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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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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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Kenney RC, Liu M, Hasanaj L, Joseph B, Abu Al-Hassan A, Balk LJ, Behbehani R, Brandt A, Calabresi PA, Frohman E, Frohman TC, Havla J, Hemmer B, Jiang H, Knier B, Korn T, Leocani L, Martinez-Lapiscina EH, Papadopoulou A, Paul F, Petzold A, Pisa M, Villoslada P, Zimmermann H, Thorpe LE, Ishikawa H, Schuman JS, Wollstein G, Chen Y, Saidha S, Galetta S, Balcer LJ. The Role of Optical Coherence Tomography Criteria and Machine Learning in Multiple Sclerosis and Optic Neuritis Diagnosis. Neurology 2022; 99:e1100-e1112. [PMID: 35764402 PMCID: PMC9536738 DOI: 10.1212/wnl.0000000000200883] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 09/29/2021] [Accepted: 05/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent studies have suggested that intereye differences (IEDs) in peripapillary retinal nerve fiber layer (pRNFL) or ganglion cell + inner plexiform (GCIPL) thickness by spectral domain optical coherence tomography (SD-OCT) may identify people with a history of unilateral optic neuritis (ON). However, this requires further validation. Machine learning classification may be useful for validating thresholds for OCT IEDs and for examining added utility for visual function tests, such as low-contrast letter acuity (LCLA), in the diagnosis of people with multiple sclerosis (PwMS) and for unilateral ON history. METHODS Participants were from 11 sites within the International Multiple Sclerosis Visual System consortium. pRNFL and GCIPL thicknesses were measured using SD-OCT. A composite score combining OCT and visual measures was compared individual measurements to determine the best model to distinguish PwMS from controls. These methods were also used to distinguish those with a history of ON among PwMS. Receiver operating characteristic (ROC) curve analysis was performed on a training data set (2/3 of cohort) and then applied to a testing data set (1/3 of cohort). Support vector machine (SVM) analysis was used to assess whether machine learning models improved diagnostic capability of OCT. RESULTS Among 1,568 PwMS and 552 controls, variable selection models identified GCIPL IED, average GCIPL thickness (both eyes), and binocular 2.5% LCLA as most important for classifying PwMS vs controls. This composite score performed best, with area under the curve (AUC) = 0.89 (95% CI 0.85-0.93), sensitivity = 81%, and specificity = 80%. The composite score ROC curve performed better than any of the individual measures from the model (p < 0.0001). GCIPL IED remained the best single discriminator of unilateral ON history among PwMS (AUC = 0.77, 95% CI 0.71-0.83, sensitivity = 68%, specificity = 77%). SVM analysis performed comparably with standard logistic regression models. DISCUSSION A composite score combining visual structure and function improved the capacity of SD-OCT to distinguish PwMS from controls. GCIPL IED best distinguished those with a history of unilateral ON. SVM performed as well as standard statistical models for these classifications. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that SD-OCT accurately distinguishes multiple sclerosis from normal controls as compared with clinical criteria.
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Affiliation(s)
- Rachel C Kenney
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Mengling Liu
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Lisena Hasanaj
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Binu Joseph
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Abdullah Abu Al-Hassan
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Lisanne J Balk
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Raed Behbehani
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Alexander Brandt
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Peter A Calabresi
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Elliot Frohman
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Teresa C Frohman
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Joachim Havla
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Bernhard Hemmer
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Hong Jiang
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Benjamin Knier
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas Korn
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Letizia Leocani
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Elena Hernandez Martinez-Lapiscina
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Athina Papadopoulou
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Friedemann Paul
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Axel Petzold
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Marco Pisa
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Pablo Villoslada
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Hanna Zimmermann
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Lorna E Thorpe
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Hiroshi Ishikawa
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Joel S Schuman
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Gadi Wollstein
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Yu Chen
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Shiv Saidha
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Steven Galetta
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Laura J Balcer
- From the Departments of Neurology (R.C.K., L.H., B.J., S.G., L.J. Balcer) and Population Health (R.C.K., M.L., L.E.T., Y.C., L.J. Balcer), New York University Grossman School of Medicine; Al-Bahar Ophthalmology Center (A.A.A.-H., R.B.), Ibn Sina Hospital, Kuwait City, Kuwait; Mulier Institute (L.J. Balk), Centre for Research on Sports in Society, Utrecht, the Netherlands; Experimental and Clinical Research Center (A.B., A. Papadopoulou, F.P., H.Z.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Neurology (A.B.), University of California, Irvine; Department of Neurology (P.A.C., S.S.), Johns Hopkins University, Baltimore, MD; Laboratory of Neuroimmunology (E.F., T.C.F.), of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig Maximilians Universität München; Data Integration for Future Medicine Consortium (DIFUTURE) (J.H.), Ludwig-Maximilians University, Munich; Department of Neurology (B.H., B.K., T.K.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H., T.K.), Germany; Bascom Palmer Eye Institute (H.J.), Department of Neurology, University of Miami Miller School of Medicine, FL; Vita-Salute University & Hospital San Raffaele (L.L., M.P.), Milano, Italy; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Neurologic Clinic and Policlinic (A. Papadopoulou), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RCN2NB) Basel, University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (F.P., H.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfields Eye Hospital (Axel Petzold), London; The National Hospital for Neurology and Neurosurgery (A. Petzold), Queen Square, UCL Institute of Neurology, United Kingdom; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam UMC, the Netherlands; Oregon Health and Science University (H.I.), Portland; Department of Ophthalmology (J.S.S., G.W., S.G., Laura J. Balcer), New York University Grossman School of Medicine; Departments of Biomedical Engineering and Electrical and Computer Engineering (J.S.S.), New York University Tandon School of Engineering, Brooklyn; Center for Neural Science (J.S.S.), New York University; and Neuroscience Institute (J.S.S.), NYU Langone Health. Dr. Kenney is currently at the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN.
