we describe a preventative treatment intervention regimen for those designated as having mild to moderate COVID-19 disease, but who exhibit features which herald the transition to the severe variant of this disease. Both of our proposed hypothesis-driven questions should be urgently subjected to rigorous assessment in the context of randomized controlled trials, in order to confirm or refute the contention that the approaches characterized herein, are in fact capable of exerting mitigating, if not abolishing, effects upon SARS-CoV-2 triggered ‘PANIC Attack’. Confirmation of our immunotherapy hypothesis would have far-reaching ramifications for the current pandemic, along with yielding invaluable lessons which could be leveraged to more effectively prepare for the next challenge to global health.
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Affiliation(s)
- Elliot M Frohman
- Department of Neurology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America; Department of Neurosurgery, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America; Department of Ophthalmology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America.
| | | | - Roberto Alejandro Cruz
- Department of Neurology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America.
| | - Reid Longmuir
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America; Veterans Affairs Medical Center, Nashville, TN, United States of America
| | - Vernon Rowe
- Rowe Neurology Institute, Lenexa, KS, United States of America.
| | | | - Thomas C Varkey
- Department of Neurology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America; The Colangelo College of Business, at Grand Canyon University, Phoenix, AZ, United States of America.
| | - Lawrence Steinman
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, United States of America.
| | - Scott S Zamvil
- Department of Neurology and Program in Immunology, University of California San Francisco, San Francisco, CA, United States of America.
| | - Teresa C Frohman
- Department of Neurology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America; Department of Neurosurgery, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America; Department of Ophthalmology, The Dell Medical School, The University of Texas at Austin, Austin, TX, United States of America.
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18
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Allen DR, Huang MU, Morris NB, Chaseling GK, Frohman EM, Jay O, Davis SL. Impaired Thermoregulatory Function during Dynamic Exercise in Multiple Sclerosis. Med Sci Sports Exerc 2019; 51:395-404. [PMID: 30779715 DOI: 10.1249/mss.0000000000001821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Impairments in sudomotor function during passive whole-body heating have been reported in multiple sclerosis (MS), a demyelinating disease of the CNS that disrupts autonomic function. However, the capability of the thermoregulatory system to control body temperature during exercise has never been assessed in MS. Thus, the aim of the present study was to test the hypothesis that thermoregulatory function is impaired in MS patients compared with healthy controls (CON) exercising at similar rates of metabolic heat production. METHODS Sweating and skin blood flow responses were compared between 12 individuals diagnosed with relapsing-remitting MS (9 females, 3 males) and 12 sex-, age-, mass-, and BSA-matched CON during a single bout of cycling exercise (rate of metabolic heat production: ∼4.5 W·kg) for 60 min in a climate-controlled room (25°C, 30% RH). RESULTS Individuals with MS exhibited an attenuated increase in cumulative whole-body sweat loss after 30 min (MS, 72 ± 51 g; CON, 104 ± 37 g; P = 0.04) and 60 min (MS, 209 ± 94 g; CON, 285 ± 62 g; P = 0.02), as well as lower sweating thermosensitivity (MS, 0.49 ± 0.26 mg·cm·min·°C; CON, 0.86 ± 0.30 mg·cm·min·°C; P = 0.049). Despite evidence for thermoregulatory dysfunction, there were no differences between MS and CON in esophageal or rectal temperatures at 30- or 60-min time points (P > 0.05). Cutaneous vasculature responses were also not different in MS compared with CON (P > 0.05). CONCLUSION Taken together, MS blunts sweating responses during exercise while cutaneous vasculature responses are preserved. Altered mechanisms of body temperature regulation in persons with MS may lead to temporary worsening of disease symptoms and limit exercise tolerance under more thermally challenging conditions.
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Affiliation(s)
- Dustin R Allen
- Applied Physiology and Wellness, Southern Methodist University, Dallas, TX.,Department of Health Sciences, Boston University, Boston, MA
| | - M U Huang
- Applied Physiology and Wellness, Southern Methodist University, Dallas, TX
| | - Nathan B Morris
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, AUSTRALIA
| | - Georgia K Chaseling
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, AUSTRALIA
| | - Elliot M Frohman
- Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, AUSTRALIA.,Charles Perkins Centre, The University of Sydney, Camperdown, NSW, AUSTRALIA
| | - Scott L Davis
- Applied Physiology and Wellness, Southern Methodist University, Dallas, TX.,Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
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19
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Perrone CM, Lisak RP, Meltzer EI, Sguigna P, Tizazu E, Jacobs D, Melamed E, Lucas A, Freeman L, Pardo G, Goodman A, Fox EJ, Costello K, Parsons MS, Zamvil SS, Frohman EM, Frohman TC. Cataclysmically disseminating neurologic presentation in an immunosuppressed lupus patient: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2019; 6:e582. [PMID: 31355318 PMCID: PMC6624090 DOI: 10.1212/nxi.0000000000000582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/08/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher M Perrone
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Robert P Lisak
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Ethan I Meltzer
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Peter Sguigna
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Etsegenet Tizazu
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Dina Jacobs
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Esther Melamed
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Ashlea Lucas
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Leorah Freeman
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Gabriel Pardo
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Andrew Goodman
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Edward J Fox
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Kathleen Costello
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Matthew S Parsons
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Scott S Zamvil
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Elliot M Frohman
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
| | - Teresa C Frohman
- Hospital of the University of Pennsylvania (C.M.P., E.T., D.J., ), Philadelphia, PA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. I. Meltzer, E. Melamed, A.L., L.F., E.J.F.), Dell Medical School at the University of Texas at Austin, TX; Department of Neurology (P.S.), MS Fellowship Training Program, UT Southwestern School of Medicine, Dallas, TX; Oklahoma Medical Research Foundation (G.P.), Oklahoma City, OK; Department of Neurology (A.G.), University of Rochester, NY; Central Texas Neurology Consultants, and Department of Neurology (E.J.F.), Dell Medical School at the University of Texas at Austin, TX; The National Multiple Sclerosis Society (K.C.), New York, NY; Yerkes National Primate Research Center (M.S.P.), Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco, San Francisco, CA; and Departments of Neurology and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin, TX
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20
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Turner MP, Hubbard NA, Sivakolundu DK, Himes LM, Hutchison JL, Hart J, Spence JS, Frohman EM, Frohman TC, Okuda DT, Rypma B. Preserved canonicality of the BOLD hemodynamic response reflects healthy cognition: Insights into the healthy brain through the window of Multiple Sclerosis. Neuroimage 2019; 190:46-55. [PMID: 29454932 DOI: 10.1016/j.neuroimage.2017.12.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022] Open
Abstract
The hemodynamic response function (HRF), a model of brain blood-flow changes in response to neural activity, reflects communication between neurons and the vasculature that supplies these neurons in part by means of glial cell intermediaries (e.g., astrocytes). Intact neural-vascular communication might play a central role in optimal cognitive performance. This hypothesis can be tested by comparing healthy individuals to those with known white-matter damage and impaired performance, as seen in Multiple Sclerosis (MS). Glial cell intermediaries facilitate the ability of neurons to adequately convey metabolic needs to cerebral vasculature for sufficient oxygen and nutrient perfusion. In this study, we isolated measurements of the HRF that could quantify the extent to which white-matter affects neural-vascular coupling and cognitive performance. HRFs were modeled from multiple brain regions during multiple cognitive tasks using piecewise cubic spline functions, an approach that minimized assumptions regarding HRF shape that may not be valid for diseased populations, and were characterized using two shape metrics (peak amplitude and time-to-peak). Peak amplitude was reduced, and time-to-peak was longer, in MS patients relative to healthy controls. Faster time-to-peak was predicted by faster reaction time, suggesting an important role for vasodilatory speed in the physiology underlying processing speed. These results support the hypothesis that intact neural-glial-vascular communication underlies optimal neural and cognitive functioning.
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Affiliation(s)
- Monroe P Turner
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Nicholas A Hubbard
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dinesh K Sivakolundu
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Lyndahl M Himes
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Joanna L Hutchison
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - John Hart
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA; Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey S Spence
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darin T Okuda
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bart Rypma
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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21
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Nolan-Kenney RC, Liu M, Akhand O, Calabresi PA, Paul F, Petzold A, Balk L, Brandt AU, Martínez-Lapiscina EH, Saidha S, Villoslada P, Al-Hassan AA, Behbehani R, Frohman EM, Frohman T, Havla J, Hemmer B, Jiang H, Knier B, Korn T, Leocani L, Papadopoulou A, Pisa M, Zimmermann H, Galetta SL, Balcer LJ. Optimal intereye difference thresholds by optical coherence tomography in multiple sclerosis: An international study. Ann Neurol 2019; 85:618-629. [PMID: 30851125 DOI: 10.1002/ana.25462] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the optimal thresholds for intereye differences in retinal nerve fiber and ganglion cell + inner plexiform layer thicknesses for identifying unilateral optic nerve lesions in multiple sclerosis. Current international diagnostic criteria for multiple sclerosis do not include the optic nerve as a lesion site despite frequent involvement. Optical coherence tomography detects retinal thinning associated with optic nerve lesions. METHODS In this multicenter international study at 11 sites, optical coherence tomography was measured for patients and healthy controls as part of the International Multiple Sclerosis Visual System Consortium. High- and low-contrast acuity were also collected in a subset of participants. Presence of an optic nerve lesion for this study was defined as history of acute unilateral optic neuritis. RESULTS Among patients (n = 1,530), receiver operating characteristic curve analysis demonstrated an optimal peripapillary retinal nerve fiber layer intereye difference threshold of 5μm and ganglion cell + inner plexiform layer threshold of 4μm for identifying unilateral optic neuritis (n = 477). Greater intereye differences in acuities were associated with greater intereye retinal layer thickness differences (p ≤ 0.001). INTERPRETATION Intereye differences of 5μm for retinal nerve fiber layer and 4μm for macular ganglion cell + inner plexiform layer are robust thresholds for identifying unilateral optic nerve lesions. These thresholds may be useful in establishing the presence of asymptomatic and symptomatic optic nerve lesions in multiple sclerosis and could be useful in a new version of the diagnostic criteria. Our findings lend further validation for utilizing the visual system in a multiple sclerosis clinical trial setting. Ann Neurol 2019;85:618-629.
