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Zuroff LR, Green AJ. The Study of Remyelinating Therapies in Multiple Sclerosis: Visual Outcomes as a Window Into Repair. J Neuroophthalmol 2024; 44:143-156. [PMID: 38654413 DOI: 10.1097/wno.0000000000002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Amelioration of disability in multiple sclerosis requires the development of complementary therapies that target neurodegeneration and promote repair. Remyelination is a promising neuroprotective strategy that may protect axons from damage and subsequent neurodegeneration. METHODS A review of key literature plus additional targeted search of PubMed and Google Scholar was conducted. RESULTS There has been a rapid expansion of clinical trials studying putative remyelinating candidates, but further growth of the field is limited by the lack of consensus on key aspects of trial design. We have not yet defined the ideal study population, duration of therapy, or the appropriate outcome measures to detect remyelination in humans. The varied natural history of multiple sclerosis, coupled with the short time frame of phase II clinical trials, requires that we develop and validate biomarkers of remyelination that can serve as surrogate endpoints in clinical trials. CONCLUSIONS We propose that the visual system may be the most well-suited and validated model for the study potential remyelinating agents. In this review, we discuss the pathophysiology of demyelination and summarize the current clinical trial landscape of remyelinating agents. We present some of the challenges in the study of remyelinating agents and discuss current potential biomarkers of remyelination and repair, emphasizing both established and emerging visual outcome measures.
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Affiliation(s)
- Leah R Zuroff
- Department of Neurology (LZ), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Neurology (AJG), University of California San Francisco, San Francisco, California
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Papadopoulou A, Pfister A, Tsagkas C, Gaetano L, Sellathurai S, D'Souza M, Cerdá-Fuertes N, Gugleta K, Descoteaux M, Chakravarty MM, Fuhr P, Kappos L, Granziera C, Magon S, Sprenger T, Hardmeier M. Visual evoked potentials in multiple sclerosis: P100 latency and visual pathway damage including the lateral geniculate nucleus. Clin Neurophysiol 2024; 161:122-132. [PMID: 38461596 DOI: 10.1016/j.clinph.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To explore associations of the main component (P100) of visual evoked potentials (VEP) to pre- and postchiasmatic damage in multiple sclerosis (MS). METHODS 31 patients (median EDSS: 2.5), 13 with previous optic neuritis (ON), and 31 healthy controls had VEP, optical coherence tomography and magnetic resonance imaging. We tested associations of P100-latency to the peripapillary retinal nerve fiber layer (pRNFL), ganglion cell/inner plexiform layers (GCIPL), lateral geniculate nucleus volume (LGN), white matter lesions of the optic radiations (OR-WML), fractional anisotropy of non-lesional optic radiations (NAOR-FA), and to the mean thickness of primary visual cortex (V1). Effect sizes are given as marginal R2 (mR2). RESULTS P100-latency, pRNFL, GCIPL and LGN in patients differed from controls. Within patients, P100-latency was significantly associated with GCIPL (mR2 = 0.26), and less strongly with OR-WML (mR2 = 0.17), NAOR-FA (mR2 = 0.13) and pRNFL (mR2 = 0.08). In multivariate analysis, GCIPL and NAOR-FA remained significantly associated with P100-latency (mR2 = 0.41). In ON-patients, P100-latency was significantly associated with LGN volume (mR2 = -0.56). CONCLUSIONS P100-latency is affected by anterior and posterior visual pathway damage. In ON-patients, damage at the synapse-level (LGN) may additionally contribute to latency delay. SIGNIFICANCE Our findings corroborate post-chiasmatic contributions to the VEP-signal, which may relate to distinct pathophysiological mechanisms in MS.
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Affiliation(s)
- Athina Papadopoulou
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Switzerland; Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Armanda Pfister
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Charidimos Tsagkas
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Shaumiya Sellathurai
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Switzerland; Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Marcus D'Souza
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland; Neurostatus AG, University Hospital of Basel, Basel, Switzerland
| | - Nuria Cerdá-Fuertes
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Switzerland; Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland; Neurostatus AG, University Hospital of Basel, Basel, Switzerland
| | - Konstantin Gugleta
- University Eye Clinic Basel, University Hospital Basel and University of Basel, Basel, Switzerland
| | | | - Mallar M Chakravarty
- Douglas Mental Health University Institute, Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal, University of Sherbrooke (M.D.), Canada
| | - Peter Fuhr
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Switzerland
| | - Ludwig Kappos
- Department of Clinical Research, University of Basel, Switzerland; Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefano Magon
- Pharma Research and Early Development, Neuroscience and Rare Diseases Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | - Martin Hardmeier
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.
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Riboni-Verri G, Chen BS, McMurran CE, Halliwell GJ, Brown JWL, Coles AJ, Cunniffe NG. Visual outcome measures in clinical trials of remyelinating drugs. BMJ Neurol Open 2024; 6:e000560. [PMID: 38389586 PMCID: PMC10882304 DOI: 10.1136/bmjno-2023-000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/15/2024] [Indexed: 02/24/2024] Open
Abstract
One of the most promising approaches to delay, prevent or reverse disability progression in multiple sclerosis (MS) is to enhance endogenous remyelination and limit axonal degeneration. In clinical trials of remyelinating drugs, there is a need for reliable, sensitive and clinically relevant outcome measures. The visual pathway, which is frequently affected by MS, provides a unique model system to evaluate remyelination of acute and chronic MS lesions in vivo and non-invasively. In this review, we discuss the different measures that have been used and scrutinise visual outcome measure selection in current and future remyelination trials.
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Affiliation(s)
- Gioia Riboni-Verri
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
| | - Benson S Chen
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
| | - Christopher E McMurran
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gregory J Halliwell
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Clinical Outcomes Research Unit (CORe), University of Melbourne, Melborune, Melborune, Australia
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
| | - Nick G Cunniffe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
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Buscho SE, Xia F, Shi S, Lin JL, Szczesny B, Zhang W, Motamedi M, Liu H. Non-Invasive Evaluation of Retinal Vascular Alterations in a Mouse Model of Optic Neuritis Using Laser Speckle Flowgraphy and Optical Coherence Tomography Angiography. Cells 2023; 12:2685. [PMID: 38067113 PMCID: PMC10705764 DOI: 10.3390/cells12232685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/04/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Optic neuritis, a characteristic feature of multiple sclerosis (MS), involves the inflammation of the optic nerve and the degeneration of retinal ganglion cells (RGCs). Although previous studies suggest that retinal blood flow alterations occur during optic neuritis, the precise location, the degree of impairment, and the underlying mechanisms remain unclear. In this study, we utilized two emerging non-invasive imaging techniques, laser speckle flowgraphy (LSFG) and optical coherence tomography angiography (OCTA), to investigate retinal vascular changes in a mouse model of MS, known as experimental autoimmune encephalomyelitis (EAE). We associated these changes with leukostasis, RGC injury, and the overall progression of EAE. LSFG imaging revealed a progressive reduction in retinal blood flow velocity and increased vascular resistance near the optic nerve head in the EAE model, indicating impaired ocular blood flow. OCTA imaging demonstrated significant decreases in vessel density, number of junctions, and total vessel length in the intermediate and deep capillary plexus of the EAE mice. Furthermore, our analysis of leukostasis revealed a significant increase in adherent leukocytes in the retinal vasculature of the EAE mice, suggesting the occurrence of vascular inflammation in the early development of EAE pathology. The abovechanges preceded or were accompanied by the characteristic hallmarks of optic neuritis, such as RGC loss and reduced visual acuity. Overall, our study sheds light on the intricate relationship between retinal vascular alterations and the progression of optic neuritis as well as MS clinical score. It also highlights the potential for the development of image-based biomarkers for the diagnosis and monitoring of optic neuritis as well as MS, particularly in response to emerging treatments.
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Affiliation(s)
- Seth E. Buscho
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX 77555, USA; (S.E.B.); (F.X.); (S.S.); (J.L.L.); (B.S.); (W.Z.); (M.M.)
| | - Fan Xia
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX 77555, USA; (S.E.B.); (F.X.); (S.S.); (J.L.L.); (B.S.); (W.Z.); (M.M.)
| | - Shuizhen Shi
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX 77555, USA; (S.E.B.); (F.X.); (S.S.); (J.L.L.); (B.S.); (W.Z.); (M.M.)
| | - Jonathan L. Lin
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX 77555, USA; (S.E.B.); (F.X.); (S.S.); (J.L.L.); (B.S.); (W.Z.); (M.M.)
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Bartosz Szczesny
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX 77555, USA; (S.E.B.); (F.X.); (S.S.); (J.L.L.); (B.S.); (W.Z.); (M.M.)
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Wenbo Zhang
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX 77555, USA; (S.E.B.); (F.X.); (S.S.); (J.L.L.); (B.S.); (W.Z.); (M.M.)
- Department of Neurobiology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Massoud Motamedi
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX 77555, USA; (S.E.B.); (F.X.); (S.S.); (J.L.L.); (B.S.); (W.Z.); (M.M.)
| | - Hua Liu
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX 77555, USA; (S.E.B.); (F.X.); (S.S.); (J.L.L.); (B.S.); (W.Z.); (M.M.)