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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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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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12
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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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13
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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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14
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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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15
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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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16
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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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17
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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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18
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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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19
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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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20
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Caldito NG, Saidha S, Sotirchos ES, Dewey BE, Cowley NJ, Glaister J, Fitzgerald KC, Al-Louzi O, Nguyen J, Rothman A, Ogbuokiri E, Fioravante N, Feldman S, Kwakyi O, Risher H, Kimbrough D, Frohman TC, Frohman E, Balcer L, Crainiceanu C, Van Zijl PCM, Mowry EM, Reich DS, Oh J, Pham DL, Prince J, Calabresi PA. Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis: a longitudinal study. Brain 2018; 141:3115-3129. [PMID: 30312381 PMCID: PMC6202573 DOI: 10.1093/brain/awy245] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [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: 04/11/2018] [Revised: 06/03/2018] [Accepted: 08/09/2018] [Indexed: 01/09/2023] Open
Abstract
On average, African Americans with multiple sclerosis demonstrate higher inflammatory disease activity, faster disability accumulation, greater visual dysfunction, more pronounced brain tissue damage and higher lesion volume loads compared to Caucasian Americans with multiple sclerosis. Neurodegeneration is an important component of multiple sclerosis, which in part accounts for the clinical heterogeneity of the disease. Brain atrophy appears to be widespread, although it is becoming increasingly recognized that regional substructure atrophy may be of greater clinical relevance. Patient race (within the limitations of self-identified ancestry) is regarded as an important contributing factor. However, there is a paucity of studies examining differences in neurodegeneration and brain substructure volumes over time in African Americans relative to Caucasian American patients. Optical coherence tomography is a non-invasive and reliable tool for measuring structural retinal changes. Recent studies support its utility for tracking neurodegeneration and disease progression in vivo in multiple sclerosis. Relative to Caucasian Americans, African American patients have been found to have greater retinal structural injury in the inner retinal layers. Increased thickness of the inner nuclear layer and the presence of microcystoid macular pathology at baseline predict clinical and radiological inflammatory activity, although whether race plays a role in these changes has not been investigated. Similarly, assessment of outer retinal changes according to race in multiple sclerosis remains incompletely characterized. Twenty-two African Americans and 60 matched Caucasian Americans with multiple sclerosis were evaluated with brain MRI, and 116 African Americans and 116 matched Caucasian Americans with multiple sclerosis were monitored with optical coherence tomography over a mean duration of 4.5 years. Mixed-effects linear regression models were used in statistical analyses. Grey matter (-0.9%/year versus -0.5%: P =0.02), white matter (-0.7%/year versus -0.3%: P =0.04) and nuclear thalamic (-1.5%/year versus -0.7%/year: P =0.02) atrophy rates were approximately twice as fast in African Americans. African Americans also exhibited higher proportions of microcystoid macular pathology (12.1% versus 0.9%, P =0.001). Retinal nerve fibre layer (-1.1% versus -0.8%: P =0.02) and ganglion cell+ inner plexiform layer (-0.7%/year versus -0.4%/year: P =0.01) atrophy rates were faster in African versus Caucasian Americans. African Americans on average exhibited more rapid neurodegeneration than Caucasian Americans and had significantly faster brain and retinal tissue loss. These results corroborate the more rapid clinical progression reported to occur, in general, in African Americans with multiple sclerosis and support the need for future studies involving African Americans in order to identify individual differences in treatment responses in multiple sclerosis.