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Affiliation(s)
- Rachel C Nolan-Kenney
- Department of Population Health, Sackler Institute for Biomedical Sciences, New York University School of Medicine, New York, NY.,Department of Neurology, New York University School of Medicine, New York, NY
| | - Mengling Liu
- Department of Population Health, Sackler Institute for Biomedical Sciences, New York University School of Medicine, New York, NY
| | - Omar Akhand
- Department of Neurology, New York University School of Medicine, New York, NY
| | | | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Petzold
- Moorfields Eye Hospital, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery & UCL Institute of Neurology, Queen Square, London, United Kingdom.,Neuro-ophthalmology Expertise Center & Multiple Sclerosis Center, Amsterdam UMC, The Netherlands
| | - Lisanne Balk
- Moorfields Eye Hospital, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery & UCL Institute of Neurology, Queen Square, London, United Kingdom.,Neuro-ophthalmology Expertise Center & Multiple Sclerosis Center, Amsterdam UMC, The Netherlands
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University of California, Irvine, Irvine, CA
| | - Elena H Martínez-Lapiscina
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Pablo Villoslada
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | | | | | - Elliot M Frohman
- Department of Neurology and Ophthalmology, University of Texas at Austin, Austin, TX
| | - Teresa Frohman
- Department of Neurology and Ophthalmology, University of Texas at Austin, Austin, TX
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany.,Data Integration for Future Medicine Consortium, Ludwig Maximilian University, Munich, Germany
| | | | - Hong Jiang
- Bascom Palmer Eye Institute, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | | | - Thomas Korn
- Munich Cluster for Systems Neurology, Munich, Germany.,Technical University of Munich, Munich, Germany
| | - Letizia Leocani
- Vita-Salute San Raffaele University and San Raffaele Hospital, Milan, Italy
| | - Athina Papadopoulou
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University Hospital of Basel, Basel, Switzerland
| | - Marco Pisa
- Vita-Salute San Raffaele University and San Raffaele Hospital, Milan, Italy
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steven L Galetta
- Department of Neurology, New York University School of Medicine, New York, NY.,Department of Ophthalmology, New York University School of Medicine, New York, NY
| | - Laura J Balcer
- Department of Neurology, New York University School of Medicine, New York, NY.,Department of Ophthalmology, New York University School of Medicine, New York, NY.,Department of Population Health, New York University School of Medicine, New York, NY
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22
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Lapides DA, Batchala PP, Donahue JH, Lisak RP, Meltzer EI, Narayan RN, Nath A, Frohman TC, Costello K, Goldman MD, Zamvil SS, Frohman EM. Cerebellar syndrome in a man treated with natalizumab: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2019; 6:e546. [PMID: 30882020 PMCID: PMC6410929 DOI: 10.1212/nxi.0000000000000546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/11/2019] [Indexed: 11/15/2022]
Affiliation(s)
- David A Lapides
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Prem P Batchala
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Joseph H Donahue
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Robert P Lisak
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Ethan I Meltzer
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Ram N Narayan
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Avi Nath
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Teresa C Frohman
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Kathleen Costello
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Myla D Goldman
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Scott S Zamvil
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Elliot M Frohman
- Departments of Neurology (D.A.L., M.D.G.), and Radiology and Medical Imaging (P.P.B., J.H.D.), Charlottesville, VA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E.I.M.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.N.N.), Barrows Neuroscience Institute, Phoenix, AZ; Neuroimmunology Branch (A.N.), National Institutes of Health, Bethesda, MD; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
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Al-Louzi O, Sotirchos ES, Vidal-Jordana A, Beh SC, Button J, Ying HS, Balcer LJ, Frohman EM, Saidha S, Calabresi PA, Newsome SD. Characteristics of morphologic macular abnormalities in neuroimmunology practice. Mult Scler 2019; 25:361-371. [PMID: 29125422 PMCID: PMC6929206 DOI: 10.1177/1352458517741206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Morphologic macular abnormalities (MMAs) are frequently seen on macular optical coherence tomography (OCT) imaging in neuroimmunology practice, yet studies pragmatically assessing prevalence and risk factors of MMAs to date are limited. OBJECTIVE To describe the characteristics of MMAs in a neuroimmunology-based academic practice. METHODS Cross-sectional study of 1450 patients (2900 eyes) who underwent spectral-domain macular OCT between June 2010 and June 2012. The association between MMAs and demographic variables was analyzed using mixed-effects logistic regression. Odds ratios (ORs) were calculated per 5-year age increments. RESULTS MMAs were observed in 338/2872 eyes (11.7%) of 232/1445 participants (16.1%). The most common abnormalities identified, included drusen (6.0%), epiretinal membrane (ERM; 5.5%), and microcystoid macular pathology (MMP; 1.9%). Overall, patients with MMAs were older (OR: 1.79, p = 5 × 10-5) and more likely to be males (OR: 2.45, p = 0.014). In particular, advancing age was associated with higher risk of drusen and ERM (OR: 1.80 and 4.26, p = 2 × 10-5 and 7 × 10-3, respectively). MMP prevalence declined with age (OR: 0.73, p = 0.015) and was associated with African-American ethnicity (OR: 15.0, p = 5 × 10-5). CONCLUSION Unexpected or incidental MMAs are common in patients assessed with OCT in neuroimmunology practice, emphasizing the importance of comprehensive OCT image review for risk stratification and appropriate ophthalmology referral.
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Affiliation(s)
- Omar Al-Louzi
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins hospital, Baltimore, MD 21287
| | - Elias S. Sotirchos
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins hospital, Baltimore, MD 21287
| | - Angela Vidal-Jordana
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona
| | - Shin C. Beh
- Department of Neurology and Ophthalmology, University of Texas Southwestern, Dallas, TX, USA
| | - Julia Button
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins hospital, Baltimore, MD 21287
| | - Howard S. Ying
- Department of Ophthalmology, Boston Medical Center, Boston, MA 02118
| | - Laura J. Balcer
- Departments of Neurology, Population Health and Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Elliot M. Frohman
- Department of Neurology and Ophthalmology, University of Texas Southwestern, Dallas, TX, USA
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins hospital, Baltimore, MD 21287
| | - Peter A. Calabresi
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins hospital, Baltimore, MD 21287
| | - Scott D. Newsome
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins hospital, Baltimore, MD 21287
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Rothman A, Murphy OC, Fitzgerald KC, Button J, Gordon-Lipkin E, Ratchford JN, Newsome SD, Mowry EM, Sotirchos ES, Syc-Mazurek SB, Nguyen J, Caldito NG, Balcer LJ, Frohman EM, Frohman TC, Reich DS, Crainiceanu C, Saidha S, Calabresi PA. Retinal measurements predict 10-year disability in multiple sclerosis. Ann Clin Transl Neurol 2019; 6:222-232. [PMID: 30847355 PMCID: PMC6389740 DOI: 10.1002/acn3.674] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/30/2018] [Accepted: 09/27/2018] [Indexed: 12/30/2022] Open
Abstract
Objective Optical coherence tomography (OCT)‐derived measures of the retina correlate with disability and cortical gray matter atrophy in multiple sclerosis (MS); however, whether such measures predict long‐term disability is unknown. We evaluated whether a single OCT and visual function assessment predict the disability status 10 years later. Methods Between 2006 and 2008, 172 people with MS underwent Stratus time domain‐OCT imaging [160 with measurement of total macular volume (TMV)] and high and low‐contrast letter acuity (LCLA) testing (n = 150; 87%). All participants had Expanded Disability Status Scale (EDSS) assessments at baseline and at 10‐year follow‐up. We applied generalized linear regression models to assess associations between baseline TMV, peripapillary retinal nerve fiber layer (pRNFL) thickness, and LCLA with 10‐year EDSS scores (linear) and with clinically significant EDSS worsening (binary), adjusting for age, sex, optic neuritis history, and baseline disability status. Results In multivariable models, lower baseline TMV was associated with higher 10‐year EDSS scores (mean increase in EDSS of 0.75 per 1 mm3 loss in TMV (mean difference = 0.75; 95% CI: 0.11–1.39; P = 0.02). In analyses using tertiles, individuals in the lowest tertile of baseline TMV had an average 0.86 higher EDSS scores at 10 years (mean difference = 0.86; 95% CI: 0.23–1.48) and had over 3.5‐fold increased odds of clinically significant EDSS worsening relative to those in the highest tertile of baseline TMV (OR: 3.58; 95% CI: 1.30–9.82; Ptrend = 0.008). pRNFL and LCLA predicted the 10‐year EDSS scores only in univariate models. Interpretation Lower baseline TMV measured by OCT significantly predicts higher disability at 10 years, even after accounting for baseline disability status.