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Nij Bijvank JA, Hof SN, Prouskas SE, Schoonheim MM, Uitdehaag BMJ, van Rijn LJ, Petzold A. A novel eye-movement impairment in multiple sclerosis indicating widespread cortical damage. Brain 2023; 146:2476-2488. [PMID: 36535900 PMCID: PMC10232247 DOI: 10.1093/brain/awac474] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/04/2022] [Accepted: 11/22/2022] [Indexed: 11/04/2023] Open
Abstract
In multiple sclerosis, remyelination trials have yet to deliver success like that achieved for relapse rates with disease course modifying treatment trials. The challenge is to have a clinical, functional outcome measure. Currently, there are none that have been validated, other than visual evoked potentials in optic neuritis. Like vision, quick eye movements (saccades) are heavily dependent on myelination. We proposed that it is possible to extrapolate from demyelination of the medial longitudinal fasciculus in the brainstem to quantitative assessment of cortical networks governing saccadic eye movements in multiple sclerosis. We have developed and validated a double-step saccadic test, which consists of a pair of eye movements towards two stimuli presented in quick succession (the demonstrate eye movement networks with saccades protocol). In this single-centre, cross-sectional cohort study we interrogated the structural and functional relationships of double-step saccades in multiple sclerosis. Data were collected for double-step saccades, cognitive function (extended Rao's Brief Repeatable Battery), disability (Expanded Disability Status Scale) and visual functioning in daily life (National Eye Institute Visual Function Questionnaire). MRI was used to quantify grey matter atrophy and multiple sclerosis lesion load. Multivariable linear regression models were used for analysis of the relationships between double-step saccades and clinical and MRI metrics. We included 209 individuals with multiple sclerosis (mean age 54.3 ± 10.5 years, 58% female, 63% relapsing-remitting multiple sclerosis) and 60 healthy control subjects (mean age 52.1 ± 9.2 years, 53% female). The proportion of correct double-step saccades was significantly reduced in multiple sclerosis (mean 0.29 ± 0.22) compared to controls (0.45 ± 0.22, P < 0.001). Consistent with this, there was a significantly larger double-step dysmetric saccadic error in multiple sclerosis (mean vertical error -1.18 ± 1.20°) compared to controls (-0.54 ± 0.86°, P < 0.001). Impaired double-step saccadic metrics were consistently associated with more severe global and local grey matter atrophy (correct responses-cortical grey matter: β = 0.42, P < 0.001), lesion load (vertical error: β = -0.28, P < 0.001), progressive phenotypes, more severe physical and cognitive impairment (correct responses-information processing: β = 0.46, P < 0.001) and visual functioning. In conclusion, double-step saccades represent a robust metric that revealed a novel eye-movement impairment in individuals with multiple sclerosis. Double-step saccades outperformed other saccadic tasks in their statistical relationship with clinical, cognitive and visual functioning, as well as global and local grey matter atrophy. Double-step saccades should be evaluated longitudinally and tested as a potential novel outcome measure for remyelination trials in multiple sclerosis.
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Affiliation(s)
- Jenny A Nij Bijvank
- Amsterdam UMC, Department of Neurology, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
- Amsterdam UMC, Department of Ophthalmology, Vrije Universiteit Amsterdam, Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
| | - Sam N Hof
- Amsterdam UMC, Department of Neurology, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
| | - Stefanos E Prouskas
- Amsterdam UMC, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, MS Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
| | - Menno M Schoonheim
- Amsterdam UMC, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, MS Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Amsterdam UMC, Department of Neurology, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
| | - Laurentius J van Rijn
- Amsterdam UMC, Department of Ophthalmology, Vrije Universiteit Amsterdam, Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
- Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, 1091 AC Amsterdam, The Netherlands
| | - Axel Petzold
- Amsterdam UMC, Department of Neurology, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
- Amsterdam UMC, Department of Ophthalmology, Vrije Universiteit Amsterdam, Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, The Netherlands
- Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery and the Queen Square Institute of Neurology, UCL, London EC1V 2PD, UK
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Patil SA, Grossman S, Kenney R, Balcer LJ, Galetta S. Where's the Vision? The Importance of Visual Outcomes in Neurologic Disorders: The 2021 H. Houston Merritt Lecture. Neurology 2023; 100:244-253. [PMID: 36522160 PMCID: PMC9931086 DOI: 10.1212/wnl.0000000000201490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/14/2022] [Indexed: 12/23/2022] Open
Abstract
Neurologists have long recognized the importance of the visual system in the diagnosis and monitoring of neurologic disorders. This is particularly true because approximately 50% of the brain's pathways subserve afferent and efferent aspects of vision. During the past 30 years, researchers and clinicians have further refined this concept to include investigation of the visual system for patients with specific neurologic diagnoses, including multiple sclerosis (MS), concussion, Parkinson disease (PD), and conditions along the spectrum of Alzheimer disease (AD, mild cognitive impairment, and subjective cognitive decline). This review highlights the visual "toolbox" that has been developed over the past 3 decades and beyond to capture both structural and functional aspects of vision in neurologic disease. Although the efforts to accelerate the emphasis on structure-function relationships in neurologic disorders began with MS during the early 2000s, such investigations have broadened to recognize the need for outcomes of visual pathway structure, function, and quality of life for clinical trials of therapies across the spectrum of neurologic disorders. This review begins with a patient case study highlighting the importance using the most modern technologies for visual pathway assessment, including optical coherence tomography. We emphasize that both structural and functional tools for vision testing can be used in parallel to detect what might otherwise be subclinical events or markers of visual and, perhaps, more global neurologic decline. Such measures will be critical because clinical trials and therapies become more available across the neurologic disease spectrum.
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Affiliation(s)
- Sachi A Patil
- From the Department of Ophthalmology (S.A.P., L.J.B, S.G.), New York University Grossman School of Medicine, NY; Department of Neurology (S.G., L.J.B., S. Galetta), New York University Grossman School of Medicine, NY; Department of Radiology and Radiological Sciences (R.K.), Vanderbilt University School of Medicine, Nashville, TN; Department of Population Health (L.J.B.), New York University Grossman School of Medicine, NY.
| | - Scott Grossman
- From the Department of Ophthalmology (S.A.P., L.J.B, S.G.), New York University Grossman School of Medicine, NY; Department of Neurology (S.G., L.J.B., S. Galetta), New York University Grossman School of Medicine, NY; Department of Radiology and Radiological Sciences (R.K.), Vanderbilt University School of Medicine, Nashville, TN; Department of Population Health (L.J.B.), New York University Grossman School of Medicine, NY
| | - Rachel Kenney
- From the Department of Ophthalmology (S.A.P., L.J.B, S.G.), New York University Grossman School of Medicine, NY; Department of Neurology (S.G., L.J.B., S. Galetta), New York University Grossman School of Medicine, NY; Department of Radiology and Radiological Sciences (R.K.), Vanderbilt University School of Medicine, Nashville, TN; Department of Population Health (L.J.B.), New York University Grossman School of Medicine, NY
| | - Laura J Balcer
- From the Department of Ophthalmology (S.A.P., L.J.B, S.G.), New York University Grossman School of Medicine, NY; Department of Neurology (S.G., L.J.B., S. Galetta), New York University Grossman School of Medicine, NY; Department of Radiology and Radiological Sciences (R.K.), Vanderbilt University School of Medicine, Nashville, TN; Department of Population Health (L.J.B.), New York University Grossman School of Medicine, NY
| | - Steven Galetta
- From the Department of Ophthalmology (S.A.P., L.J.B, S.G.), New York University Grossman School of Medicine, NY; Department of Neurology (S.G., L.J.B., S. Galetta), New York University Grossman School of Medicine, NY; Department of Radiology and Radiological Sciences (R.K.), Vanderbilt University School of Medicine, Nashville, TN; Department of Population Health (L.J.B.), New York University Grossman School of Medicine, NY
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Daniels K, Frequin STFM, van de Garde EMW, Biesma DH, van der Wees PJ, van der Nat PB, Ben-Zacharia AB, Cohen E, Gonçalves PJC, Kragt JJ, Hynes SM, Marron FE. Development of an international, multidisciplinary, patient-centered Standard Outcome Set for Multiple Sclerosis: The S.O.S.MS project. Mult Scler Relat Disord 2023; 69:104461. [PMID: 36563595 DOI: 10.1016/j.msard.2022.104461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Currently, outcomes of Multiple Sclerosis (MS) are not standardized and it is unclear which outcomes matter most to people living with MS. A consensus between patients and healthcare professionals on which outcomes to measure and how, would facilitate a move towards value-based MS care. OBJECTIVE to develop an internationally accepted, patient-relevant Standard Outcome Set for MS (S.O.S.MS). METHODS A mixed-method design was used, including a systematic literature review, four patient focus groups (n=30) and a RAND-modified Delphi process with seventeen MS experts of five disciplines from seven countries (the Netherlands, United States of America, Portugal, Ireland, India, New Zealand, Switzerland and Turkey). RESULTS A standard outcome set for MS was defined, consisting of fourteen outcomes divided in four domains: disease activity (n=3), symptoms (n=4), functional status (n=6), and quality of life (n=1). For each outcome, an outcome measure was selected and the measurement protocol was defined. In addition, seven case-mix variables were selected. CONCLUSION This standard outcome set provides a guideline for measuring outcomes of MS in clinical practice and research. Using this set to monitor and (inter)nationally benchmark real-world outcomes of MS can support improvement of patient value and ultimately guide the transition towards value-based MS care.
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Affiliation(s)
- K Daniels
- Department of Value-Based Healthcare, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), the Netherlands.
| | - S T F M Frequin
- Department of Neurology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands
| | - E M W van de Garde
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - D H Biesma
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - P J van der Wees
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), the Netherlands
| | - P B van der Nat
- Department of Value-Based Healthcare, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), the Netherlands
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8
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Nguyen MNL, Zhu C, Kolbe SC, Butzkueven H, White OB, Fielding J, Kilpatrick TJ, Egan GF, Klistorner A, van der Walt A. Early predictors of visual and axonal outcomes after acute optic neuritis. Front Neurol 2022; 13:945034. [PMID: 36158958 PMCID: PMC9493016 DOI: 10.3389/fneur.2022.945034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background Predicting long-term visual outcomes and axonal loss following acute optic neuritis (ON) is critical for choosing treatment. Predictive models including all clinical and paraclinical measures of optic nerve dysfunction following ON are lacking. Objectives Using a prospective study method, to identify 1 and 3 months predictors of 6 and 12 months visual outcome (low contrast letter acuity 2.5%) and axonal loss [retinal nerve fiber layer thickness and multifocal evoked potential (mfVEP) amplitude] following acute ON. Methods In total, 37 patients of acute ON onset were evaluated within 14 days using between-eye asymmetry of visual acuity, color vision (Ishihara plates), optical coherence tomography, mfVEP, and optic nerve magnetic resonance imaging [magnetic transfer ratio (MTR) and diffusion tensor imaging (DTI)]. Results Visual outcome at 6 and 12 months was best predicted by Ishihara asymmetry at 1 and 3 months following ON onset. Axonal loss at 6 and 12 months was reliably predicted by Ishihara asymmetry at 1 month. Optic nerve MTR and DTI at 3 months post-acute ON could predict axonal loss at 6 and 12 months. Conclusions Simple Ishihara asymmetry testing 1 month after acute ON onset can best predict visual outcome and axonal loss at 6 and 12 months in a clinical or research setting.