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Affiliation(s)
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Blake E Dewey
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Norah J Cowley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Glaister
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Omar Al-Louzi
- Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - James Nguyen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alissa Rothman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Esther Ogbuokiri
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Fioravante
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sydney Feldman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ohemaa Kwakyi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hunter Risher
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorlan Kimbrough
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Austin Dell Medical School, Austin TX, USA
| | - Elliot Frohman
- Department of Neurology, University of Texas Austin Dell Medical School, Austin TX, USA
| | - Laura Balcer
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | | | - Peter C M Van Zijl
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel S Reich
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins University, Baltimore MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Rockville, MD, USA
| | - Jiwon Oh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Neurology, St. Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada
| | - Dzung L Pham
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
- Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jerry Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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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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22
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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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23
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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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24
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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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25
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Gonzalez Caldito N, Antony B, He Y, Lang A, Nguyen J, Rothman A, Ogbuokiri E, Avornu A, Balcer L, Frohman E, Frohman TC, Bhargava P, Prince J, Calabresi PA, Saidha S. Analysis of Agreement of Retinal-Layer Thickness Measures Derived from the Segmentation of Horizontal and Vertical Spectralis OCT Macular Scans. Curr Eye Res 2017; 43:415-423. [PMID: 29240464 DOI: 10.1080/02713683.2017.1406526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/25/2022]
Abstract
PURPOSE Optical coherence tomography (OCT) is a reliable method used to quantify discrete layers of the retina. Spectralis OCT is a device used for this purpose. Spectralis OCT macular scan imaging acquisition can be obtained on either the horizontal or vertical plane. The vertical protocol has been proposed as favorable, due to postulated reduction in confound of Henle's fibers on segmentation-derived metrics. Yet, agreement of the segmentation measures of horizontal and vertical macular scans remains unexplored. Our aim was to determine this agreement. MATERIALS AND METHODS Horizontal and vertical macular scans on Spectralis OCT were acquired in 20 healthy controls (HCs) and 20 multiple sclerosis (MS) patients. All scans were segmented using Heidelberg software and a Johns Hopkins University (JHU)-developed method. Agreement was analyzed using Bland-Altman analyses and intra-class correlation coefficients (ICCs). RESULTS Using both segmentation techniques, mean differences (agreement at the cohort level) in the thicknesses of all macular layers derived from both acquisition protocols in MS patients and HCs were narrow (<1 µm), while the limits of agreement (LOA) (agreement at the individual level) were wider. Using JHU segmentation mean differences (and LOA) for the macular retinal nerve fiber layer (RNFL) and ganglion cell layer + inner plexiform layer (GCIP) in MS were 0.21 µm (-1.57-1.99 µm) and -0.36 µm (-1.44-1.37 µm), respectively. CONCLUSIONS OCT segmentation measures of discrete retinal-layer thicknesses derived from both vertical and horizontal protocols on Spectralis OCT agree excellently at the cohort level (narrow mean differences), but only moderately at the individual level (wide LOA). This suggests patients scanned using either protocol should continue to be scanned with the same protocol. However, due to excellent agreement at the cohort level, measures derived from both acquisitions can be pooled for outcome purposes in clinical trials.
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Affiliation(s)
| | - Bhavna Antony
- b Department of Electrical and Computer Engineering , Johns Hopkins University , Baltimore , MD , USA
| | - Yufan He
- b Department of Electrical and Computer Engineering , Johns Hopkins University , Baltimore , MD , USA
| | - Andrew Lang
- b Department of Electrical and Computer Engineering , Johns Hopkins University , Baltimore , MD , USA
| | - 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
| | - Esther Ogbuokiri
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Ama Avornu
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Laura Balcer
- c Department of Neurology , New York University Langone Medical Center , New York , NY , USA
| | - Elliot Frohman
- d Department of Neurology and Ophthalmology , University of Texas Austin Dell Medical School , Austin TX , USA
| | - Teresa C Frohman
- d Department of Neurology and Ophthalmology , University of Texas Austin Dell Medical School , Austin TX , USA
| | - Pavan Bhargava
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jerry Prince
- b Department of Electrical and Computer Engineering , Johns Hopkins University , 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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26
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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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27
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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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28
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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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29
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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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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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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, 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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Fielding J, Clough M, Beh S, Millist L, Sears D, Frohman AN, Lizak N, Lim J, Kolbe S, Rennaker RL, Frohman TC, White OB, Frohman EM. Ocular motor signatures of cognitive dysfunction in multiple sclerosis. Nat Rev Neurol 2015; 11:637-45. [PMID: 26369516 DOI: 10.1038/nrneurol.2015.174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The anatomical and functional overlap between ocular motor command circuitry and the higher-order networks that form the scaffolding for cognition makes for a compelling hypothesis that measures of ocular motility could provide a means to sensitively interrogate cognitive dysfunction in people with multiple sclerosis (MS). Such an approach may ultimately provide objective and reproducible measures of cognitive dysfunction that offer an innovative capability to refine diagnosis, improve prognostication, and more accurately codify disease burden. A further dividend may be the validation and application of biomarkers that can be used in studies aimed at identifying and monitoring preventative, protective and even restorative properties of novel neurotherapeutics in MS. This Review discusses the utility of ocular motor measures in patients with MS to characterize disruption to wide-ranging networks that support cognitive function.