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Affiliation(s)
- Alissa Rothman
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | - Olwen C Murphy
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | | | - Julia Button
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | | | - John N Ratchford
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | - Scott D Newsome
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | - Ellen M Mowry
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | | | | | - James Nguyen
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | | | - Laura J Balcer
- Department of Neurology New York University Langone Medical Center New York New York
| | - Elliot M Frohman
- Department of Neurology and Ophthalmology Dell Medical School University of Texas Austin Austin Texas
| | - Teresa C Frohman
- Department of Neurology and Ophthalmology Dell Medical School University of Texas Austin Austin Texas
| | - Daniel S Reich
- Department of Neurology Johns Hopkins University Baltimore Maryland.,Translational Neuroradiology Unit National Institutes of Health Bethesda Maryland.,Department of Biostatistics Johns Hopkins University Baltimore Maryland
| | | | - Shiv Saidha
- Department of Neurology Johns Hopkins University Baltimore Maryland
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25
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Bradshaw MJ, Lisak RP, Meltzer E, Melamed E, Lucas A, Freeman L, Frohman TC, Costello K, Balcer L, Galetta S, Chitnis T, Zamvil SS, Frohman EM. A young man in "double-trouble": Hallucinations and cranial nerve palsies: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2018; 6:e526. [PMID: 30637300 PMCID: PMC6310360 DOI: 10.1212/nxi.0000000000000526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/23/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Michael J Bradshaw
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Robert P Lisak
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Ethan Meltzer
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Esther Melamed
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Ashlea Lucas
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Leorah Freeman
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Teresa C Frohman
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Kathleen Costello
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Laura Balcer
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Steven Galetta
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Scott S Zamvil
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
| | - Elliot M Frohman
- Partners Multiple Sclerosis Center (M.J.B., T.C.), Brigham and Women's Hospital; Massachusetts General Hospital (M.J.B., T.C.); Harvard Medical School (M.J.B., T.C.), Boston, MA; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (E. Meltzer, E. Melamed, A.L.), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), McGovern Medical School at UT Health, Houston; Department of Neurology and Ophthalmology (T.C.F., E.M.F.), Dell Medical School at the University of Texas at Austin; The National Multiple Sclerosis Society (K.C.), New York; Departments of Neurology (L.B., S.G.), Population Health and Ophthalmology, New York University School of Medicine; and Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco
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26
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Romeo AR, Lisak RP, Meltzer E, Fox EJ, Melamed E, Lucas A, Freeman L, Frohman TC, Costello K, Zamvil SS, Frohman EM, Gelfand JM. A young man with numbness in arms and legs. Neurol Neuroimmunol Neuroinflamm 2018; 5:e509. [PMID: 30465017 PMCID: PMC6225923 DOI: 10.1212/nxi.0000000000000509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew R Romeo
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Robert P Lisak
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Ethan Meltzer
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Edward J Fox
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Esther Melamed
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Ashlea Lucas
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Leorah Freeman
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Teresa C Frohman
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Kathleen Costello
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Scott S Zamvil
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Elliot M Frohman
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
| | - Jeffrey M Gelfand
- Department of Neurology (A.R.R., S.S.Z., J.M.G.) and Program in Immunology (S.S.Z.), University of California San Francisco; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Partner's Neurology Training Program (E.M.); MGH and Brigham and Women's Hospitals, Harvard Medical School, Boston, MA; and E.M. is now with the Department of Neurology, Dell Medical School at the University of Texas at Austin; Central Texas Neurology Consultants (E.J.F.), and Department of Neurology, Dell Medical School at the University of Texas at Austin; Department of Neurology (E.M., A.L.), and Department of Neurology and Ophthalmology (T.C.F., E.F), Dell Medical School at the University of Texas at Austin; Department of Neurology (L.F.), University of Texas at Houston; and the National Multiple Sclerosis Society, New York, NY
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Nguyen J, Rothman A, Fitzgerald K, Whetstone A, Syc-Mazurek S, Aquino J, Balcer LJ, Frohman EM, Frohman TC, Crainiceanu C, Beier M, Newsome SD, Calabresi PA, Saidha S. Visual Pathway Measures are Associated with Neuropsychological Function in Multiple Sclerosis. Curr Eye Res 2018; 43:941-948. [PMID: 29634379 DOI: 10.1080/02713683.2018.1459730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine the relationships between visual function and ganglion cell and inner plexiform layer thickness and neuropsychological measures in multiple sclerosis (MS). METHODS Ninety-five relapsing-remitting MS (RRMS) and 36 progressive MS patients underwent 100%-contrast visual acuity (VA), 2.5%- and 1.25%-contrast letter acuity (LA) testing, Cirrus-HD-optical coherence tomography, and neuropsychological assessments. Mixed-effects regression models were used to assess relationships. RESULTS Across the cohort, 1.25%-contrast LA was associated with Symbol Digit Modalities Test (SDMT; β = 2.17, p = 0.005) and Brief Visuospatial Memory Test-Revised (BVMT-R) total recall (TR) and delayed recall (DR) scores (β = 0.31, p < 0.001; β = 0.15, p = 0.039, respectively). 2.5%-contrast LA was associated with BVMT-R TR scores (β = 0.27, p = 0.006). In the RRMS cohort, 1.25%-contrast LA was generally more significantly associated with cognitive measures: SDMT (β = 2.97, p = 0.001) and BVMT-R TR (β = 0.32, p < 0.001) and DR (β = 0.22, p = 0.012). CONCLUSION This study suggests that visual pathway measures, particularly visual function measures, reflect aspects of cognitive function in MS, further supporting their roles as complementary outcomes in MS neuroprotection trials.
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Affiliation(s)
- James Nguyen
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Alissa Rothman
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Kathryn Fitzgerald
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Anna Whetstone
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Stephanie Syc-Mazurek
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jannelle Aquino
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Laura J Balcer
- b Department of Neurology , New York University Langone Medical Center , New York , NY , USA
| | - Elliot M Frohman
- c Department of Neurology and Ophthalmology , University of Texas Southwestern , Dallas , TX , USA
| | - Teresa C Frohman
- c Department of Neurology and Ophthalmology , University of Texas Southwestern , Dallas , TX , USA
| | - Ciprian Crainiceanu
- d Department of Biostatistics , Johns Hopkins University , Baltimore , MD , USA
| | - Meghan Beier
- e Department of Physical Medicine and Rehabilitation , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Scott D Newsome
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Peter A Calabresi
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Shiv Saidha
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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28
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Sobhanian MJ, Agarwal R, Meltzer E, Kildebeck E, Frohman BS, Frohman AN, Galetta SL, Saidha S, White O, Villoslada P, Paul F, Petzold A, Rennaker RL, Martinez-Lapiscina EH, Balcer LJ, Kardon R, Frohman EM, Frohman TC. Identification and treatment of the visual processing asymmetry in MS patients with optic neuritis: The Pulfrich phenomenon. J Neurol Sci 2018; 387:60-69. [PMID: 29571874 DOI: 10.1016/j.jns.2018.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/27/2017] [Accepted: 01/24/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Pulfrich phenomenon (PF) is the illusory perception that an object moving linearly along a 2-D plane appears to instead follow an elliptical 3-D trajectory, a consequence of inter-eye asymmetry in the timing of visual object identification in the visual cortex; with optic neuritis as a common etiology. OBJECTIVE We have designed an objective method to identify the presence and magnitude of the PF, in conjunction with a cooresponding strategy by which to abolish the effect; with monocular application of neutral density filters to the less affected fellow eye, in patients with MS and a history of optic neuropathy (e.g. related to acute optic neuritis or subclinical optic neuropathy). METHODS Twenty-three MS patients with a history of acute unilateral or bilateral optic neuritis, and ten healthy control subjects (HC) were recruited to participate in a pilot study to assess our strategy. Subjects were asked to indicate whether a linearly moving pendulum ball followed a linear 2-D path versus an illusory 3-D elliptical object-motion trajectory, by reporting the ball's approximation to one of nine horizontally-oriented colored wires that were positioned parallel to one another and horizontal to the linear pendulum path. Perceived motion of the bob that moved along wires behind or in front (along the 'Z' plane) of the middle reference wire indicated an illusory elliptical trajectory of ball motion consistent with the PF. RESULTS When the neutral density filter titration was applied to the fellow eye the severity of the PF decreased, eventually being fully abolished in all but one patient. The magnitude of neutral density filtering required correlated to the severity of the patient's initial PF magnitude (p < 0.001). CONCLUSIONS We ascertained the magnitude of the visual illusion associated with the PF, and the corresponding magnitude of neutral density filtering necessary to abolish it.