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Affiliation(s)
- Minh N. L. Nguyen
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Chao Zhu
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Scott C. Kolbe
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Owen B. White
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
| | | | - Gary F. Egan
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| | | | - Anneke van der Walt
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
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Park SH, Park CY, Shin YJ, Jeong KS, Kim NH. Low Contrast Visual Evoked Potentials for Early Detection of Optic Neuritis. Front Neurol 2022; 13:804395. [PMID: 35572925 PMCID: PMC9099025 DOI: 10.3389/fneur.2022.804395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Optic neuritis (ON) detection is important for the early diagnosis and management of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, the conventional high-contrast visual evoked potential (VEP) used for ON detection lacks sensitivity for identifying ON presenting as mild or unremarkable visual disturbance, which is common in first-episode ON. Therefore, this study aimed to investigate whether a change in contrast or check size improves the sensitivity of VEP to first-ever ON. In total, 60 patients with the demyelinating disease (29 MS and 31 idiopathic patients with ON) without ON or with first-ever ON at least 6 months prior and 32 healthy controls underwent neuro-ophthalmic evaluations. VEPs were induced using three pattern-reversal checkerboard stimuli having, respectively, 10% contrast with a check size of 32' (LC32 VEP), 100% contrast with a check size of 32' (HC32 VEP; conventional VEP), and 100% contrast with a check size of 16' (HC16 VEP). The receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) were calculated to determine the most appropriate VEP method for detecting optic nerve involvement. The optimal cut-off point was determined using the Youden index (J-index). The McNemar test was used to determine whether dichotomous proportions were equivalent. In comparison with first-ever ON eyes (n = 39) and healthy eyes (n = 64), LC32 VEP showed the highest AUC for discriminating ON (0.750, p < 0.001; 0.730 for HC32 VEP, p < 0.001; 0.702 for HC16 VEP, p = 0.001). In the first-ever ON group, LC32 VEP and conventional HC32 VEP were abnormal in 76.9 and 43.6%, respectively (McNemar, p < 0.001), and combining these tests did not improve sensitivity. These indicate that LC32 VEP is the most sensitive method for detecting first-ever ON. Visual evoked potential with 10% contrast stimuli was superior to conventional VEP for detecting first-ever ON. Thus, adding these LC stimuli might be helpful in identifying optic nerve involvement in ON with mild or unremarkable visual impairment.
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Affiliation(s)
- Soo-Hyun Park
- Department of Neurology, Department of Critical Care Medicine, Department of Internal Hospital, Inha University, Incheon, South Korea
| | - Choul-Yong Park
- Department of Ophthalmology, Dongguk University-Seoul Graduate School of Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Young Joo Shin
- Department of Ophthalmology, Hallym University Medical Center, Seoul, South Korea
| | - Kyoung Sook Jeong
- Department of Occupational and Environmental Medicine, Wonju Severance Hospital, Wonju, South Korea
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University-Seoul Graduate School of Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- *Correspondence: Nam-Hee Kim
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Hof S, Loonstra F, de Ruiter L, van Rijn L, Petzold A, Uitdehaag B, Bijvank JN. The prevalence of internuclear ophthalmoparesis in a population-based cohort of individuals with multiple sclerosis. Mult Scler Relat Disord 2022; 63:103824. [DOI: 10.1016/j.msard.2022.103824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
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Graves JS, Oertel FC, Van der Walt A, Collorone S, Sotirchos ES, Pihl-Jensen G, Albrecht P, Yeh EA, Saidha S, Frederiksen J, Newsome SD, Paul F. Leveraging Visual Outcome Measures to Advance Therapy Development in Neuroimmunologic Disorders. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 9:9/2/e1126. [PMID: 34955459 PMCID: PMC8711076 DOI: 10.1212/nxi.0000000000001126] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 11/04/2021] [Indexed: 12/19/2022]
Abstract
The visual system offers unparalleled precision in the assessment of neuroaxonal damage. With the majority of patients with multiple sclerosis (MS) experiencing afferent and efferent visual dysfunction, outcome measures capturing these deficits provide insight into neuroaxonal injury, even in those with minimal disability. Ideal for use in clinical trials, visual measures are generally inexpensive, accessible, and reproducible. Quantification of visual acuity, visual fields, visual quality of life, and electrophysiologic parameters allows assessment of function, whereas optical coherence tomography (OCT) provides reliable measures of the structural integrity of the anterior afferent visual pathway. The technology of oculomotor biometrics continues to advance, and discrete measures of fixation, smooth pursuit, and saccadic eye movement abnormalities are ready for inclusion in future trials of MS progression. Visual outcomes allow tracking of neuroaxonal injury and aid in distinguishing MS from diseases such as neuromyelitis optica spectrum disorder (NMOSD) or myelin oligodendrocyte glycoprotein antibody-associated diseases (MOGAD). OCT has also provided unique insights into pathophysiology, including the identification of foveal pitting in NMOSD, possibly from damage to Müller cells, which carry an abundance of aquaporin-4 channels. For some study designs, the cost-benefit ratio favors visual outcomes over more expensive MRI outcomes. With the next frontier of therapeutics focused on remyelination and neuroprotection, visual outcomes are likely to take center stage. As an international community of collaborative, committed, vision scientists, this review by the International MS Visual System Consortium (IMSVISUAL) outlines the quality standards, informatics, and framework needed to routinely incorporate vision outcomes into MS and NMOSD trials.
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Affiliation(s)
- Jennifer S Graves
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada.
| | - Frederike Cosima Oertel
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Anneke Van der Walt
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Sara Collorone
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Elias S Sotirchos
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Gorm Pihl-Jensen
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Philipp Albrecht
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - E Ann Yeh
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Shiv Saidha
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Jette Frederiksen
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Scott Douglas Newsome
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Friedemann Paul
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
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12
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Chen Q, Fang M, Miri S, Thakor K, Delgado S, Hernandez J, Alba DE, Gregori G, Porciatti V, Wang J, Jiang H. Retinal microvascular and neuronal function in patients with multiple sclerosis: 2-year follow-up. Mult Scler Relat Disord 2021; 56:103314. [PMID: 34634624 DOI: 10.1016/j.msard.2021.103314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/11/2021] [Accepted: 10/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the longitudinal changes in retinal microstructure, microvasculature, microcirculation, and axonal and neuronal functions in patients with relapsing-remitting multiple sclerosis (RRMS) over the time course of about two years. METHODS A total of 30 patients (60 eyes) with RRMS were followed for a period of 27 ± 6 months and evaluated with a battery of clinical tests including low contrast letter acuity (LCLA), intraretinal layer thicknesses by optical coherence tomography (OCT), ganglion cell function by steady-state pattern electroretinography (PERG), axonal function by polarization-sensitive OCT, volumetric vessel density (VVD) by OCT angiography, and retinal tissue perfusion (RTP) by retinal function imager. RESULTS Axonal function measured as retinal nerve fiber layer birefringence in the temporal quadrant and vessel density in the deep vascular plexus were significantly decreased at 2-year follow-up (P < 0.05). Subgroup analyses showed that the increased retinal blood flow volume occurred in patients with no evidence of disease activity (NEDA), and with stable or improved visual function (P < 0.05). There was no significant difference in the expanded disability state scale, LCLA, RTP, VVD, or PERG measures between the two visits (P > 0.05). CONCLUSION To our best knowledge, this is the first 2-year prospective comprehensive study with a detailed assessment of retinal microstructure and neuronal functions in patients with RRMS. The recovery of retinal microcirculation occurred in patients with NEDA, and stable or improved visual function, suggesting these measurements as potential imaging biomarkers for monitoring disease progression.
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Affiliation(s)
- Qi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Min Fang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States; Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Shahnaz Miri
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kinjal Thakor
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Silvia Delgado
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jeffrey Hernandez
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Diego Eduardo Alba
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Vittorio Porciatti
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States.
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Krajnc N, Bsteh G, Berger T. Clinical and Paraclinical Biomarkers and the Hitches to Assess Conversion to Secondary Progressive Multiple Sclerosis: A Systematic Review. Front Neurol 2021; 12:666868. [PMID: 34512500 PMCID: PMC8427301 DOI: 10.3389/fneur.2021.666868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
Conversion to secondary progressive (SP) course is the decisive factor for long-term prognosis in relapsing multiple sclerosis (MS), generally considered the clinical equivalent of progressive MS-associated neuroaxonal degeneration. Evidence is accumulating that both inflammation and neurodegeneration are present along a continuum of pathologic processes in all phases of MS. While inflammation is the prominent feature in early stages, its quality changes and relative importance to disease course decreases while neurodegenerative processes prevail with ongoing disease. Consequently, anti-inflammatory disease-modifying therapies successfully used in relapsing MS are ineffective in SPMS, whereas specific treatment for the latter is increasingly a focus of MS research. Therefore, the prevention, but also the (anticipatory) diagnosis of SPMS, is of crucial importance. The problem is that currently SPMS diagnosis is exclusively based on retrospectively assessing the increase of overt physical disability usually over the past 6–12 months. This inevitably results in a delay of diagnosis of up to 3 years resulting in periods of uncertainty and, thus, making early therapy adaptation to prevent SPMS conversion impossible. Hence, there is an urgent need for reliable and objective biomarkers to prospectively predict and define SPMS conversion. Here, we review current evidence on clinical parameters, magnetic resonance imaging and optical coherence tomography measures, and serum and cerebrospinal fluid biomarkers in the context of MS-associated neurodegeneration and SPMS conversion. Ultimately, we discuss the necessity of multimodal approaches in order to approach objective definition and prediction of conversion to SPMS.