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Affiliation(s)
- Joanne Fielding
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia.,Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Parkville, VIC 3050, Australia
| | - Meaghan Clough
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Shin Beh
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Lynette Millist
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Parkville, VIC 3050, Australia
| | - Derek Sears
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Ashley N Frohman
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Nathaniel Lizak
- Monash School of Medicine, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Jayne Lim
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Parkville, VIC 3050, Australia
| | - Scott Kolbe
- Department of Anatomy and Neuroscience, Medical Building, University of Melbourne, Parkville, VIC 3010, Australia
| | - Robert L Rennaker
- Department of Bioengineering and Computer Science, University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, USA
| | - Teresa C Frohman
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Owen B White
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Parkville, VIC 3050, Australia
| | - Elliot M Frohman
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.,Department of Bioengineering and Computer Science, University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, USA
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Frohman AN, Okuda DT, Beh S, Treadaway K, Mooi C, Davis SL, Shah A, Frohman TC, Frohman EM. Aquatic training in MS: neurotherapeutic impact upon quality of life. Ann Clin Transl Neurol 2015; 2:864-72. [PMID: 26339680 PMCID: PMC4554447 DOI: 10.1002/acn3.220] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/12/2015] [Indexed: 11/26/2022] Open
Abstract
Three fundamental principals associated with aquatic therapy differentiate it with respect to exercise on land, and in air. These are buoyancy (reduction in weight of the body within the buoyant medium of water), viscosity (a “drag force” is generated when moving within water, when compared with the same movement in air), and the thermodynamic aspect of water exercise, during which the heat capacity of water is about 1000 times greater than that of an equivalent amount of air; equating to a heat transfer from the body into water at a rate 25 times faster than that of air. Aquatic conditioning, can improve neurologic functioning, with dividends favorably impacting activities of daily living, health maintenance, safety, and ultimately quality of life. Here, we review the application of aquatic exercise training in MS patients.
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Affiliation(s)
- Ashley N Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Shin Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas ; Multiple Sclerosis, Neuroimmunology, Neuro-Ophthalmology, Neuro-Otology Fellow, Collaborative MS Fellowship Training Program, UT Southwestern, Johns Hopkins Hospital Baltimore, Maryland and New York University NYU Langone Medical Center, New York
| | - Katherine Treadaway
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Caroline Mooi
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Scott L Davis
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas ; Department of Applied Physiology and Wellness, Southern Methodist University Dallas, Texas
| | - Anjali Shah
- Department of Physical Medicine Rehabilitation, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Teresa C Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas ; Department of Behavioral and Brain Sciences, University of Texas at Dallas Dallas, Texas ; Department of BioEngineering, University of Texas at Dallas Dallas, Texas
| | - Elliot M Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas ; Department of Behavioral and Brain Sciences, University of Texas at Dallas Dallas, Texas ; Department of BioEngineering, University of Texas at Dallas Dallas, Texas ; Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
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Clough M, Mitchell L, Millist L, Lizak N, Beh S, Frohman TC, Frohman EM, White OB, Fielding J. Ocular motor measures of cognitive dysfunction in multiple sclerosis II: working memory. J Neurol 2015; 262:1138-47. [PMID: 25851742 DOI: 10.1007/s00415-015-7644-4] [Citation(s) in RCA: 21] [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] [Received: 12/15/2014] [Revised: 01/10/2015] [Accepted: 01/11/2015] [Indexed: 11/24/2022]
Abstract
Our companion paper documents pervasive inhibitory deficits in multiple sclerosis (MS) using ocular motor (OM) measures. Here we investigated the utility of an OM working memory (WMem) task in characterising WMem deficits in these patients as a function of disease status and disease duration. 22 patients with CIS, 22 early clinically definite MS patients (CDMS: <7 years of diagnosis), 22 late CDMS patients (>7 years from diagnosis), and 22 healthy controls participated. All participants completed the ocular motor WMem task, the paced auditory serial addition test (PASAT), and the symbol digit modalities test (SDMT). Clinical disability was characterised in CDMS patients using the Expanded Disability Severity Scale (EDSS). WMem performance was measured as proportion of errors (WMem errors), saccade latency, and relative sensitivity to WMem loading (WMem effect), an indicator of WMem capacity. All patient groups performed more WMem errors than controls with proportion of WMem errors, and degree of WMem effect increasing with increasing disease duration. A larger WMem effect, reflecting poorer WMem capacity, corresponded to poorer performance on neuropsychological measures, and a higher disability score for CDMS patients with the longest disease duration; an observation that suggests wider implication of WMem executive processes with advancing disease. Conspicuously, performance decrements on standard neuropsychological testing did not similarly increase commensurate with disease duration. The ocular motor WMem task appears to meaningfully dissociate WMem deficit from healthy individuals as well as a function of increasing disease duration. Potentially, this task represents a highly informative and objective method by which to ascertain progressive WMem changes from the earliest inception of MS.