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Affiliation(s)
- Millad J Sobhanian
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA
| | - Rohit Agarwal
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA
| | - Ethan Meltzer
- Partner's Neurology Residency Training Program, Massachusettes General & Brigham & Women's Hospitals, Harvard Medical School, Cambridge, MA, USA
| | - Eric Kildebeck
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA; The Center for Engineering Innovation, University of Texas at Dallas, Richardson, TX, USA
| | - Benjamin S Frohman
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA
| | - Ashley N Frohman
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA
| | - Steven L Galetta
- The Department of Neurology, Population Health, New York University School of Medicine, New York, NY, USA; The Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Shiv Saidha
- The Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Owen White
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Department of Medicine, University of Melbourne, Parkville, Australia
| | - Pablo Villoslada
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Barcelona, Spain; University of California at San Francisco, USA
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Clinical and Experimental, Multiple Sclerosis Research Center, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Petzold
- Moorfields Eye Hospital, City Road, London, UK; The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, Queen Square, London, UK; Neuro-ophthalmology Expertise Centre VUmc, Amsterdam, Netherlands
| | - Robert L Rennaker
- School of Biomedical Engineering, University of Texas at Dallas, Richardson, TX, USA; Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | | | - Laura J Balcer
- The Department of Neurology, Population Health, New York University School of Medicine, New York, NY, USA; The Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Randy Kardon
- Department of Ophthalmology, University of Iowa, USA; Center for Prevention and Treatment of Visual Loss, Iowa City, IA, USA
| | - Elliot M Frohman
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA; School of Biomedical Engineering, University of Texas at Dallas, Richardson, TX, USA; Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Teresa C Frohman
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA; School of Biomedical Engineering, University of Texas at Dallas, Richardson, TX, USA; Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA.
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29
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Mallery RM, Poolman P, Thurtell MJ, Full JM, Ledolter J, Kimbrough D, Frohman EM, Frohman TC, Kardon RH. Visual Fixation Instability in Multiple Sclerosis Measured Using SLO-OCT. ACTA ACUST UNITED AC 2018; 59:196-201. [DOI: 10.1167/iovs.17-22391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Robert M. Mallery
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
| | - Pieter Poolman
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
- Iowa City VA Center for Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Matthew J. Thurtell
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
- Department of Neurology, University of Iowa, Iowa City, Iowa, United States
| | - Jan M. Full
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
- Iowa City VA Center for Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Johannes Ledolter
- Iowa City VA Center for Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Dorlan Kimbrough
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Elliot M. Frohman
- Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin, Texas, United States
| | - Teresa C. Frohman
- Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin, Texas, United States
| | - Randy H. Kardon
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
- Iowa City VA Center for Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
- Department of Neurology, University of Iowa, Iowa City, Iowa, United States
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30
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Petzold A, Balcer LJ, Calabresi PA, Costello F, Frohman TC, Frohman EM, Martinez-Lapiscina EH, Green AJ, Kardon R, Outteryck O, Paul F, Schippling S, Vermersch P, Villoslada P, Balk LJ. Retinal layer segmentation in multiple sclerosis: a systematic review and meta-analysis. Lancet Neurol 2017; 16:797-812. [PMID: 28920886 DOI: 10.1016/s1474-4422(17)30278-8] [Citation(s) in RCA: 337] [Impact Index Per Article: 48.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 03/13/2017] [Accepted: 08/03/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Structural retinal imaging biomarkers are important for early recognition and monitoring of inflammation and neurodegeneration in multiple sclerosis. With the introduction of spectral domain optical coherence tomography (SD-OCT), supervised automated segmentation of individual retinal layers is possible. We aimed to investigate which retinal layers show atrophy associated with neurodegeneration in multiple sclerosis when measured with SD-OCT. METHODS In this systematic review and meta-analysis, we searched for studies in which SD-OCT was used to look at the retina in people with multiple sclerosis with or without optic neuritis in PubMed, Web of Science, and Google Scholar between Nov 22, 1991, and April 19, 2016. Data were taken from cross-sectional cohorts and from one timepoint from longitudinal studies (at least 3 months after onset in studies of optic neuritis). We classified data on eyes into healthy controls, multiple-sclerosis-associated optic neuritis (MSON), and multiple sclerosis without optic neuritis (MSNON). We assessed thickness of the retinal layers and we rated individual layer segmentation performance by random effects meta-analysis for MSON eyes versus control eyes, MSNON eyes versus control eyes, and MSNON eyes versus MSON eyes. We excluded relevant sources of bias by funnel plots. FINDINGS Of 25 497 records identified, 110 articles were eligible and 40 reported data (in total 5776 eyes from patients with multiple sclerosis [1667 MSON eyes and 4109 MSNON eyes] and 1697 eyes from healthy controls) that met published OCT quality control criteria and were suitable for meta-analysis. Compared with control eyes, the peripapillary retinal nerve fibre layer (RNFL) showed thinning in MSON eyes (mean difference -20·10 μm, 95% CI -22·76 to -17·44; p<0·0001) and in MSNON eyes (-7·41 μm, -8·98 to -5·83; p<0·0001). The macula showed RNFL thinning of -6·18 μm (-8·07 to -4·28; p<0·0001) in MSON eyes and -2·15 μm (-3·15 to -1·15; p<0·0001) in MSNON eyes compared with control eyes. Atrophy of the macular ganglion cell layer and inner plexiform layer (GCIPL) was -16·42 μm (-19·23 to -13·60; p<0·0001) for MSON eyes and -6·31 μm (-7·75 to -4·87; p<0·0001) for MSNON eyes compared with control eyes. A small degree of inner nuclear layer (INL) thickening occurred in MSON eyes compared with control eyes (0·77 μm, 0·25 to 1·28; p=0·003). We found no statistical difference in the thickness of the combined outer nuclear layer and outer plexiform layer when we compared MSNON or MSON eyes with control eyes, but we found a small degree of thickening of the combined layer when we compared MSON eyes with MSNON eyes (1·21 μm, 0·24 to 2·19; p=0·01). INTERPRETATION The largest and most robust differences between the eyes of people with multiple sclerosis and control eyes were found in the peripapillary RNFL and macular GCIPL. Inflammatory disease activity might be captured by the INL. Because of the consistency, robustness, and large effect size, we recommend inclusion of the peripapillary RNFL and macular GCIPL for diagnosis, monitoring, and research. FUNDING None.
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Affiliation(s)
- Axel Petzold
- Moorfields Eye Hospital, London, UK; Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam and Dutch Expertise Centre for Neuro-ophthalmology, VU University Medical Center, Amsterdam, Netherlands; Institute of Neurology, University College London, London, UK.
| | - Laura J Balcer
- Department of Neurology, Department of Ophthalmology, and Department of Population Health, New York University School of Medicine, New York, NY, USA
| | | | - Fiona Costello
- Department of Clinical Neurosciences and Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elena H Martinez-Lapiscina
- Center of Neuroimmunology, Institute of Biomedical Research August Pi Sunyer, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ari J Green
- Multiple Sclerosis Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Randy Kardon
- Iowa City VA Center for Prevention and Treatment of Visual Loss, Department of Veterans Affairs Hospital Iowa City, and Department of Ophthalmology and Visual Sciences, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Olivier Outteryck
- Department of Neurology, University of Lille Nord de France, Lille, France
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité, Department of Neurology, Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research Section, University Hospital Zurich, Zurich, Switzerland
| | - Patrik Vermersch
- Université Lille, CHRU Lille, LYRIC-INSERM U995, FHU Imminent, Lille, France
| | - Pablo Villoslada
- Center of Neuroimmunology, Institute of Biomedical Research August Pi Sunyer, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Lisanne J Balk
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam and Dutch Expertise Centre for Neuro-ophthalmology, VU University Medical Center, Amsterdam, Netherlands
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31
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Hubbard NA, Turner MP, Ouyang M, Himes L, Thomas BP, Hutchison JL, Faghihahmadabadi S, Davis SL, Strain JF, Spence J, Krawczyk DC, Huang H, Lu H, Hart J, Frohman TC, Frohman EM, Okuda DT, Rypma B. Calibrated imaging reveals altered grey matter metabolism related to white matter microstructure and symptom severity in multiple sclerosis. Hum Brain Mapp 2017; 38:5375-5390. [PMID: 28815879 DOI: 10.1002/hbm.23727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/13/2017] [Accepted: 07/04/2017] [Indexed: 12/23/2022] Open
Abstract
Multiple sclerosis (MS) involves damage to white matter microstructures. This damage has been related to grey matter function as measured by standard, physiologically-nonspecific neuroimaging indices (i.e., blood-oxygen-level dependent signal [BOLD]). Here, we used calibrated functional magnetic resonance imaging and diffusion tensor imaging to examine the extent to which specific, evoked grey matter physiological processes were associated with white matter diffusion in MS. Evoked changes in BOLD, cerebral blood flow (CBF), and oxygen metabolism (CMRO2 ) were measured in visual cortex. Individual differences in the diffusion tensor measure, radial diffusivity, within occipital tracts were strongly associated with MS patients' BOLD and CMRO2 . However, these relationships were in opposite directions, complicating the interpretation of the relationship between BOLD and white matter microstructural damage in MS. CMRO2 was strongly associated with individual differences in patients' fatigue and neurological disability, suggesting that alterations to evoked oxygen metabolic processes may be taken as a marker for primary symptoms of MS. This work demonstrates the first application of calibrated and diffusion imaging together and details the first application of calibrated functional MRI in a neurological population. Results lend support for neuroenergetic hypotheses of MS pathophysiology and provide an initial demonstration of the utility of evoked oxygen metabolism signals for neurology research. Hum Brain Mapp 38:5375-5390, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Nicholas A Hubbard
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Monroe P Turner
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas
| | - Minhui Ouyang