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Affiliation(s)
- Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Seraji M, Mohebbi M, Safari A, Krekelberg B. Multiple sclerosis reduces synchrony of the magnocellular pathway. PLoS One 2021; 16:e0255324. [PMID: 34437558 PMCID: PMC8389379 DOI: 10.1371/journal.pone.0255324] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/15/2021] [Indexed: 02/01/2023] Open
Abstract
Multiple Sclerosis (MS) is an autoimmune demyelinating disease that damages the insulation of nerve cell fibers in the brain and spinal cord. In the visual system, this demyelination results in a robust delay of visually evoked potentials (VEPs), even in the absence of overt clinical symptoms such as blurred vision. VEPs, therefore, offer an avenue for early diagnosis, monitoring disease progression, and, potentially, insight into the differential impairment of specific pathways. A primary hypothesis has been that visual stimuli driving the magno-, parvo-, and konio-cellular pathways should lead to differential effects because these pathways differ considerably in terms of myelination. Experimental tests of this hypothesis, however, have led to conflicting results. Some groups reported larger latency effects for chromatic stimuli, while others found equivalent effects across stimulus types. We reasoned that this lack of pathway specificity could, at least in part, be attributed to the relatively coarse measure of pathway impairment afforded by the latency of a VEP. We hypothesized that network synchrony could offer a more sensitive test of pathway impairments. To test this hypothesis, we analyzed the synchrony of occipital electroencephalography (EEG) signals during the presentation of visual stimuli designed to bias activity to one of the three pathways. Specifically, we quantified synchrony in the occipital EEG using two graph-theoretic measures of functional connectivity: the characteristic path length (L; a measure of long-range connectivity) and the clustering coefficient (CC; a measure of short-range connectivity). Our main finding was that L and CC were both smaller in the MS group than in controls. Notably, this change in functional connectivity was limited to the magnocellular pathway. The effect sizes (Hedge's g) were 0.89 (L) and 1.26 (CC) measured with magno stimuli. Together, L and CC define the small-world nature of a network, and our finding can be summarized as a reduction in the small-worldness of the magnocellular network. We speculate that the reduced efficiency of information transfer associated with a reduction in small-worldness could underlie visual deficits in MS. Relating these measures to differential diagnoses and disease progression is an important avenue for future work.
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Affiliation(s)
- Masoud Seraji
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, New Jersey, United States of America
- Behavioral and Neural Sciences Graduate Program, Rutgers University, Newark, New Jersey, United States of America
- * E-mail:
| | - Maryam Mohebbi
- School of Electrical Engineering, K.N.Toosi University of Technology, Tehran, Iran
| | - Amirhossein Safari
- School of Electrical Engineering, K.N.Toosi University of Technology, Tehran, Iran
| | - Bart Krekelberg
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, New Jersey, United States of America
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15
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Srpova B, Sobisek L, Novotna K, Uher T, Friedova L, Vaneckova M, Krasensky J, Kubala Havrdova E, Horakova D. The clinical and paraclinical correlates of employment status in multiple sclerosis. Neurol Sci 2021; 43:1911-1920. [PMID: 34392392 DOI: 10.1007/s10072-021-05553-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/31/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To identify the clinical and paraclinical markers of employment status in multiple sclerosis (MS). METHODS This was a cross-sectional sub-study investigating 1226 MS patients. To minimalized confounding effect, two groups of patients, matched by sex, age, and education, were selected: 307 patients with full time employment and 153 unemployed patients receiving disability pension. We explored associations between employment status and Expanded Disability Status Scale (EDSS), 25 Foot Walk Test (25FWT), Nine Hole Peg Test (9HPT), Brief International Cognitive Assessment for MS (BICAMS), Paced Auditory Serial Addition Test (PASAT), Beck Depression Inventory (BDI), SLOAN charts (SLOAN), and brain volumetric MRI measures. RESULTS Both groups differed significantly on all variables of interest (p < 0.001). In the univariate analyses, EDSS, SDMT (Symbol Digit Modalities Test) adjusted for BDI, 25FWT, and 9HPT best explained variability in vocational status. In multivariate analyses, the combination of EDSS, 25FWT, SDMT, BDI, and corpus callosum fraction (CCF) explained the greatest variability. As a next step, after patients were matched by EDSS, differences in SDMT, 25FWT (both p < 0.001), 9HPT, CCF, and T2 lesion volume were still present (all p < 0.005) between both groups. The best multivariate model consisted of SDMT, BDI, and T2 lesion volume. CONCLUSIONS EDSS, walking ability, cognitive performance, and MRI volumetric parameters are independently associated with employment status.
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Affiliation(s)
- Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Lukas Sobisek
- Department of Statistics and Probability, University of Economics in Prague, Prague, Czech Republic
| | - Klara Novotna
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Friedova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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16
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Chen Q, Jiang H, Delgado S, Hernandez J, Alba DE, Gregori G, Rammohan KW, Porciatti V, Wang J. Longitudinal Study of Retinal Structure, Vascular, and Neuronal Function in Patients With Relapsing-Remitting Multiple Sclerosis: 1-Year Follow-Up. Transl Vis Sci Technol 2021; 10:6. [PMID: 34111252 PMCID: PMC8107487 DOI: 10.1167/tvst.10.6.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective The purpose of this study was to quantify retinal structural, vascular, and functional changes in patients with relapsing-remitting multiple sclerosis (RRMS) over 1 year. Methods Eighty-eight eyes of 44 patients with RRMS underwent assessments of low contrast letter acuity (LCLA), retinal ganglion cell function detected by the steady-state pattern electroretinogram (PERG), axonal microstructural integrity measured as birefringence, intraretinal layer thicknesses by ultra-high-resolution optical coherence tomography (OCT), volumetric vessel density (VVD) by OCT angiography, and retinal tissue perfusion (RTP) by the Retinal Function Imager (RFI). All measurements were performed at baseline and 1-year follow-up. The impacts of disease activities and a history of optic neuritis (ON) were analyzed. Results Compared to baseline, there were no significant differences in all variables (P > 0.05), except for the axonal birefringence and RTP. The birefringence's of the retinal fiber layer at the temporal and superior quadrants was significantly decreased (P < 0.05), whereas RTP was significantly increased (P < 0.05). In the subgroup with ON, significantly longer PERG latency and decreased VVD were observed at follow-up (P < 0.05). In patients with improved LCLA, significantly increased RTP and decreased VVD (P < 0.05) were also observed. Conclusions This is the first longitudinal study that assessed the RTP and VVD, along with other retinal structural and functional parameters in MS. The recovery of retinal vascular function occurred with the improved LCLA, suggesting that these measurements may be associated with disease progression. Translational Relevance The retinal microvascular changes could be potential biomarkers for monitoring therapeutic efficacy in MS.
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Affiliation(s)
- Qi Chen
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, China,Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Silvia Delgado
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jeffrey Hernandez
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diego Eduardo Alba
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kottil W. Rammohan
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vittorio Porciatti
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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17
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Jiang H, Gameiro GR, Hu H, Monsalve PF, Dong C, Hernandez J, Delgado SR, Porciatti VD, Wang J. Shortened Pattern Electroretinogram Latency and Impaired Autoregulatory Dynamics to Steady-State Stimuli in Patients With Multiple Sclerosis. J Neuroophthalmol 2021; 41:60-68. [PMID: 31977664 DOI: 10.1097/wno.0000000000000894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The steady-state pattern electroretinogram (PERG) is a sensitive measure of retinal ganglion cell (RGC) function that includes within-test progressive changes-adaptation-reflecting RGC autoregulatory dynamics. Comprehensive PERG assessment in patients with multiple sclerosis (MS) (with or without optic neuritis [ON]) may provide unique information about RGC dysfunction and its progression, as well as a comparison between functional loss and structural loss as measured by optical coherence tomography (OCT). The goal of this project was to measure steady-state PERG components and their associations with intraretinal layer thicknesses in MS. METHODS One hundred forty eyes of 70 patients with relapsing-remitting MS and 126 eyes of 63 age- and sex-matched healthy control subjects (HC) were investigated using a new-generation PERG method and ultrahigh-resolution OCT. Of MS eyes, there were 30 eyes with ON (MSON), 22 non-ON fellow eyes (MSFE), and 88 non-ON MS eyes (MSNON). PERG amplitude, phase (latency), and adaptation of amplitude and phase were measured and correlated with OCT-determined thicknesses of intraretinal layers. RESULTS The average PERG amplitude in MSON eyes was significantly lower than MSFE (P = 0.007), MSNON (P = 0.002), and HC (P < 0.001). The PERG amplitude in MSFE eyes was also significantly lower than HC (P = 0.039). The PERG latency in MSON eyes was significantly shorter than in MSFE (P = 0.001), MSNON (P = 0.002), and HC (P < 0.001). The PERG latency in MSFE (P = 0.007) and MSNON (P = 0.002) was significantly shorter than in HC. However, no significant differences were found between MSFE and MSNON (P > 0.05). PERG adaptation of amplitude in MSON was significantly lower than that in MSNON (P = 0.039) and HC (P = 0.037). Both the amplitude and latency in the MS eyes were significantly correlated with the thicknesses of the macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (GCIPL). CONCLUSIONS Shortened PERG latency and impaired autoregulatory dynamics occurred in MS, suggesting preferential dysfunction of small, slower RGC axons and decreased ability of RGC to autoregulate their gain in response to PERG stimulus. The established relations of PERG measurements with intraretinal thickness measurements suggested that PERG losses were primarily associated with GCIPL and mRNFL thinning.