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Affiliation(s)
- Meaghan Clough
- School of Psychological Sciences, Monash University, Clayton, 3800, Australia
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Kimbrough DJ, Sotirchos ES, Wilson JA, Al-Louzi O, Conger A, Conger D, Frohman TC, Saidha S, Green AJ, Frohman EM, Balcer LJ, Calabresi PA. Retinal damage and vision loss in African American multiple sclerosis patients. Ann Neurol 2015; 77:228-36. [PMID: 25382184 DOI: 10.1002/ana.24308] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 10/12/2014] [Accepted: 11/06/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine whether African American (AA) multiple sclerosis (MS) patients exhibit more retinal damage and visual impairment compared to Caucasian American (CA) MS patients. METHODS A total of 687 MS patients (81 AAs) and 110 healthy control (HC) subjects (14 AAs) were recruited at 3 academic hospitals between 2008 and 2012. Using mixed effects regression models, we compared high- and low-contrast visual acuity (HCVA and LCVA) and high-definition spectral domain optical coherence tomography measures of retinal architecture between MS patients of self-identified AA and CA ancestry. RESULTS In HCs, baseline peripapillary retinal nerve fiber layer (RNFL) thickness was 6.1µm greater in AAs (p = 0.047), whereas ganglion cell/inner plexiform layer (GCIP) thickness did not differ by race. In MS patients, baseline RNFL did not differ by race, and GCIP was 3.98µm thinner in AAs (p = 0.004). AAs had faster RNFL and GCIP thinning rates compared to CAs (p = 0.004 and p = 0.046, respectively). AA MS patients had lower baseline HCVA (p = 0.02) and worse LCVA per year of disease duration (p = 0.039). Among patients with an acute optic neuritis (AON) history, AAs had greater loss of HCVA than CA patients (p = 0.012). INTERPRETATION This multicenter investigation provides objective evidence that AA MS patients exhibit accelerated retinal damage compared to CA MS patients. Self-identified AA ancestry is associated with worse MS-related visual disability, particularly in the context of an AON history, suggesting a more aggressive inflammatory disease course among AA MS patients or a subpopulation therein.
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Affiliation(s)
- Shin C Beh
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Frohman EM, Monaco MC, Remington G, Ryschkewitsch C, Jensen PN, Johnson K, Perkins M, Liebner J, Greenberg B, Monson N, Frohman TC, Douek D, Major EO. JC virus in CD34+ and CD19+ cells in patients with multiple sclerosis treated with natalizumab. JAMA Neurol 2014; 71:596-602. [PMID: 24664166 DOI: 10.1001/jamaneurol.2014.63] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Infection with JC virus (JCV) may lead to development of demyelinating progressive multifocal leukoencephalopathy in patients with multiple sclerosis (MS) who are treated with natalizumab. OBJECTIVE To determine whether mononuclear cells in circulation from MS patients treated with natalizumab harbor JCV DNA. DESIGN, SETTING, AND PARTICIPANTS In this prospective investigation, we enrolled 49 MS patients from the Clinical Center for Multiple Sclerosis at The University of Texas Southwestern Medical Center and 18 healthy volunteers. We drew 120-mL blood samples from 26 MS patients at baseline and at approximately 3-month intervals to 10 months during the course of natalizumab infusions. One blood sample was drawn from 23 MS patients receiving natalizumab for more than 24 months and from 18 healthy volunteers. INTERVENTIONS Natalizumab treatment of MS. MAIN OUTCOMES AND MEASURES The blood samples were separated using flow cytometry into CD34+, CD19+, and CD3+ cell subsets; DNA templates were prepared using quantitative polymerase chain reaction for JCV DNA identification. Plasma samples were tested for anti-JCV antibodies by enzyme-linked immunosorbent assays performed at the Laboratory of Molecular Medicine and Neuroscience, National Institute of Neurological and Communicative Diseases and Stroke. RESULTS Thirteen of the 26 patients (50%) with baseline and follow-up blood samples had detectable viral DNA in at least 1 cell compartment at 1 or more points. Ten of the 23 patients (44%) receiving treatment for more than 24 months and 3 of the 18 healthy volunteers (17%) also had detectable viral DNA in 1 or more cell compartment. Fifteen of the 49 MS patients (31%) were confirmed to harbor JCV in CD34+ cells and 12 of 49 (24%) in CD19+ cells. Only 1 of 18 healthy volunteers were viremic in CD34+ cells and none in CD19+ cells. Nine patients and 1 healthy volunteer were viremic but had seronegative test results for JCV antibodies. CONCLUSIONS AND RELEVANCE JC virus DNA was detectable within cell compartments of natalizumab-treated MS patients after treatment inception and longer. JC virus DNA may harbor in CD34+ cells in bone marrow that mobilize into the peripheral circulation at high concentrations. Latently infected cells initiate differentiation to CD19+ cells that favors growth of JCV. These data link the mechanism of natalizumab treatment with progressive multifocal leukoencephalopathy.