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lyndahl Himes
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas
| | - Binu P Thomas
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joanna L Hutchison
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas
| | | | - Scott L Davis
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas
| | - Jeremy F Strain
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | - Jeffrey Spence
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas
| | - Daniel C Krawczyk
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hao Huang
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John Hart
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Teresa C Frohman
- Department of Neurology, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Elliot M Frohman
- Department of Neurology, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bart Rypma
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
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32
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Allen DR, Huang M, Parupia IM, Dubelko AR, Frohman EM, Davis SL. Multiple Sclerosis Impairs Sweating but not Skin Blood Flow during a Passive Whole-Body Heat Stress. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000516864.42083.ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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33
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Meltzer E, Sguigna PV, Subei A, Beh S, Kildebeck E, Conger D, Conger A, Lucero M, Frohman BS, Frohman AN, Saidha S, Galetta S, Calabresi PA, Rennaker R, Frohman TC, Kardon RH, Balcer LJ, Frohman EM. Retinal Architecture and Melanopsin-Mediated Pupillary Response Characteristics: A Putative Pathophysiologic Signature for the Retino-Hypothalamic Tract in Multiple Sclerosis. JAMA Neurol 2017; 74:574-582. [PMID: 28135360 PMCID: PMC5822208 DOI: 10.1001/jamaneurol.2016.5131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/21/2016] [Indexed: 12/19/2022]
Abstract
Importance A neurophysiologic signature of the melanopsin-mediated persistent constriction phase of the pupillary light reflex may represent a surrogate biomarker for the integrity of the retinohypothalamic tract, with potential utility for investigating alterations in homeostatic mechanisms associated with brain disorders and implications for identifying new treatments. Objective To characterize abnormalities of retinal architecture in patients with multiple sclerosis (MS) and corresponding alterations in the melanopsin-mediated sustained pupillary constriction response. Design, Setting, and Participants The case-control study was an experimental assessment of various stimulus-induced pupillary response characteristics and was conducted at a university clinical center for MS from September 6, 2012, to February 2015. Twenty-four patients with MS (48 eyes) and 15 individuals serving as controls (30 eyes) participated. The melanopsin-mediated, sustained pupillary constriction phase response following cessation of a blue light stimulus was compared with the photoreceptor-mediated pupillary constriction phase response following cessation of a red light stimulus. Optical coherence tomography was used to characterize the association between pupillary response characteristics and alterations in retinal architecture, specifically, the thickness of the retinal ganglion cell layer and inner plexiform layer (GCL + IPL). Main Outcomes and Measures Association of pupillary response characteristics with alterations in retinal architecture. Results Of 24 patients with MS included in the analysis, 17 were women (71%); mean (SD) age was 47 (11) years. Compared with eyes from individuals with MS who had normal optical coherence tomography-derived measures of retinal GCL + IPL thickness, eyes of patients who had GCL + IPL thickness reductions to less than the first percentile exhibited a correspondingly significant attenuation of the melanopsin-mediated sustained pupillary response (mean [SD] pupillary diameter ratios at a point in time, 0.18 [0.1] vs 0.33 [0.09]; P < .001, generalized estimating equation models accounting for age and within-patient intereye correlations). Conclusions and Relevance In this case-control study, attenuation of the melanopsin-mediated sustained pupillary constriction response was significantly associated with thinning of the GCL + IPL sector of the retina in the eyes of patients with MS, particularly those with a history of acute optic neuritis. Melanopsin-containing ganglion cells in the retina represent, at least in part, the composition of the retinohypothalamic tract. As such, our findings may signify the ability to elucidate a putative surrogate neurophysiologic signature that correlates with a constellation of homeostatic mechanisms in both health and illness.
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Affiliation(s)
- Ethan Meltzer
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Peter V. Sguigna
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Adnan Subei
- Department of Neurology, Michigan State University, East Lansing
| | - Shin Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Eric Kildebeck
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
- Center for Engineering Innovation, University of Texas at Dallas
| | - Darrel Conger
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Amy Conger
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Marlen Lucero
- Student, Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Benjamin S. Frohman
- Student, Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Ashley N. Frohman
- Student, Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Steven Galetta
- Department of Neurology, Population Health, New York University School of Medicine, New York
| | | | | | - Teresa C. Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Randy H. Kardon
- Department of Ophthalmology, University of Iowa, Iowa City
- Iowa City Veterans Affairs Center for Prevention and Treatment of Visual Loss, Iowa City
| | - Laura J. Balcer
- Department of Neurology, Population Health, New York University School of Medicine, New York
- Department of Ophthalmology, New York University School of Medicine, New York
| | - Elliot M. Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
- Department of Bioengineering, University of Texas at Dallas
- Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas
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34
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Hainline C, Rizzo JR, Hudson TE, Dai W, Birkemeier J, Raynowska J, Nolan RC, Hasanaj L, Selesnick I, Frohman TC, Frohman EM, Galetta SL, Balcer LJ, Rucker JC. Capturing saccades in multiple sclerosis with a digitized test of rapid number naming. J Neurol 2017; 264:989-998. [PMID: 28389741 DOI: 10.1007/s00415-017-8484-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 01/25/2023]
Abstract
The King-Devick (K-D) test of rapid number naming is a visual performance measure that captures saccadic eye movements. Patients with multiple sclerosis (MS) have slowed K-D test times associated with neurologic disability and reduced quality of life. We assessed eye movements during the K-D test to identify characteristics associated with slowed times. Participants performed a computerized K-D test with video-oculography. The 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and its 10-Item Neuro-Ophthalmic Supplement measured vision-specific quality of life (VSQOL). Among 25 participants with MS (age 37 ± 10 years, range 20-59) and 42 controls (age 33 ± 9 years, range 19-54), MS was associated with significantly longer (worse) K-D times (58.2 ± 19.8 vs. 43.8 ± 8.6 s, P = 0.001, linear regression models, accounting for age). In MS, test times were slower among patients with higher (worse) Expanded Disability Status Scale scores (P = 0.01). Average inter-saccadic intervals (ISI) were significantly longer in MS participants compared to controls (362 ± 103 vs. 286 ± 50 ms, P = 0.001), and were highly associated with prolonged K-D times in MS (P = 0.006). MS participants generated greater numbers of saccades (P = 0.007). VSQOL scores were reduced in MS patients with longer (worse) K-D times (P = 0.04-0.001) and longer ISI (P = 0.002-0.001). Patients with MS have slowed K-D times that may be attributable to prolonged ISI and greater numbers of saccades. The K-D test and its requisite eye movements capture VSQOL and make rapid number naming a strong candidate efferent visual performance measure in MS.
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Affiliation(s)
- Clotilde Hainline
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
| | - John-Ross Rizzo
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Todd E Hudson
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Weiwei Dai
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
- Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Joel Birkemeier
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
| | - Jenelle Raynowska
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
| | - Rachel C Nolan
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
| | - Lisena Hasanaj
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
| | - Ivan Selesnick
- Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven L Galetta
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Laura J Balcer
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Janet C Rucker
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA.
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
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Allen DR, Huang M, Parupia IM, Dubelko AR, Frohman EM, Davis SL. Impaired sweating responses to a passive whole body heat stress in individuals with multiple sclerosis. J Neurophysiol 2017; 118:7-14. [PMID: 28275061 DOI: 10.1152/jn.00897.2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/02/2017] [Accepted: 03/07/2017] [Indexed: 01/11/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS), disrupting autonomic function. The aim of this study was to test the hypothesis that individuals with MS have blunted control of thermoregulatory reflex increases in sweat rate (SR) and cutaneous vasodilation compared with controls during a passive whole body heat stress (WBH). Eighteen individuals with relapsing-remitting MS and 18 healthy controls (Con) participated in the study. Core temperature (Tcore), skin temperature, heart rate, arterial blood pressure (10-min intervals), skin blood flow (laser-Doppler flux, LDF), and SR were continuously measured during normothermic baseline (34°C water perfusing a tube-lined suit) and WBH (increased Tcore 0.8°C via 48°C water perfusing the suit). Following WBH, local heaters were warmed to 42°C, inducing peak cutaneous vasodilation at the site of LDF collection. Cutaneous vascular conductance (CVC) was calculated as the ratio of LDF to mean arterial pressure and expressed as a percentage of peak achieved during local heating. Individuals with MS had attenuated SR responses to WBH (ΔSR from baseline: Con, 0.65 ± 0.27; MS, 0.42 ± 0.17 mg·cm-2·min-1, P = 0.003), whereas Δ%CVC42C from baseline was similar between groups (Con, 42 ± 16%; MS, 38 ± 12%, P = 0.39). SR responses were blunted as a function of Tcore in MS (interaction: group × Tcore, P = 0.03), of which differences were evident at ΔTcore 0.7°C and 0.8°C (P < 0.05). No interaction was observed in Δ%CVC42C Taken together, the findings show MS blunts sweating responses, whereas control of the cutaneous vasculature is preserved, in response to WBH.NEW & NOTEWORTHY This study is the first to assess the reflex control of the thermoregulatory system in individuals living with multiple sclerosis (MS). The novel findings are twofold. First, attenuated increases in sweat rate in subjects with MS compared with healthy controls were observed in response to a moderate increase (0.8°C) in core temperature via passive whole body heat stress. Second, it appears the reflex control of the cutaneous vasculature is preserved in MS.