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Affiliation(s)
- Hong Jiang
- Department of Ophthalmology (HJ, GRG, HH, PFM, VDP, JW), Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida; Department of Neurology (HJ, CD, JH, SRD), University of Miami, Miller School of Medicine, Miami, Florida; and Department of Ophthalmology (HH), Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
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18
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Nij Bijvank JA, Sánchez Aliaga E, Balk LJ, Coric D, Davagnanam I, Tan HS, Uitdehaag BMJ, van Rijn LJ, Petzold A. A model for interrogating the clinico-radiological paradox in multiple sclerosis: Internuclear ophthalmoplegia. Eur J Neurol 2021; 28:1617-1626. [PMID: 33426786 PMCID: PMC8248033 DOI: 10.1111/ene.14723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
Background and purpose The clinico‐radiological paradox in multiple sclerosis (MS) is well recognized, relevant and yet poorly understood. The suitability of an in vivo model for the clinico‐radiological paradox was tested, using internuclear ophthalmoplegia (INO) and the medial longitudinal fasciculus (MLF). Methods In this cross‐sectional study lesions of the MLF were rated by an experienced MS neuroradiologist blinded to all other information. The presence of an INO was objectively determined by a validated infrared oculography protocol (DEMoNS). Clinical information, including the National Eye Institute Visual Function Questionnaire, was obtained. Results This study included 202 patients with MS. The clinico‐radiological paradox occurred in 50 patients (25%). This consisted of 45 patients having an INO without an MLF lesion and five patients with an MLF lesion but without an INO. The visual function overall score was related to the presence of an INO (p = 0.016), but not to MLF lesions seen on magnetic resonance imaging (MRI) (p = 0.207). A consensus list of potential causes for the clinico‐radiological paradox was compiled and the MRI images were deposited in a repository. Conclusion This study provides an objective and quantitative model to investigate the clinico‐radiological paradox. Our data suggest that pathology of the MLF is more frequently detected and more clinically relevant by infrared oculography than by MLF lesion rating on MRI.
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Affiliation(s)
- Jenny A Nij Bijvank
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esther Sánchez Aliaga
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lisanne J Balk
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Danko Coric
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Indran Davagnanam
- National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, Moorfields Eye Hospital, UCL, London, UK
| | - H Stevie Tan
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laurentius J van Rijn
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Axel Petzold
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, Moorfields Eye Hospital, UCL, London, UK
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19
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Park SH, Park CY, Shin YJ, Jeong KS, Kim NH. Low Contrast Visual Acuity Might Help to Detect Previous Optic Neuritis. Front Neurol 2020; 11:602193. [PMID: 33414762 PMCID: PMC7783398 DOI: 10.3389/fneur.2020.602193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/09/2020] [Indexed: 01/02/2023] Open
Abstract
Optic neuritis (ON) has been considered to be an important factor in the diagnosis of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), making ON detection increasingly critical for early diagnosis. Furthermore, subclinical ONs presenting no distinct decrease in visual acuity can be missed. Low contrast visual acuity (LC-VA) is known to be able to capture visual loss not seen in conventional high-contrast visual acuity (HC-VA) in MS. Therefore, to increase the sensitivity of ON detection, we investigated the advantage of LC-VA over conventional HC-VA. One hundred and eight patients with demyelinating disease (35 MS, 73 NMOSD) with ON at least 3 months prior and 35 controls underwent neuro-ophthalmic evaluation, including best-corrected conventional high contrast visual acuity (HC-VA) and 2.5% and 1.25% low contrast visual acuity (LC-VA). Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) of various visual functions were used to determine the most relevant visual function test for the detection of optic nerve involvement. Additionally, the optimal cutoff point was obtained from the Youden index (J-index) as the points with the best sensitivity-specificity balance. When distinguishing ON from non-ON, the area under the ROC curve (AUC) was highest for the 2.5% LC-VA (0.835, P < 0.001; sensitivity 71.5%, specificity 88.6%), while it was 0.710 (P < 0.001) for the HC-VA and 0.770 (P < 0.001) for the 1.25% LC-VA. In discriminating between controls and ON, the AUC was also highest for the 2.5% LC-VA 0.754 (P < 0.001; sensitivity 71.5%, specificity 78.5%), while it was 0.719 (P < 0.001) for HC-VA and 0.688 (P < 0.001) for 1.25% LC-VA. In eyes with a history of ON (n = 137), the HC-VA and 2.5% LC-VA were abnormal in 64.2 and 71.5%, respectively (P < 0.001), with their combination detecting abnormalities in approximately 85.4% (P < 0.001). The 2.5% LC-VA was superior to HC-VA in detecting ON when distinguishing ON from non-ON or control. The 2.5% LC-VA might be a useful, feasible, and rapid method to detect ON. Furthermore, combining 2.5% LC-VA with conventional HC-VA would be better for detecting optic nerve involvements.
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Affiliation(s)
- Soo-Hyun Park
- Department of Neurology, Department of Critical Care Medicine, Department of Internal Hospital, Inha University, Incheon, South Korea
| | - Choul Yong Park
- Department of Ophthalmology, Dongguk University Ilsan Hospital and Dongguk University-Seoul Graduate School of Medicine, Goyang, South Korea
| | - Young Joo Shin
- Department of Ophthalmology, Hallym University Medical Center, Seoul, South Korea
| | - Kyoung Sook Jeong
- Department of Occupational and Environmental Medicine, Wonju Severance Hospital, Wonju, South Korea
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital and Dongguk University-Seoul Graduate School of Medicine, Goyang, South Korea
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20
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Galetta SL. Sprinting into the field of neuro-ophthalmology from the streets of Brooklyn. CEREBELLUM & ATAXIAS 2020; 7:10. [PMID: 32695429 PMCID: PMC7370262 DOI: 10.1186/s40673-020-00118-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022]
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21
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Rohowetz LJ, Vu Q, Ablabutyan L, Gratton SM, Kunjukunju N, Wallace BS, Koulen P. Microperimetry as a diagnostic tool for the detection of early, subclinical retinal damage and visual impairment in multiple sclerosis. BMC Ophthalmol 2020; 20:367. [PMID: 32917153 PMCID: PMC7488495 DOI: 10.1186/s12886-020-01620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A majority of multiple sclerosis patients experience visual impairment, often as the initial presenting symptom of the disease. While structural changes in the retinal nerve fiber layer and optic nerve have demonstrated correlations with brain atrophy in multiple sclerosis using magnetic resonance imaging, a non-invasive, cost-effective, and clinically efficacious modality to identify early damage and facilitate prompt therapeutic intervention to slow the progression of multiple sclerosis and its ocular manifestations, is still urgently needed. In this study, we sought to determine the role of macular sensitivity measured by microperimetry in the detection of subclinical multiple sclerosis-related retinal damage and visual dysfunction. METHODS This cross-sectional observational case-control study involved population-based samples of multiple sclerosis patients and age-, race-, and gender-matched healthy control subjects. Among the key criteria for the multiple sclerosis patients were diagnosis by the McDonald criteria, visual acuity greater than 20/25, and no history of optic neuritis. Macular sensitivity and average macular thickness were measured in all subjects using microperimetry and spectral-domain optical coherence tomography, respectively. Pearson correlation coefficients were measured using bivariate correlations. Sample means, mean differences, and 95% confidence intervals were calculated using independent sample t-tests. RESULTS Twenty-eight eyes from 14 MS patients and 18 eyes from 9 control subjects were included. Mean macular sensitivity of control subjects and multiple sclerosis patients in decibels was 18.2 ± 0.4 and 16.5 ± 0.4, respectively, corresponding to a mean difference of 1.7 (95% CI, 1.1-2.4; P < 0.001). Macular sensitivity was positively correlated with macular thickness in multiple sclerosis patients (r = 0.49, P = 0.01) but not control subjects (r = 0.15, P = 0.55). CONCLUSIONS Macular sensitivity as measured by microperimetry was decreased in multiple sclerosis patients with normal visual acuity and no history of optic neuritis. Furthermore, macular sensitivity demonstrated a positive correlation with macular thickness as measured by optical coherence tomography. As such, microperimetry may represent a non-invasive and efficient method to identify signs of subclinical visual dysfunction that correspond with early macular architectural changes characteristic of multiple sclerosis.
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Affiliation(s)
- Landon J Rohowetz
- Vision Research Center, Department of Ophthalmology, School of Medicine, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO, 64108, USA
| | - Qui Vu
- Vision Research Center, Department of Ophthalmology, School of Medicine, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO, 64108, USA
| | - Lilit Ablabutyan
- Vision Research Center, Department of Ophthalmology, School of Medicine, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO, 64108, USA
| | - Sean M Gratton
- Vision Research Center, Department of Ophthalmology, School of Medicine, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO, 64108, USA
| | - Nancy Kunjukunju
- Vision Research Center, Department of Ophthalmology, School of Medicine, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO, 64108, USA
| | - Billi S Wallace
- Vision Research Center, Department of Ophthalmology, School of Medicine, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO, 64108, USA.,Harry S Truman Memorial Veterans' Hospital, Department of Surgery (Ophthalmology section), 800 Hospital Drive, Columbia, MO, 65201, USA
| | - Peter Koulen
- Vision Research Center, Department of Ophthalmology, School of Medicine, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO, 64108, USA. .,Department of Biomedical Sciences, School of Medicine, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO, 64108, USA.
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22
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Ihl T, Kadas EM, Oberwahrenbrock T, Endres M, Klockgether T, Schroeter J, Brandt AU, Paul F, Minnerop M, Doss S, Schmitz-Hübsch T, Zimmermann HG. Investigation of Visual System Involvement in Spinocerebellar Ataxia Type 14. CEREBELLUM (LONDON, ENGLAND) 2020; 19:469-482. [PMID: 32338350 PMCID: PMC7351844 DOI: 10.1007/s12311-020-01130-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Spinocerebellar ataxia type 14 (SCA-PRKCG, formerly SCA14) is a rare, slowly progressive disorder caused by conventional mutations in protein kinase Cγ (PKCγ). The disease usually manifests with ataxia, but previous reports suggested PRKCG variants in retinal pathology. To systematically investigate for the first time visual function and retinal morphology in patients with SCA-PRKCG. Seventeen patients with PRKCG variants and 17 healthy controls were prospectively recruited, of which 12 genetically confirmed SCA-PRKCG patients and 14 matched controls were analyzed. We enquired a structured history for visual symptoms. Vision-related quality of life was obtained with the National Eye Institute Visual Function Questionnaire (NEI-VFQ) including the Neuro-Ophthalmic Supplement (NOS). Participants underwent testing of visual acuity, contrast sensitivity, visual fields, and retinal morphology with optical coherence tomography (OCT). Measurements of the SCA-PRKCG group were analyzed for their association with clinical parameters (ataxia rating and disease duration). SCA-PRKCG patients rate their vision-related quality of life in NEI-VFQ significantly worse than controls. Furthermore, binocular visual acuity and contrast sensitivity were worse in SCA-PRKCG patients compared with controls. Despite this, none of the OCT measurements differed between groups. NEI-VFQ and NOS composite scores were related to ataxia severity. Additionally, we describe one patient with a genetic variant of uncertain significance in the catalytic domain of PKCγ who, unlike all confirmed SCA-PRKCG, presented with a clinically silent epitheliopathy. SCA-PRKCG patients had reduced binocular vision and vision-related quality of life. Since no structural retinal damage was found, the pathomechanism of these findings remains unclear.