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Affiliation(s)
- Elliot M Frohman
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas2Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas
| | - Maria Chiara Monaco
- Laboratory of Molecular Medicine and Neuroscience, National Institutes of Health (NIH), Bethesda, Maryland
| | - Gina Remington
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas
| | - Caroline Ryschkewitsch
- Laboratory of Molecular Medicine and Neuroscience, National Institutes of Health (NIH), Bethesda, Maryland
| | - Peter N Jensen
- Laboratory of Molecular Medicine and Neuroscience, National Institutes of Health (NIH), Bethesda, Maryland
| | - Kory Johnson
- Bioinformatics Section, National Institute of Neurological and Communicative Diseases and Stroke, NIH, Bethesda, Maryland
| | - Molly Perkins
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Julia Liebner
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Benjamin Greenberg
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas
| | - Nancy Monson
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas
| | - Teresa C Frohman
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas
| | - Daniel Douek
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Eugene O Major
- Laboratory of Molecular Medicine and Neuroscience, National Institutes of Health (NIH), Bethesda, Maryland
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Schnurman ZS, Frohman TC, Beh SC, Conger D, Conger A, Saidha S, Galetta S, Calabresi PA, Green AJ, Balcer LJ, Frohman EM. Retinal architecture and mfERG: Optic nerve head component response characteristics in MS. Neurology 2014; 82:1888-96. [PMID: 24789865 DOI: 10.1212/wnl.0000000000000447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To describe a novel neurophysiologic signature of the retinal ganglion cell and to elucidate its relationship to abnormalities in validated structural and functional measures of the visual system. METHODS We used multifocal electroretinogram-generated optic nerve head component (ONHC) responses from normal subjects (n = 18), patients with multiple sclerosis (MS) (n = 18), and those with glaucoma (n = 3). We then characterized the relationship between ONHC response abnormalities and performance on low-contrast visual acuity, multifocal visual-evoked potential-induced cortical responses, and average and quadrant retinal nerve fiber layer (RNFL) thicknesses, as measured by spectral-domain optical coherence tomography. RESULTS Compared with the eyes of normal subjects, the eyes of patients with MS exhibited an increased number of abnormal or absent ONHC responses (p < 0.0001). For every 7-letter reduction in low-contrast letter acuity, there were corresponding 4.6 abnormal ONHC responses at 2.5% contrast (p < 0.0001) and 6.6 abnormalities at the 1.25% contrast level (p < 0.0001). Regarding average RNFL thickness, for each 10-μm thickness reduction, we correspondingly observed 6.8 abnormal ONHC responses (p = 0.0002). The most robust association was between RNFL thinning in the temporal quadrant and ONHC response abnormalities (p < 0.0001). CONCLUSION Further characterization of ONHC abnormalities (those that are reversible and irreversible) may contribute to the development of novel neurotherapeutic strategies aimed at achieving neuroprotective, and perhaps even neurorestorative, effects in disorders that target the CNS in general, and MS in particular.
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Affiliation(s)
- Zane S Schnurman
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Teresa C Frohman
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Shin C Beh
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Darrel Conger
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Amy Conger
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Shiv Saidha
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Steven Galetta
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Peter A Calabresi
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Ari J Green
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Laura J Balcer
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco.
| | - Elliot M Frohman
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco.
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Beh SC, Frohman TC, Frohman EM. Isolated mammillary body involvement on MRI in Wernicke's encephalopathy. J Neurol Sci 2013; 334:172-5. [DOI: 10.1016/j.jns.2013.07.2516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
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Frohman TC, Beh SC, Saidha S, Schnurman Z, Conger D, Conger A, Ratchford JN, Lopez C, Galetta SL, Calabresi PA, Balcer LJ, Green AJ, Frohman EM. Optic nerve head component responses of the multifocal electroretinogram in MS. Neurology 2013; 81:545-51. [PMID: 23825172 DOI: 10.1212/wnl.0b013e31829e6faa] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To employ a novel stimulation paradigm in order to elicit multifocal electroretinography (mfERG)-induced optic nerve head component (ONHC) responses, believed to be contingent upon the transformation in electrical transmission properties of retinal ganglion cell axons from membrane to saltatory conduction mechanisms, as they traverse the lamina cribrosa and obtain oligodendrocyte myelin. We further sought to characterize abnormalities in ONHC responses in eyes from patients with multiple sclerosis (MS). METHODS In 10 normal subjects and 7 patients with MS (including eyes with and without a history of acute optic neuritis), we utilized a novel mfERG stimulation paradigm that included interleaved global flashes in order to elicit the ONHC responses from 103 retinal patches of pattern-reversal stimulation. RESULTS The number of abnormal or absent ONHC responses was significantly increased in MS patient eyes compared to normal subject eyes (p < 0.001, by general estimating equation modeling, and accounting for age and within-subject, intereye correlations). CONCLUSION Studying the relationship between ONHC abnormalities and alterations in validated structural and functional measures of the visual system may facilitate the ability to dissect and characterize the pathobiological mechanisms that contribute to tissue damage in MS, and may have utility to detect and monitor neuroprotective or restorative effects of novel therapies.