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Affiliation(s)
- Dustin R Allen
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Mu Huang
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Iqra M Parupia
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Ariana R Dubelko
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Elliot M Frohman
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Scott L Davis
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and .,Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
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Button J, Al-Louzi O, Lang A, Bhargava P, Newsome SD, Frohman T, Balcer LJ, Frohman EM, Prince J, Calabresi PA, Saidha S. Disease-modifying therapies modulate retinal atrophy in multiple sclerosis: A retrospective study. Neurology 2017; 88:525-532. [PMID: 28077493 DOI: 10.1212/wnl.0000000000003582] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/10/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To retrospectively investigate whether disease-modifying therapies (DMTs) exert differential effects on rates of retinal atrophy in relapsing-remitting multiple sclerosis (RRMS), as assessed using optical coherence tomography (OCT). METHODS A total of 402 patients with RRMS followed at the Johns Hopkins MS Center who underwent Cirrus-HD OCT were assessed for eligibility. Inclusion criteria included at least 1 year of OCT follow-up and adherence to a single DMT during the period of follow-up. Combined thickness of the ganglion cell + inner plexiform (GCIP) and other retinal layers was computed utilizing automated macular segmentation. Retinal thickness changes were analyzed using mixed-effects linear regression. RESULTS The effects of glatiramer acetate (GA; n = 48), natalizumab (NAT; n = 46), and interferon-β-1a subcutaneously (IFNSC; n = 35) and intramuscularly (IFNIM; n = 28) were assessed. Baseline analyses revealed no significant differences between groups in terms of age, sex, optic neuritis history, or follow-up duration. During follow-up, relative to NAT-treated patients, IFNSC- and GA-treated patients exhibited 0.37 μm/y (p < 0.001) and 0.14 μm/y (p = 0.035) faster rates of GCIP thinning, respectively, adjusting for the interval between initiation of DMT and OCT monitoring (gap time), age, sex, relapses, and disease duration. In the IFNSC group, GCIP thinning was 1.53 μm/y faster during the first year of therapy vs during the time interval afterwards (p < 0.001). CONCLUSIONS Rates of GCIP atrophy in patients with RRMS vary according to DMT utilization. Our findings support OCT for monitoring neurodegenerative treatment effects in the retina, an easily accessible tissue, and as a practical outcome measure in RRMS clinical trials.
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Affiliation(s)
- Julia Button
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Omar Al-Louzi
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Andrew Lang
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Pavan Bhargava
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Scott D Newsome
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Teresa Frohman
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Laura J Balcer
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Elliot M Frohman
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Jerry Prince
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Peter A Calabresi
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Shiv Saidha
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York.
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Beh SC, Kildebeck E, Narayan R, Desena A, Schell D, Rowe ES, Rowe V, Burns D, Whitworth L, Frohman TC, Greenberg B, Frohman EM. High-dose methotrexate with leucovorin rescue: For monumentally severe CNS inflammatory syndromes. J Neurol Sci 2017; 372:187-195. [DOI: 10.1016/j.jns.2016.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/20/2016] [Accepted: 11/07/2016] [Indexed: 11/30/2022]
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Chen D, Ireland SJ, Remington G, Alvarez E, Racke MK, Greenberg B, Frohman EM, Monson NL. CD40-Mediated NF-κB Activation in B Cells Is Increased in Multiple Sclerosis and Modulated by Therapeutics. J Immunol 2016; 197:4257-4265. [PMID: 27798157 DOI: 10.4049/jimmunol.1600782] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/22/2016] [Indexed: 12/20/2022]
Abstract
CD40 interacts with CD40L and plays an essential role in immune regulation and homeostasis. Recent research findings, however, support a pathogenic role of CD40 in a number of autoimmune diseases. We previously showed that memory B cells from relapsing-remitting multiple sclerosis (RRMS) patients exhibited enhanced proliferation with CD40 stimulation compared with healthy donors. In this study, we used a multiparameter phosflow approach to analyze the phosphorylation status of NF-κB and three major MAPKs (P38, ERK, and JNK), the essential components of signaling pathways downstream of CD40 engagement in B cells from MS patients. We found that memory and naive B cells from RRMS and secondary progressive MS patients exhibited a significantly elevated level of phosphorylated NF-κB (p-P65) following CD40 stimulation compared with healthy donor controls. Combination therapy with IFN-β-1a (Avonex) and mycophenolate mofetil (Cellcept) modulated the hyperphosphorylation of P65 in B cells of RRMS patients at levels similar to healthy donor controls. Lower disease activity after the combination therapy correlated with the reduced phosphorylation of P65 following CD40 stimulation in treated patients. Additionally, glatiramer acetate treatment also significantly reduced CD40-mediated P65 phosphorylation in RRMS patients, suggesting that reducing CD40-mediated p-P65 induction may be a general mechanism by which some current therapies modulate MS disease.
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Affiliation(s)
- Ding Chen
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Sara J Ireland
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Gina Remington
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Enrique Alvarez
- Department of Neurology, University of Colorado, Aurora, CO 80045
| | - Michael K Racke
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH 43210; and
| | - Benjamin Greenberg
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Elliot M Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Nancy L Monson
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390; .,Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75390
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Zhovtis Ryerson L, Frohman TC, Foley J, Kister I, Weinstock-Guttman B, Tornatore C, Pandey K, Donnelly S, Pawate S, Bomprezzi R, Smith D, Kolb C, Qureshi S, Okuda D, Kalina J, Rimler Z, Green R, Monson N, Hoyt T, Bradshaw M, Fallon J, Chamot E, Bucello M, Beh S, Cutter G, Major E, Herbert J, Frohman EM. Extended interval dosing of natalizumab in multiple sclerosis. J Neurol Neurosurg Psychiatry 2016; 87:885-9. [PMID: 26917698 DOI: 10.1136/jnnp-2015-312940] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/06/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Natalizumab (NTZ), a monoclonal antibody to human α4β1/β7 integrin, is an effective therapy for multiple sclerosis (MS), albeit associated with progressive multifocal leukoencephalopathy (PML). Clinicians have been extending the dose of infusions with a hypothesis of reducing PML risk. The aim of the study is to evaluate the clinical consequences of reducing NTZ frequency of infusion up to 8 weeks 5 days. METHODS A retrospective chart review in 9 MS centres was performed in order to identify patients treated with extended interval dosing (EID) regimens of NTZ. Patients were stratified into 3 groups based on EID NTZ treatment schedule in individual centres: early extended dosing (EED; n=249) every 4 weeks 3 days to 6 weeks 6 days; late extended dosing (LED; n=274) every 7 weeks to 8 weeks 5 days; variable extended dosing (n=382) alternating between EED and LED. These groups were compared with patients on standard interval dosing (SID; n=1093) every 4 weeks. RESULTS 17% of patients on SID had new T2 lesions compared with 14% in EID (p=0.02); 7% of patients had enhancing T1 lesions in SID compared with 9% in EID (p=0.08); annualised relapse rate was 0.14 in the SID group, and 0.09 in the EID group. No evidence of clinical or radiographic disease activity was observed in 62% of SID and 61% of EID patients (p=0.83). No cases of PML were observed in EID group compared with 4 cases in SID cohort. CONCLUSIONS Dosing intervals up to 8 weeks 5 days did not diminish effectiveness of NTZ therapy. Further monitoring is ongoing to evaluate if the risk of PML is reduced in patients on EID.
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Affiliation(s)
- L Zhovtis Ryerson
- Department of Neurology, Langone Medical Center, New York University, New York, New York, USA
| | - T C Frohman
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J Foley
- Rocky Mountain MS Clinic, Salt Lake City, Utah, USA
| | - I Kister
- Department of Neurology, Langone Medical Center, New York University, New York, New York, USA
| | | | | | - K Pandey
- Barnabas Health MS Center, Livingston, New Jersey, USA
| | - S Donnelly
- CUNY Graduate Center, New York, New York, USA
| | - S Pawate
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R Bomprezzi
- University of Massachusetts School of Medicine, Worcester, Massachusetts, USA
| | - D Smith
- Multiple Sclerosis Center of Connecticut, Norwich, Connecticut, USA
| | - C Kolb
- University of Buffalo, Buffalo, New York, USA
| | - S Qureshi
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - D Okuda
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J Kalina
- Department of Neurology, Langone Medical Center, New York University, New York, New York, USA
| | - Z Rimler
- Department of Neurology, Langone Medical Center, New York University, New York, New York, USA
| | - R Green
- Barnabas Health MS Center, Livingston, New Jersey, USA
| | - N Monson
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - T Hoyt
- Rocky Mountain MS Clinic, Salt Lake City, Utah, USA
| | - M Bradshaw
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Fallon
- Department of Neurology, Langone Medical Center, New York University, New York, New York, USA
| | - E Chamot
- University of Alabama School of Public Health, Birmingham, Alabama, USA
| | - M Bucello
- University of Buffalo, Buffalo, New York, USA
| | - S Beh
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - G Cutter
- University of Alabama School of Public Health, Birmingham, Alabama, USA
| | - E Major
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - J Herbert
- Department of Neurology, Langone Medical Center, New York University, New York, New York, USA
| | - E M Frohman
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Bioengineering, University of Texas at Dallas, Dallas, Texas, USA Department of Behavioural and Brain Sciences, University of Texas at Dallas, Dallas, Texas, USA
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Abstract
Patients with MS exhibit a broad diversity of ocular motor syndromes. We describe a patient with relapsing-remitting MS who developed an unusual variation of the dorsal midbrain syndrome, character ized by monocular convergent-retraction nystagmus in the right eye, accompanied by divergent-retraction nystagmus in the fellow eye upon attempted upward gaze. Examination also revealed a skew deviation with a left hyperdeviation and severe adductio n limitation in the left eye during attempted right gaze. We propose that a left INO accounted for the inability of the left eye to adduct (and result in convergent-retraction) during attempted upward saccades. We consider the patho physiologic mechanisms responsible for our observations and review important details of the dorsal midbrain ocular motor circuitr y.