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Affiliation(s)
- Thomas Ihl
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ella M Kadas
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Timm Oberwahrenbrock
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matthias Endres
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site, Berlin, Germany
| | - Thomas Klockgether
- Department of Neurology, University Hospital of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Jan Schroeter
- University Tissue Bank, Cornea Bank Berlin, Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander U Brandt
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, University of California, Irvine, CA, USA
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martina Minnerop
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Sarah Doss
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurological Sciences, Movement Disorders Section, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
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23
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Nguyen J, Rothman A, Gonzalez N, Avornu A, Ogbuokiri E, Balcer LJ, Galetta SL, Frohman EM, Frohman T, Crainiceanu C, Calabresi PA, Saidha S. Macular Ganglion Cell and Inner Plexiform Layer Thickness Is More Strongly Associated With Visual Function in Multiple Sclerosis Than Bruch Membrane Opening-Minimum Rim Width or Peripapillary Retinal Nerve Fiber Layer Thicknesses. J Neuroophthalmol 2020; 39:444-450. [PMID: 30921169 DOI: 10.1097/wno.0000000000000768] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) measurements of ganglion cell + inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses are associated with visual function (VF) and disability in multiple sclerosis (MS). However, the value of measuring Bruch membrane opening-minimum rim width (BMO-MRW) thickness in MS remains unclear. METHODS Sixty-eight patients with MS and 22 healthy controls (HCs) underwent spectral domain OCT, 100%-contrast visual acuity (VA), 2.5%- and 1.25%-contrast letter acuity (LA), and Expanded Disability Status Scale (EDSS) testing. Mixed-effects linear regression models, accounting for within-subject, intereye correlations, were used to assess relationships. RESULTS The MS cohort exhibited significantly lower BMO-MRW (P = 0.01), pRNFL at 3.7-, 4.1-, and 4.7-mm diameters surrounding the optic disc (P < 0.001 for all), and GCIPL (P < 0.001) thicknesses than HCs. BMO-MRW thickness was associated with 100%-VA (P < 0.001, R = 0.08), 2.5%-LA (P < 0.001; R = 0.13), and 1.25%-LA (P = 0.002; R = 0.11). All measured pRNFL thicknesses were associated with high- and low-contrast VF (all: P < 0.001). GCIPL thickness was more strongly associated with 100%-VA (P < 0.001; R = 0.23), 2.5%-LA (P < 0.001; R = 0.27), and 1.25%-LA (P < 0.001; R = 0.21) than the other OCT measures assessed. All OCT measures were significantly, but weakly, associated with EDSS scores. CONCLUSIONS BMO-MRW and pRNFL thicknesses are reduced and associated with VF and disability in MS, but GCIPL thickness is a stronger marker of visual impairment. Our findings corroborate the utility of OCT in providing valuable information regarding the MS disease process.
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Affiliation(s)
- James Nguyen
- Department of Neurology (JN, AR, NG, AA, EO, PAC, and SS), Johns Hopkins University School of Medicine, Baltimore, Maryland; Departments of Neurology (LJB and SLG), Population Health (LJB and SLG), and Ophthalmology (LJB and SLG), New York University School of Medicine, New York, New York; Departments of Neurology (EMF and TF) and Ophthalmology (EMF and TF), Dell Medical School, University of Texas at Austin, Austin, Texas; and Department of Biostatistics (CC), Johns Hopkins University, Baltimore, Maryland
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Macaron G, Moss BP, Li H, Baldassari LE, Rao SM, Schindler D, Alberts JL, Weber M, Ayers M, Bethoux F, Boissy A, Chizmadia D, Conway DS, Fink C, Fox RJ, Gales S, Green B, Hara-Cleaver C, Jordan N, Mahajan KR, McGinley MP, Miller DM, Namey M, Rae-Grant A, Rensel M, Young H, Willis MA, Ontaneda D, Cohen JA, Bermel RA. Technology-enabled assessments to enhance multiple sclerosis clinical care and research. Neurol Clin Pract 2020; 10:222-231. [PMID: 32642324 PMCID: PMC7292568 DOI: 10.1212/cpj.0000000000000710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/19/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Comprehensive and efficient assessments are necessary for clinical care and research in chronic diseases. Our objective was to assess the implementation of a technology-enabled tool in MS practice. METHOD We analyzed prospectively collected longitudinal data from routine multiple sclerosis (MS) visits between September 2015 and May 2018. The MS Performance Test, comprising patient-reported outcome measures (PROMs) and neuroperformance tests (NPTs) self-administered using a tablet, was integrated into routine care. Descriptive statistics, Spearman correlations, and linear mixed-effect models were used to examine the implementation process and relationship between patient characteristics and completion of assessments. RESULTS A total of 8022 follow-up visits from 4199 patients (median age 49.9 [40.2-58.8] years, 32.1% progressive course, and median disease duration 13.6 [5.9-22.3] years) were analyzed. By the end of integration, the tablet version of the Timed 25-Foot Walk was obtained in 89.0% of patients and the 9-Hole Peg Test in 94.8% compared with 74.2% and 64.3%, respectively before implementation. The greatest increase in data capture occurred in processing speed and low-contrast acuity assessments (0% prior vs 78.4% and 36.7%, respectively, following implementation). Four PROMs were administered in 41%-98% of patients compared with a single depression questionnaire with a previous capture rate of 70.6%. Completion rates and time required to complete each NPT improved with subsequent visits. Younger age and lower disability scores were associated with shorter completion time and higher completion rates. CONCLUSIONS Integration of technology-enabled data capture in routine clinical practice allows acquisition of comprehensive standardized data for use in patient care and clinical research.
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Affiliation(s)
- Gabrielle Macaron
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Brandon P Moss
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Hong Li
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Laura E Baldassari
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Stephen M Rao
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - David Schindler
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Jay L Alberts
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Malory Weber
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Malissa Ayers
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - François Bethoux
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Adrienne Boissy
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Desiree Chizmadia
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Devon S Conway
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Charlene Fink
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Shauna Gales
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Bethany Green
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Claire Hara-Cleaver
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Neal Jordan
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Kedar R Mahajan
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Marisa P McGinley
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Deborah M Miller
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Marie Namey
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Alexander Rae-Grant
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Hilary Young
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Mary A Willis
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI
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Jiang H, Gameiro GR, Liu Y, Lin Y, Hernandez J, Deng Y, Gregori G, Delgado S, Wang J. Visual Function and Disability Are Associated with Increased Retinal Volumetric Vessel Density in Patients with Multiple Sclerosis. Am J Ophthalmol 2020; 213:34-45. [PMID: 31926161 DOI: 10.1016/j.ajo.2019.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The goal of this study was to determine the volumetric vessel density (VVD) in the intraretinal layers and its relationship with visual function and disability in patients with multiple sclerosis (MS). DESIGN Cross-sectional study. METHODS A total of 80 patients with relapsing-remitting MS and 99 age- and sex-matched healthy controls (HC) were recruited. The retinal microvascular network in the macular area was imaged using optical coherence tomography angiography in 123 eyes without a history of optic neuritis (ON) (MSNON) and 36 eyes with a history of ON (MSON). The VVD was calculated as the vessel densities in the retinal vascular network (RVN), superficial vascular plexus (SVP), or deep vascular plexus (DVP) of an annulus (0.6-2.5 mm in diameter), divided by the corresponding tissue volume of the intraretinal layers respectively. RESULTS The VVD of RVN and DVP in MSNON were significantly higher than in HC (P < .05). The VVD of RVN, SVP, and DVP in MSON were significantly higher than in MSNON and HC (P < .05). The VVD in both RVN and SVP were positively related to EDSS and disease duration, but negatively related to low-contrast letter acuity (P < .05). The VVD measurements were also negatively and strongly related to the corresponding tissue volumes (P < .05). CONCLUSIONS This is the first study to reveal increased retinal VVD in patients with relapsing-remitting MS. The measurements of VVD in the RVN and SVP were related to disability and visual function, which may be developed as image markers for tracking disease progression.
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Nij Bijvank J, Petzold A, Coric D, Tan H, Uitdehaag B, Balk L, van Rijn L. Saccadic delay in multiple sclerosis: A quantitative description. Vision Res 2020; 168:33-41. [DOI: 10.1016/j.visres.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
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Hu H, Jiang H, Gameiro GR, Hernandez J, Delgado S, Wang J. Focal Thickness Reduction of the Ganglion Cell-Inner Plexiform Layer Best Discriminates Prior Optic Neuritis in Patients With Multiple Sclerosis. Invest Ophthalmol Vis Sci 2020; 60:4257-4269. [PMID: 31618762 PMCID: PMC6996667 DOI: 10.1167/iovs.19-27574] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose The goal was to visualize topographic thickness maps of the intraretinal layers and evaluate their discrimination abilities and relationships with clinical manifestations in patients with multiple sclerosis (MS) and a history of optic neuritis (ON). Methods Thirty patients with relapsing-remitting MS (34 eyes with a history of ON [MSON] and 26 non-ON fellow eyes [MSFE]) were recruited together with 63 age- and sex-matched controls (HC). Ultrahigh resolution optical coherence tomography was used to image the macula and the volumetric data set was segmented to yield six intraretinal layers. Topographic thickness maps were aligned and averaged for the visualization. The thickness maps were partitioned using the Early Treatment Diabetic Retinopathy Study (ETDRS) and related to Sloan low-contrast letter acuity (LCLA), Expanded Disability Status Scale (EDSS), and disease duration. Results Focal thickness reduction occurred in the macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (GCIPL), with the most profound reduction occurring in MSON eyes (P < 0.05). A horseshoe-like thickness reduction pattern (U Zone) in the GCIPL appeared in MSON. The thickness of the U Zone had better discrimination power than the ETDRS partitions (area under the curve = 0.97) and differentiated 96% of MSON from HC. The thickness of the U Zone was positively correlated to 2.5% LCLA (r = 0.38, P < 0.05) and 1.25% LCLA (r = 0.57, P < 0.05). Conclusions The horseshoe-like thickness reduction of the GCIPL appeared to be an ON-specific focal thickness alteration with the highest discrimination power of prior ON.