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Affiliation(s)
- Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center at Dallas, USA
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Frohman TC, Davis SL, Beh S, Greenberg BM, Remington G, Frohman EM. Uhthoff's phenomena in MS—clinical features and pathophysiology. Nat Rev Neurol 2013; 9:535-40. [DOI: 10.1038/nrneurol.2013.98] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Saidha S, Sotirchos ES, Oh J, Syc SB, Seigo MA, Shiee N, Eckstein C, Durbin MK, Oakley JD, Meyer SA, Frohman TC, Newsome S, Ratchford JN, Balcer LJ, Pham DL, Crainiceanu CM, Frohman EM, Reich DS, Calabresi PA. Relationships between retinal axonal and neuronal measures and global central nervous system pathology in multiple sclerosis. JAMA Neurol 2013; 70:34-43. [PMID: 23318513 DOI: 10.1001/jamaneurol.2013.573] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine the relationships between conventional and segmentation-derived optical coherence tomography (OCT) retinal layer thickness measures with intracranial volume (a surrogate of head size) and brain substructure volumes in multiple sclerosis (MS). DESIGN Cross-sectional study. SETTING Johns Hopkins University, Baltimore, Maryland. PARTICIPANTS A total of 84 patients with MS and 24 healthy control subjects. MAIN OUTCOME MEASURES High-definition spectral-domain OCT conventional and automated segmentation-derived discrete retinal layer thicknesses and 3-T magnetic resonance imaging brain substructure volumes. RESULTS Peripapillary retinal nerve fiber layer as well as composite ganglion cell layer+inner plexiform layer thicknesses in the eyes of patients with MS without a history of optic neuritis were associated with cortical gray matter (P=.01 and P=.04, respectively) and caudate (P=.04 and P=.03, respectively) volumes. Inner nuclear layer thickness, also in eyes without a history of optic neuritis, was associated with fluid-attenuated inversion recovery lesion volume (P=.007) and inversely associated with normal-appearing white matter volume (P=.005) in relapsing-remitting MS. As intracranial volume was found to be related with several of the OCT measures in patients with MS and healthy control subjects and is already known to be associated with brain substructure volumes, all OCT-brain substructure relationships were adjusted for intracranial volume. CONCLUSIONS Retinal measures reflect global central nervous system pathology in multiple sclerosis, with thicknesses of discrete retinal layers each appearing to be associated with distinct central nervous system processes. Moreover, OCT measures appear to correlate with intracranial volume in patients with MS and healthy control subjects, an important unexpected factor unaccounted for in prior studies examining the relationships between peripapillary retinal nerve fiber layer thickness and brain substructure volumes.
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Affiliation(s)
- Shiv Saidha
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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Ratchford JN, Saidha S, Sotirchos ES, Oh JA, Seigo MA, Eckstein C, Durbin MK, Oakley JD, Meyer SA, Conger A, Frohman TC, Newsome SD, Balcer LJ, Frohman EM, Calabresi PA. Active MS is associated with accelerated retinal ganglion cell/inner plexiform layer thinning. Neurology 2013; 80:47-54. [PMID: 23267030 DOI: 10.1212/wnl.0b013e31827b1a1c] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine the effect of clinical and radiologic disease activity on the rate of thinning of the ganglion cell/inner plexiform (GCIP) layer and the retinal nerve fiber layer in patients with multiple sclerosis (MS) using optical coherence tomography (OCT). METHODS One hundred sixty-four patients with MS and 59 healthy controls underwent spectral-domain OCT scans every 6 months for a mean follow-up period of 21.1 months. Baseline and annual contrast-enhanced brain MRIs were performed. Patients who developed optic neuritis during follow-up were excluded from analysis. RESULTS Patients with the following features of disease activity during follow-up had faster rates of annualized GCIP thinning: relapses (42% faster, p = 0.007), new gadolinium-enhancing lesions (54% faster, p < 0.001), and new T2 lesions (36% faster, p = 0.02). Annual GCIP thinning was 37% faster in those with disability progression during follow-up, and 43% faster in those with disease duration <5 years vs >5 years (p = 0.003). Annual rates of GCIP thinning were highest in patients exhibiting combinations of new gadolinium-enhancing lesions, new T2 lesions, and disease duration <5 years (70% faster in patients with vs without all 3 characteristics, p < 0.001). CONCLUSIONS MS patients with clinical and/or radiologic nonocular disease activity, particularly early in the disease course, exhibit accelerated GCIP thinning. Our findings suggest that retinal changes in MS reflect global CNS processes, and that OCT-derived GCIP thickness measures may have utility as an outcome measure for assessing neuroprotective agents, particularly in early, active MS.