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Affiliation(s)
- Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA.
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Frohman EM, Brannon K, Alexander S, Sims D, Phillips JT, O'Leary S, Hawker K, Racke MK. Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management. Mult Scler 2016; 10:302-7. [PMID: 15222696 DOI: 10.1191/1352458504ms1002oa] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: The objective for this article is to highlight some of the adverse skin manifestations associated with injectable disease modifying therapy for multiple sclerosis (MS). Early identification and intervention can often lead to minimal consequences and prolonged patient tolerance and compliance with these agents. A t the University of Texas Southwestern Medical C enter at Dallas and Texas Neurology in Dallas we actively follow appro ximately 5000 MS patients. The majority of our patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) are treated with one of the currently available disease modifying agents (DMA s). O ur experience with these patients, and the challenges they face in continuing long-term treatment, constitutes the basis of our proposed treatment strategies. Conclusion: Skin reactio ns in response to injectable DMA therapy in MS are generally mild. However, some reactio ns can evolve into potentially serious lesions culminating in infection, necro sis, and in some circumstances requiring surgical repair.
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Affiliation(s)
- E M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75235, USA.
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Mohiuddin IH, Pillai V, Baughman EJ, Greenberg BM, Frohman EM, Crawford MP, Sinha S, Karandikar NJ. Induction of regulatory T-cells from memory T-cells is perturbed during acute exacerbation of multiple sclerosis. Clin Immunol 2016; 166-167:12-8. [PMID: 27154631 DOI: 10.1016/j.clim.2016.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 12/24/2022]
Abstract
Regulatory T-cells (Tregs) are vital for maintaining immunological self-tolerance, and the transcription factor FOXP3 is considered critical for their development and function. Peripheral Treg induction may significantly contribute to the total Treg pool in healthy adults, and this pathway may be enhanced in thymic-deficient conditions like multiple sclerosis (MS). Here, we evaluated iTreg formation from memory versus naïve CD4(+)CD25(-) T-cell precursors. We report the novel finding that memory T-cells readily expressed CD25 and FOXP3, and demonstrated significantly greater suppressive function. Additionally, the CD25(-)FOXP3(-) fraction of stimulated memory T-cells also displayed robust suppression not observed in naïve counterparts or ex vivo resting (CD25(-)) T-cells. This regulatory population was present in both healthy subjects and clinically-quiescent MS patients, but was specifically deficient during disease exacerbation. These studies indicate that iTreg development and function are precursor dependent. Furthermore, MS quiescence appears to correlate with restoration of suppressive function in memory-derived CD4(+)CD25(-)FOXP3(-) iTregs.
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Affiliation(s)
- Imran H Mohiuddin
- Department of Pathology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Vinodh Pillai
- Department of Pathology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Ethan J Baughman
- Department of Pathology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Benjamin M Greenberg
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Elliot M Frohman
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Michael P Crawford
- Department of Pathology, University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
| | - Sushmita Sinha
- Department of Pathology, University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
| | - Nitin J Karandikar
- Department of Pathology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA; Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA; Department of Pathology, University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA.
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Sinha S, Cunnusamy K, Chaudhary P, Greenberg BM, Frohman EM, Karandikar NJ. Immunobiology of antigen presenting cells during relapse vs. remission in multiple sclerosis. The Journal of Immunology 2016. [DOI: 10.4049/jimmunol.196.supp.49.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Multiple sclerosis (MS) is the most common cause of neurological disability in young adults. Approximately 80% of MS patients initially present with the relapsing-remitting disease. Although studies suggest immune hyperactivity during relapse, role of specific immune cells has been understudied. We investigated whether APCs might be the drivers of inflammation during an MS-relapse. Paired blood samples were obtained from patients during relapse (Rel) and remission (Rem) phase of MS. APCs were immunophenotyped for activation, inhibition and migration-associated markers. T cell-cytokine stimulatory potential of Rel vs. Rem-APCs was studied by co-culturing sorted APC-subtypes with healthy donor-CD3+ T cells. Rel-monocytes displayed a significantly higher expression of adhesion molecules while inhibitory receptor ILT4 was significantly increased on Rem-monocytes. Further, Rel-monocytes stimulated significantly more IFN-g and IL-17 from allogeneic CD4+ T-cells. Rel- B-cells had a significantly higher expression of adhesion molecules and displayed significantly increased potential of stimulating IFN-g from allogeneic CD8+ T-cells. Inhibitory receptor ILT3 was significantly increased on PDCs during Rem. Functionally, Rel-MDC stimulated significantly more IL-17 and IFN-g from allogeneic CD4+ and CD8+ T-cells, respectively. Overall, our study suggests that these key differences in APC subsets during Rel vs Rem phases could potentially modulate T cell responses by favoring more pro-inflammatory T-cell phenotype during MS relapse. Combined with our publications related to differential regulatory ability of CD4 and CD8 T-cells this study provides great insights into the underlying immunopathology of an MS relapse.
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Huang M, Allen DR, Keller DM, Fadel PJ, Frohman EM, Davis SL. Impaired carotid baroreflex control of arterial blood pressure in multiple sclerosis. J Neurophysiol 2016; 116:81-7. [PMID: 27075533 DOI: 10.1152/jn.00003.2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/08/2016] [Indexed: 11/22/2022] Open
Abstract
Multiple sclerosis (MS), a progressive neurological disease, can lead to impairments in the autonomic control of cardiovascular function. We tested the hypothesis that individuals with relapsing-remitting MS (n = 10; 7 females, 3 males; 13 ± 4 yr from diagnosis) exhibit impaired carotid baroreflex control of blood pressure and heart rate compared with sex, age, and body weight-matched healthy individuals (CON: n = 10; 7 females, 3 males). At rest, 5-s trials of neck pressure (NP; +40 Torr) and neck suction (NS; -60 Torr) were applied to simulate carotid hypotension and hypertension, respectively, while mean arterial pressure (MAP; finger photoplethysmography), heart rate (HR), cardiac output (CO; Modelflow), and total vascular conductance (TVC) were continuously measured. In response to NP, there was a blunted increase in peak MAP responses (MS: 5 ± 2 mmHg) in individuals with MS compared with healthy controls (CON: 9 ± 3 mmHg; P = 0.005), whereas peak HR responses were not different between groups. At the peak MAP response to NP, individuals with MS demonstrated an attenuated decrease in TVC (MS, -10 ± 4% baseline vs. CON, -15 ± 4% baseline, P = 0.012), whereas changes in CO were similar between groups. Following NS, all cardiovascular responses (i.e., nadir MAP and HR and percent changes in CO and TVC) were not different between MS and CON groups. These data suggest that individuals with MS have impaired carotid baroreflex control of blood pressure via a blunted vascular conductance response resulting in a diminished ability to increase MAP in response to a hypotensive challenge.