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Affiliation(s)
- Huiling Hu
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China.,Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Giovana Rosa Gameiro
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jeffrey Hernandez
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Silvia Delgado
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
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Zhang Y, Taylor BV, Simpson S, Blizzard L, Palmer AJ, van der Mei I. Validation of 0-10 MS symptom scores in the Australian multiple sclerosis longitudinal study. Mult Scler Relat Disord 2019; 39:101895. [PMID: 31884383 DOI: 10.1016/j.msard.2019.101895] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/26/2019] [Accepted: 12/14/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) symptom measurements often use multiple-item scales per symptom, creating a high burden when multiple symptoms are assessed. We aimed to examine the validity, stability and responsiveness of single-item 0-10 numeric rating MS Symptom Scores (MSSymS). METHODS The study included 1,985 participants from the Australian Multiple Sclerosis Longitudinal Study. Thirteen MS symptoms were assessed using the MSSymS, of which we were able to validate six (walking difficulties, fatigue, pain, feelings of anxiety, feelings of depression and vision problems). Comparison measures included Patient Determined Disease Steps (PDDS), Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), and Assessment of Quality of Life (AQoL). We used spearman rank correlation for concurrent validity, linear regression for predictive validity, intra-class correlations for stability, and percentage change for responsiveness. RESULTS We found high correlations between walking difficulties and PDDS (r = 0.82), pain and AQoL-pain (r = 0.77), fatigue and FSS (r = 0.72); moderate correlations between feelings of anxiety and HADS-Anxiety (r = 0.68), feelings of depression and HADS-Depression (r = 0.63); and low correlation between vision and AQoL-vision (r = 0.43) For predictive validity, the graphs with quality of life were largely overlapping and the R2 of the regression lines were generally similar. The stability and responsiveness of the MSSymS were adequate. CONCLUSION The six assessed symptoms of the MSSymS performed equally well compared to validated comparison measures in terms of concurrent and predictive validity, temporal stability and responsiveness.
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Affiliation(s)
- Yan Zhang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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Baldassari LE, Nakamura K, Moss BP, Macaron G, Li H, Weber M, Jones SE, Rao SM, Miller D, Conway DS, Bermel RA, Cohen JA, Ontaneda D, McGinley MP. Technology-enabled comprehensive characterization of multiple sclerosis in clinical practice. Mult Scler Relat Disord 2019; 38:101525. [PMID: 31759186 DOI: 10.1016/j.msard.2019.101525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/08/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Objective and longitudinal measurements of disability in patients with multiple sclerosis (MS) are desired in order to monitor disease status and response to disease-modifying and symptomatic therapies. Technology-enabled comprehensive assessment of MS patients, including neuroperformance tests (NPTs), patient-reported outcome measures (PROMs), and MRI, is incorporated into clinical care at our center. The relationships of each NPT with PROMs and MRI measures in a real-world setting are incompletely studied, particularly in larger datasets. OBJECTIVES To demonstrate the utility of comprehensive neurological assessment and determine the association between NPTs, PROMs, and quantitative MRI measures in a large MS clinical cohort. METHODS NPTs (processing speed [PST], contrast sensitivity [CST], manual dexterity [MDT], and walking speed [WST]) and physical disability-related PROMs (Quality of Life in Neurological Disorders [Neuro-QoL], Patient Determined Disease Steps [PDDS], and Patient-Reported Outcomes Measurement Information System Global-10 [PROMIS-10] physical) were collected as part of routine clinical care. Fully-automated MRI analysis calculated T2-lesion volume (T2LV), whole brain fraction (WBF), thalamic volume (TV), and cervical spinal cord cross-sectional area (CA) for brain MRIs completed within 3 months of a clinic visit during which NPTs and PROMs were assessed. Spearman's rank correlation coefficients evaluated the cross-sectional associations of NPTs with PROMs and MRI measures. Linear regression was utilized to determine which combination of clinical characteristics, patient demographics, MRI measures, and PROMs best cross-sectionally explained each NPT result. RESULTS 997 unique patients (age 47.7 ± 11.4 years, 71.8% female) who underwent assessments over a 2-year period were included. Correlations among NPTs and PROMs were moderate. PST correlations were strongest for Neuro-QoL upper extremity (NQ-UE) (Spearman's rho = 0.43) and lower extremity (NQ-LE) (0.47). CST correlations were strongest for NQ-UE (0.33), NQ-LE (0.36), and PDDS (-0.31). MDT correlations were strongest for NQ-UE (-0.53), NQ-LE (-0.54), and PDDS (0.53). WST correlations were strongest for PDDS (0.64) and NQ-LE (-0.65). NPTs also had moderate correlations with MRI metrics, the strongest of which were observed with PST (with T2LV (-0.44) and WBF (0.49)). Spearman's rho for other NPT-MRI correlations ranged from 0.23 to 0.36. Linear regression identified age, disease duration, PROMIS-10 physical, NQ-UE, NQ-LE, T2LV and WBF as significant cross-sectional explanatory variables for PST (adjusted R2=0.46). For CST, significant variables included age and NQ-LE (adjusted R2 = 0.30). For MDT, significant variables included PDDS, PROMIS-10 physical, NQ-UE, NQ-LE, T2LV, and WBF (adjusted R2=0.37). For WST, significant variables included sex, PDDS, NQ-LE, T2LV, and CA (adjusted R2=0.39). CONCLUSIONS Impaired performance on NPTs correlated with worse physical disability-related PROMs and MRI disease severity, but the strongest cross-sectional explanatory variables for each NPT component varied. This study supports the use of comprehensive, objective quantification of MS status in clinical and research settings. Future longitudinal analyses can determine predictors of treatment response and disability worsening.
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Affiliation(s)
- Laura E Baldassari
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Kunio Nakamura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Brandon P Moss
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Gabrielle Macaron
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Hong Li
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Malory Weber
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Stephen E Jones
- Imaging Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Stephen M Rao
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, United States
| | - Deborah Miller
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Devon S Conway
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Marisa P McGinley
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States.
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Morrow SA, Fraser JA, Day C, Bowman D, Rosehart H, Kremenchutzky M, Nicolle M. Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids: A Randomized Clinical Trial. JAMA Neurol 2019; 75:690-696. [PMID: 29507942 DOI: 10.1001/jamaneurol.2018.0024] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Intravenous (IV) administration of corticosteroids is the standard of care in the treatment of acute optic neuritis. However, it is uncertain whether a bioequivalent dose of corticosteroid administered orally, which may be more cost-efficient and convenient for patients, is as effective as IV administration in the treatment of acute optic neuritis. Objective To determine whether recovery of vision following treatment of acute optic neuritis with a high-dose IV corticosteroid is superior to that with a bioequivalent dose of an oral corticosteroid. Design, Setting, and Participants This single-blind (participants unblinded) randomized clinical trial with 6-month follow-up was conducted at a single tertiary care center in London, Ontario, Canada. Participants were enrolled from March 2012 to May 2015, with the last participant's final visit occurring November 2015. Patients 18 to 64 years of age presenting within 14 days of acute optic neuritis onset, without any recovery at time of randomization and without history of optic neuritis in the same eye, were screened. Inclusion criteria included best-corrected visual acuity (BCVA) of 20/40 or worse and corticosteroids deemed required by treating physician. In total, 89 participants were screened; 64 were eligible, but 9 declined to participate. Thus, 55 participants were enrolled and randomized. Primary analysis was unadjusted and according to the intention-to-treat principle. Interventions Participants were randomized 1:1 to the IV methylprednisolone sodium succinate (1000-mg) or oral prednisone (1250-mg) group. Main Outcomes and Measures Primary outcome was recovery of the latency of the P100 component of the visual evoked potential at 6 months. Secondary outcomes were the P100 latency at 1 month and BCVA as assessed with Early Treatment Diabetic Retinopathy Study letter scores on the alphabet chart and scores on low-contrast letters at 1 and 6 months. Results Of 55 randomized participants, the final analyzed cohort comprised 23 participants in the IV and 22 in the oral treatment groups. The mean (SD) age of the cohort was 34.6 (9.5) years, and there were 28 women (62.2%). At 6 months' recovery, P100 latency in the IV group improved by 62.9 milliseconds (from a mean [SD] of 181.9 [53.6] to 119.0 [16.5] milliseconds), and the oral group improved by 66.7 milliseconds (from a mean [SD] of 200.5 [67.2] to 133.8 [31.5] milliseconds), with no significant difference between groups (P = .07). Similarly, no significant group difference was found in the mean P100 latency recovery at 1 month. For BCVA, recovery between the groups did not reach statistical significance at 1 month or 6 months. In addition, improvements in low-contrast (1.25% and 2.5%) BCVA were not significantly different between treatment groups at 1 or 6 months' recovery. Conclusions and Relevance This study finds that bioequivalent doses of oral corticosteroids may be used as an alternative to IV corticosteroids to treat acute optic neuritis. Trial Registration clinicaltrials.gov Identifier: NCT01524250.