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Affiliation(s)
- John N Ratchford
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Saidha S, Sotirchos ES, Oh J, Syc SB, Seigo MA, Shiee N, Eckstein C, Durbin MK, Oakley JD, Meyer SA, Frohman TC, Newsome S, Ratchford JN, Balcer LJ, Pham DL, Crainiceanu CM, Frohman EM, Reich DS, Calabresi PA. Relationships Between Retinal Axonal and Neuronal Measures and Global Central Nervous System Pathology in Multiple Sclerosis. JAMA Neurol 2012. [DOI: 10.1001/archneurol.2013.573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Blazek P, Davis SL, Greenberg BM, Conger A, Conger D, Vernino S, Beh S, Stuve O, Saidha S, Ratchford JN, Green A, Calabresi PA, Balcer LJ, Frohman TC, Frohman EM. Objective characterization of the relative afferent pupillary defect in MS. J Neurol Sci 2012; 323:193-200. [PMID: 23026533 DOI: 10.1016/j.jns.2012.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop an objective and precise neurophysiologic method from which to identify and characterize the presence and magnitude of relative afferent pupillary defects (RAPD) in patients with MS. METHODS Binocular infrared pupillometry was performed in 40 control subjects and 32 MS patients with RAPDs, using two precisely defined sequences of alternating light flashes (right-left and left-right). We analyzed three distinct pupillary metrics in response to light stimulation. These included percent diameter change (DC), constriction curve area (CCA), which measures change in diameter over time, and the phase-plane curve area (PCA) which measures change in diameter with change in velocity. Direct and consensual response ratios (for each eye) were computed and analyzed for each metric in response to both the first flash (i.e. first phase) and second flash (i.e. second phase) of the 'swinging flashlight' test. RESULTS Second flash pupillary response metric asymmetry ratios yielded the highest discriminatory power for RAPD detection. Receiver operating characteristic areas under the curve for each of the pupillary metric response asymmetry ratios were as follows: diameter change: 0.97; constriction curve area: 0.96; phase-plane curve area: 0.95 (p<0.0001 for all comparisons compared to normal subjects). The sum of these three squared ratios (SSR) yielded a combined metric with the greatest discriminatory power (receiver operator characteristic area under the curve=0.99). CONCLUSIONS Second flash (i.e. the second phase of the swinging light test) pupillary metric response asymmetry ratios are highly sensitive and specific for the confirmation and characterization of an RAPD in patients with MS. This objective neurophysiologic method may be useful for studying the relationship between a stereotyped reflex, and nervous system architecture, with potential ramifications for detecting and monitoring neuroprotective and restorative effects of novel agents in MS treatment trials.
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Affiliation(s)
- Paul Blazek
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, USA
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Castro-Borrero W, Graves D, Frohman TC, Flores AB, Hardeman P, Logan D, Orchard M, Greenberg B, Frohman EM. Current and emerging therapies in multiple sclerosis: a systematic review. Ther Adv Neurol Disord 2012; 5:205-20. [PMID: 22783370 DOI: 10.1177/1756285612450936] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [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: 01/06/2023] Open
Abstract
Multiple sclerosis (MS) is a potentially disabling chronic autoimmune neurological disease that mainly affects young adults. Our understanding of the pathophysiology of MS has significantly advanced in the past quarter of a century. This has led to the development of many disease-modifying therapies (DMTs) that prevent exacerbations and new lesions in patients with relapsing remitting MS (RRMS). So far there is no drug available that can completely halt the neurodegenerative changes associated with the disease. It is the purpose of this review to provide concise information regarding mechanism of action, indications, side effects and safety of Food and Drug Administration and European Medicines Agency approved agents for MS, emerging therapies, and drugs that can be considered for off-label use in MS.
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Affiliation(s)
- Wanda Castro-Borrero
- University of Connecticut Health Center, Neurology Associates, 263 Farmington Ave., Farmington, CT 06030-5357, USA
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Frohman AR, Schnurman Z, Conger A, Conger D, Beh S, Greenberg B, Sutter E, Calabresi PA, Balcer LJ, Frohman TC, Frohman EM. Multifocal visual evoked potentials are influenced by variable contrast stimulation in MS. Neurology 2012; 79:797-801. [PMID: 22815550 DOI: 10.1212/wnl.0b013e3182661edc] [Citation(s) in RCA: 19] [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: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that patients with multiple sclerosis (MS) with intereye asymmetry on low contrast letter acuity, and thickness of the retinal nerve fiber layer (RNFL), would exhibit corresponding changes in cortical timing and amplitude responses on pattern reversal multifocal visual evoked potentials (mfVEP), contingent upon variable stimulus contrast. METHODS In a cross-sectional study, we investigated a cohort of 11 normal subjects and 40 patients with MS, 21 of whom had a history of acute optic neuritis (MS-AON) with an intereye asymmetry with respect to RNFL thickness, and on low contrast letter acuity performance. Pattern reversal mfVEP was performed at high (100%), low (33.3%), and very low (14.2%) Michelson-contrast levels. RESULTS Compared to baseline measures at 100% contrast, the mean amplitude of the mfVEP was reduced in MS-AON eyes, upon pattern-reversal stimulation at the 2 lower contrast levels (p < 0.0001). With respect to changes in timing responses, the intereye asymmetry was increased in the MS-AON patients upon lower contrast pattern-reversal stimulation (p < 0.0001 for 33.3% compared to 100%, and p < 0.001 for 14.2% compared to 100%). The fellow eye in 12 (57%; p < 0.001) of the patients with an abnormal eye, and a history of AON, revealed abnormal amplitude and timing responses upon low contrast stimulation (signifying unmasking of occult damage). CONCLUSIONS Our findings support the hypothesis that mfVEP metric abnormalities are contingent upon contrast magnitude during pattern reversal stimulation. Further, this paradigm was capable of unmasking occult abnormalities in a significant number of apparently unaffected eyes.
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Affiliation(s)
- Audrey R Frohman
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, USA
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