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Affiliation(s)
- Mu Huang
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas
| | - Dustin R Allen
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas; Kinesiology, University of Texas at Arlington, Arlington, Texas; and
| | - David M Keller
- Kinesiology, University of Texas at Arlington, Arlington, Texas; and
| | - Paul J Fadel
- Kinesiology, University of Texas at Arlington, Arlington, Texas; and
| | - Elliot M Frohman
- Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Scott L Davis
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas; Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
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45
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Frohman EM, Stüve O, Frohman TC, Lisak R. In Memoriam: John F. Kurtzke, MD (1926-2015). JAMA Neurol 2016; 73:482-3. [DOI: 10.1001/jamaneurol.2016.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elliot M. Frohman
- Department of Ophthalmology, University of Texas Southwestern School of Medicine, Dallas2Department of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, Dallas
| | - Olaf Stüve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, Dallas
| | - Teresa C. Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, Dallas3Department of Bioengineering and Computer Science, University of Texas, Dallas4Department of Behavioral and Brain Sciences, University of Texas, Dal
| | - Robert Lisak
- Department of Neurology, Wayne State School of Medicine, Detroit, Michigan6Department of Immunology and Microbiology, Wayne State School of Medicine, Detroit, Michigan
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Hubbard NA, Hutchison JL, Turner MP, Sundaram S, Oasay L, Robinson D, Strain J, Weaver T, Davis SL, Remington GM, Huang H, Biswal BB, Hart J, Frohman TC, Frohman EM, Rypma B. Asynchrony in executive networks predicts cognitive slowing in multiple sclerosis. Neuropsychology 2016; 30:75-86. [DOI: 10.1037/neu0000202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Affiliation(s)
- Sara S Qureshi
- Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
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Voskuhl RR, Wang H, Wu TCJ, Sicotte NL, Nakamura K, Kurth F, Itoh N, Bardens J, Bernard JT, Corboy JR, Cross AH, Dhib-Jalbut S, Ford CC, Frohman EM, Giesser B, Jacobs D, Kasper LH, Lynch S, Parry G, Racke MK, Reder AT, Rose J, Wingerchuk DM, MacKenzie-Graham AJ, Arnold DL, Tseng CH, Elashoff R. Estriol combined with glatiramer acetate for women with relapsing-remitting multiple sclerosis: a randomised, placebo-controlled, phase 2 trial. Lancet Neurol 2015; 15:35-46. [PMID: 26621682 DOI: 10.1016/s1474-4422(15)00322-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/09/2015] [Accepted: 10/28/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Relapses of multiple sclerosis decrease during pregnancy, when the hormone estriol is increased. Estriol treatment is anti-inflammatory and neuroprotective in preclinical studies. In a small single-arm study of people with multiple sclerosis estriol reduced gadolinium-enhancing lesions and was favourably immunomodulatory. We assessed whether estriol treatment reduces multiple sclerosis relapses in women. METHODS We did a randomised, double-blind, placebo-controlled phase 2 trial at 16 academic neurology centres in the USA, between June 28, 2007, and Jan 9, 2014. Women aged 18-50 years with relapsing-remitting multiple sclerosis were randomly assigned (1:1) with a random permuted block design to either daily oral estriol (8 mg) or placebo, each in combination with injectable glatiramer acetate 20 mg daily. Patients and all study personnel, except for pharmacists and statisticians, were masked to treatment assignment. The primary endpoint was annualised relapse rate after 24 months, with a significance level of p=0.10. Relapses were confirmed by an increase in Expanded Disability Status Scale score assessed by an independent physician. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00451204. FINDINGS We enrolled 164 patients: 83 were allocated to the estriol group and 81 were allocated to the placebo group. The annualised confirmed relapse rate was 0.25 relapses per year (95% CI 0.17-0.37) in the estriol group versus 0.37 relapses per year (0.25-0.53) in the placebo group (adjusted rate ratio 0.63, 95% CI 0.37-1.05; p=0.077). The proportion of patients with serious adverse events did not differ substantially between the estriol group and the placebo group (eight [10%] of 82 patients vs ten [13%] of 76 patients). Irregular menses were more common in the estriol group than in the placebo group (19 [23%] vs three [4%], p=0.0005), but vaginal infections were less common (one [1%] vs eight [11%], p=0.0117). There were no differences in breast fibrocystic disease, uterine fibroids, or endometrial lining thickness as assessed by clinical examination, mammogram, uterine ultrasound, or endometrial lining biopsy. INTERPRETATION Estriol plus glatiramer acetate met our criteria for reducing relapse rates, and treatment was well tolerated over 24 months. These results warrant further investigation in a phase 3 trial. FUNDING National Institutes of Health, National Multiple Sclerosis Society, Conrad N Hilton Foundation, Jack H Skirball Foundation, Sherak Family Foundation, and the California Community Foundation.
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Affiliation(s)
- Rhonda R Voskuhl
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.
| | - HeJing Wang
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - T C Jackson Wu
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Florian Kurth
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Noriko Itoh
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Jenny Bardens
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Anne H Cross
- Washington University School of Medicine, St Louis, MO, USA
| | | | - Corey C Ford
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Barbara Giesser
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Dina Jacobs
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lloyd H Kasper
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Sharon Lynch
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Michael K Racke
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | | | - John Rose
- Salt Lake City VA Medical Center, Salt Lake City, UT, USA
| | | | - Allan J MacKenzie-Graham
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Chi Hong Tseng
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert Elashoff
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
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Ligocki AJ, Rivas JR, Rounds WH, Guzman AA, Li M, Spadaro M, Lahey L, Chen D, Henson PM, Graves D, Greenberg BM, Frohman EM, Ward ES, Robinson W, Meinl E, White CL, Stowe AM, Monson NL. A Distinct Class of Antibodies May Be an Indicator of Gray Matter Autoimmunity in Early and Established Relapsing Remitting Multiple Sclerosis Patients. ASN Neuro 2015; 7:7/5/1759091415609613. [PMID: 26489686 PMCID: PMC4710131 DOI: 10.1177/1759091415609613] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
*These authors contributed equally to the work in this manuscript.We have previously identified a distinct class of antibodies expressed by B cells in the cerebrospinal fluid (CSF) of early and established relapsing remitting multiple sclerosis (RRMS) patients that is not observed in healthy donors. These antibodies contain a unique pattern of mutations in six codons along VH4 antibody genes that we termed the antibody gene signature (AGS). In fact, patients who have such B cells in their CSF are identified as either having RRMS or developing RRMS in the future. As mutations in antibody genes increase antibody affinity for particular antigens, the goal for this study was to investigate whether AGS(+) antibodies bind to brain tissue antigens. Single B cells were isolated from the CSF of 10 patients with early or established RRMS. We chose 32 of these B cells that expressed antibodies enriched for the AGS for further study. We generated monoclonal full-length recombinant human antibodies (rhAbs) and used both immunological assays and immunohistochemistry to investigate the capacity of these AGS(+) rhAbs to bind brain tissue antigens. AGS(+) rhAbs did not recognize myelin tracts in the corpus callosum. Instead, AGS(+) rhAbs recognized neuronal nuclei and/or astrocytes, which are prevalent in the cortical gray matter. This pattern was unique to the AGS(+) antibodies from early and established RRMS patients, as AGS(+) antibodies from an early neuromyelitis optica patient did not display the same reactivity. Prevalence of CSF-derived B cells expressing AGS(+) antibodies that bind to these cell types may be an indicator of gray matter-directed autoimmunity in early and established RRMS patients.
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Affiliation(s)
- Ann J Ligocki
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jacqueline R Rivas
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William H Rounds
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alyssa A Guzman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Min Li
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melania Spadaro
- Institute of Clinical Neuroimmunology, Ludwig-Maximilian-University, Munich, Germany
| | - Lauren Lahey
- Department of Immunology and Rheumatology, Stanford University, CA, USA
| | - Ding Chen
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Paul M Henson
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Donna Graves
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin M Greenberg
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elliot M Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - E Sally Ward
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William Robinson
- Department of Immunology and Rheumatology, Stanford University, CA, USA
| | - Edgar Meinl
- Institute of Clinical Neuroimmunology, Ludwig-Maximilian-University, Munich, Germany
| | - Charles L White
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ann M Stowe
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nancy L Monson
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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50
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Saidha S, Al-Louzi O, Ratchford JN, Bhargava P, Oh J, Newsome SD, Prince JL, Pham D, Roy S, van Zijl P, Balcer LJ, Frohman EM, Reich DS, Crainiceanu C, Calabresi PA. Optical coherence tomography reflects brain atrophy in multiple sclerosis: A four-year study. Ann Neurol 2015; 78:801-13. [PMID: 26190464 DOI: 10.1002/ana.24487] [Citation(s) in RCA: 273] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 07/15/2015] [Accepted: 07/15/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this work was to determine whether atrophy of specific retinal layers and brain substructures are associated over time, in order to further validate the utility of optical coherence tomography (OCT) as an indicator of neuronal tissue damage in patients with multiple sclerosis (MS). METHODS Cirrus high-definition OCT (including automated macular segmentation) was performed in 107 MS patients biannually (median follow-up: 46 months). Three-Tesla magnetic resonance imaging brain scans (including brain-substructure volumetrics) were performed annually. Individual-specific rates of change in retinal and brain measures (estimated with linear regression) were correlated, adjusting for age, sex, disease duration, and optic neuritis (ON) history. RESULTS Rates of ganglion cell + inner plexiform layer (GCIP) and whole-brain (r = 0.45; p < 0.001), gray matter (GM; r = 0.37; p < 0.001), white matter (WM; r = 0.28; p = 0.007), and thalamic (r = 0.38; p < 0.001) atrophy were associated. GCIP and whole-brain (as well as GM and WM) atrophy rates were more strongly associated in progressive MS (r = 0.67; p < 0.001) than relapsing-remitting MS (RRMS; r = 0.33; p = 0.007). However, correlation between rates of GCIP and whole-brain (and additionally GM and WM) atrophy in RRMS increased incrementally with step-wise refinement to exclude ON effects; excluding eyes and then patients (to account for a phenotype effect), the correlation increased to 0.45 and 0.60, respectively, consistent with effect modification. In RRMS, lesion accumulation rate was associated with GCIP (r = -0.30; p = 0.02) and inner nuclear layer (r = -0.25; p = 0.04) atrophy rates. INTERPRETATION Over time GCIP atrophy appears to mirror whole-brain, and particularly GM, atrophy, especially in progressive MS, thereby reflecting underlying disease progression. Our findings support OCT for clinical monitoring and as an outcome in investigative trials.
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Affiliation(s)
- Shiv Saidha
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Omar Al-Louzi
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - John N Ratchford
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Pavan Bhargava
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Jiwon Oh
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD.,Department of Computer Science, Johns Hopkins University, Baltimore, MD.,Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD
| | - Dzung Pham
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD.,Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD.,Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Snehashis Roy
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD.,Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD.,Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Peter van Zijl
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD
| | - Laura J Balcer
- Department of Neurology, New York University Langone Medical Center, New York, NY
| | - Elliot M Frohman
- Department of Neurology and Ophthalmology, University of Texas Southwestern, Dallas, TX
| | - Daniel S Reich
- Department of Neurology, Johns Hopkins University, Baltimore, MD.,Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD.,Department of Biostatistics, Johns Hopkins University, Baltimore, MD.,Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD
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