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Affiliation(s)
- Sarah A Morrow
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
| | - J Alexander Fraser
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada.,Department of Ophthalmology, Western University, London, Ontario, Canada
| | - Chad Day
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
| | - Denise Bowman
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
| | - Heather Rosehart
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
| | - Marcelo Kremenchutzky
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Nicolle
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
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Nij Bijvank JA, Petzold A, Coric D, Tan HS, Uitdehaag BMJ, Balk LJ, van Rijn LJ. Quantification of Visual Fixation in Multiple Sclerosis. Invest Ophthalmol Vis Sci 2019; 60:1372-1383. [PMID: 30938772 DOI: 10.1167/iovs.18-26096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Eye movement abnormalities are common in multiple sclerosis (MS), and infrared oculography is a noninvasive method for quantification. This study aims to describe and classify abnormalities of visual fixation and their clinical relevance in MS. Methods A validated standardized infrared oculography protocol, Demonstrate Eye Movement Networks with Saccades, was used for quantifying gaze stability during a fixation task in MS patients and healthy controls. Saccadic intrusions, gaze drift, and stability of fixation around the drift line were used to subclassify MS patients by performing receiver operating characteristic analyses of different parameters. The relationship between the presence of abnormalities of fixation and visual functioning was analyzed using logistic regression models, which was adjusted for possible confounders. Results This cross-sectional study included 213 subjects with MS and 57 healthy controls. Square wave jerk abnormalities were present in 24% of MS patients. The prevalence was higher in more disabled subjects. The presence of larger square wave jerks (with a higher amplitude) in the MS patients was related to complaints of focusing on stationary objects (odds ratio, 2.2; P = 0.035) and a lower vision-related quality of life (odds ratio, 2.56; P = 0.012). Conclusions This study provided a comprehensive overview of the characteristics of problems with visual fixation in subjects with MS. The most important and most common finding was the presence of larger square wave jerks during fixation, which was related to visual functioning in daily life.
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Affiliation(s)
- Jenny A Nij Bijvank
- Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Multiple Sclerosis Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - Axel Petzold
- Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Multiple Sclerosis Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands.,Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery, the University College London Institute of Neurology, London, United Kingdom
| | - Danko Coric
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Multiple Sclerosis Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - H Stevie Tan
- Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Multiple Sclerosis Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - Lisanne J Balk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Multiple Sclerosis Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - Laurentius J van Rijn
- Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands.,Onze Lieve Vrouwe Gasthuis, Department of Ophthalmology, Amsterdam, The Netherlands
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Shi C, Jiang H, Gameiro GR, Hu H, Hernandez J, Delgado S, Wang J. Visual Function and Disability Are Associated With Focal Thickness Reduction of the Ganglion Cell-Inner Plexiform Layer in Patients With Multiple Sclerosis. Invest Ophthalmol Vis Sci 2019; 60:1213-1223. [PMID: 30913293 PMCID: PMC6892386 DOI: 10.1167/iovs.18-25809] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose The purpose of this study was to visualize the topographic thickness patterns of the intraretinal layers and their associations with clinical manifestations in patients with multiple sclerosis (MS). Methods Ninety-four eyes of 47 relapsing-remitting MS patients without history of optic neuritis were imaged using optical coherence tomography and compared with 134 eyes of 67 healthy subjects. Volumetric data centered on the fovea were segmented to obtain the thickness maps of six intraretinal layers. The thickness measurements partitioned using the Early Treatment Diabetic Retinopathy Study (ETDRS) partition were correlated to the Expanded Disability State Scale (EDSS) and Sloan low contrast visual acuity (LCVA). The receiver-operating characteristics (ROC) curves were calculated to obtain the area under the ROC curves (AUCs). Results The ganglion cell-inner plexiform layer (GCIPL) showed horseshoe-like thickness reduction profoundly at the nasal sector. The most profound thickness reduction zone (circular area, diameter = 1 mm) was located at 2 mm in the nasal sector and 0.4 mm inferior from the fovea, named the “M zone.” The thickness reduction of the M zone was −7.3 μm in MS eyes, which was the most profound alteration, compared to any ETDRS sectors. The AUC of the M zone was 0.75. The relationship between the thickness of the M zone and EDSS (r = −0.59, P < 0.001) or 2.5% LCVA (r = 0.51, P < 0.001) were ranked as the strongest relation compared to any ETDRS sectors. Conclusions This is the first study, to our knowledge, to visualize focal thickness alteration of GCIPL and reveal its relationship to visual function and disability in patients with MS without history of optic neuritis.
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Affiliation(s)
- Ce Shi
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Giovana Rosa Gameiro
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Huiling Hu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Jeffrey Hernandez
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Silvia Delgado
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
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Macaron G, Ontaneda D. Diagnosis and Management of Progressive Multiple Sclerosis. Biomedicines 2019; 7:E56. [PMID: 31362384 PMCID: PMC6784028 DOI: 10.3390/biomedicines7030056] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022] Open
Abstract
Multiple sclerosis is a chronic autoimmune disease of the central nervous system that results in varying degrees of disability. Progressive multiple sclerosis, characterized by a steady increase in neurological disability independently of relapses, can occur from onset (primary progressive) or after a relapsing-remitting course (secondary progressive). As opposed to active inflammation seen in the relapsing-remitting phases of the disease, the gradual worsening of disability in progressive multiple sclerosis results from complex immune mechanisms and neurodegeneration. A few anti-inflammatory disease-modifying therapies with a modest but significant effect on measures of disease progression have been approved for the treatment of progressive multiple sclerosis. The treatment effect of anti-inflammatory agents is particularly observed in the subgroup of patients with younger age and evidence of disease activity. For this reason, a significant effort is underway to develop molecules with the potential to induce myelin repair or halt the degenerative process. Appropriate trial methodology and the development of clinically meaningful disability outcome measures along with imaging and biological biomarkers of progression have a significant impact on the ability to measure the efficacy of potential medications that may reverse disease progression. In this issue, we will review current evidence on the physiopathology, diagnosis, measurement of disability, and treatment of progressive multiple sclerosis.
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Affiliation(s)
- Gabrielle Macaron
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Evolution of Visual Outcomes in Clinical Trials for Multiple Sclerosis Disease-Modifying Therapies. J Neuroophthalmol 2019; 38:202-209. [PMID: 29750734 DOI: 10.1097/wno.0000000000000662] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
: BACKGROUND:: The visual pathways are increasingly recognized as an ideal model to study neurodegeneration in multiple sclerosis (MS). Low-contrast letter acuity (LCLA) and optical coherence tomography (OCT) are validated measures of function and structure in MS. In fact, LCLA was the topic of a recent review by the Multiple Sclerosis Outcome Assessments Consortium (MSOAC) to qualify this visual measure as a primary or secondary clinical trial endpoint with the Food and Drug Administration (FDA) and other regulatory agencies. This review focuses on the use of LCLA and OCT measures as outcomes in clinical trials to date of MS disease-modifying therapies. METHODS A Pubmed search using the specific key words "optical coherence tomography," "low-contrast letter acuity," "multiple sclerosis," and "clinical trials" was performed. An additional search on the clinicaltrials.gov website with the same key words was used to find registered clinical trials of MS therapies that included these visual outcome measures. RESULTS As demonstrated by multiple clinical trials, LCLA and OCT measures are sensitive to treatment effects in MS. LCLA has been used in many clinical trials to date, and findings suggest that 7 letters of LCLA at the 2.5% contrast level are meaningful change. Few clinical trials using the benefits of OCT have been performed, although results of observational studies have solidified the ability of OCT to assess change in retinal structure. Continued accrual of clinical trial and observational data is needed to validate the use of OCT in clinical trials, but preliminary work suggests that an intereye difference in retinal nerve fiber layer thickness of 5-6 μm is a clinically meaningful threshold that identifies an optic nerve lesion in MS. CONCLUSIONS Visual impairment represents a significant component of overall disability in MS. LCLA and OCT enhance the detection of visual pathway injury and can be used as measures of axonal and neuronal integrity. Continued investigation is ongoing to further incorporate these vision-based assessments into clinical trials of MS therapies.
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Saccadic fatigability in the oculomotor system. J Neurol Sci 2019; 402:167-174. [DOI: 10.1016/j.jns.2019.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/29/2019] [Accepted: 05/20/2019] [Indexed: 11/17/2022]
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Liu Y, Delgado S, Jiang H, Lin Y, Hernandez J, Deng Y, Gameiro GR, Wang J. Retinal Tissue Perfusion in Patients with Multiple Sclerosis. Curr Eye Res 2019; 44:1091-1097. [PMID: 31046490 DOI: 10.1080/02713683.2019.1612444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: The goal of this work was to determine whether the retinal tissue perfusion (RTP) is impaired in patients with multiple sclerosis (MS). Methods: Seventy-four patients [66 relapsing-remitting MS (RRMS) and 8 clinically isolated syndrome (CIS)] and 74 age- and gender-matched healthy controls were recruited. RTP was calculated as the retinal blood flow (measured using retinal function imager) supplying the macular area divided by the corresponding tissue volume of the inner retina from the inner limiting membrane to the outer plexiform layer, as measured by ultrahigh-resolution optical coherence tomography. Results: The RTP in the MS group was 2.37 ± 0.59 nl/s/mm3 (mean ± standard deviation), which was significantly lower than the control group (4.06 ± 0.89 nl/s/mm3, P < .001), reflecting a decrease of 42%. The blood flow volume was 2.50 ± 0.50 nl/s in MS, which was 45% lower than in the control group (4.56 ± 0.91 nl/s, P < .001). In addition, the tissue volume of the inner retina was significantly lower than in the control group (P < .05). The RTP in patients with MS was significantly correlated with the retinal blood flow volume (r = 0.84, P < .001) and retinal tissue volume (r = -0.56, P < .001). However, the retinal blood flow in patients with MS was not related to the tissue volume (r = -0.06, P = .59). Conclusions: Impaired retinal tissue perfusion occurred in patients with MS, which could be developed as a possible biomarker in monitoring disease progression in MS.
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Affiliation(s)
- Yi Liu
- Department of Ophthalmology, Third Affiliated Hospital of Nanjing University of Chinese Medicine , Nanjing , China.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Silvia Delgado
- MS Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Hong Jiang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA.,MS Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Ying Lin
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , Guangdong , China
| | - Jeffrey Hernandez
- MS Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Yuqing Deng
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , Guangdong , China
| | - Giovana Rosa Gameiro
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
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Nij Bijvank JA, van Rijn LJ, Balk LJ, Tan HS, Uitdehaag BMJ, Petzold A. Diagnosing and quantifying a common deficit in multiple sclerosis: Internuclear ophthalmoplegia. Neurology 2019; 92:e2299-e2308. [PMID: 31004067 PMCID: PMC6598816 DOI: 10.1212/wnl.0000000000007499] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/15/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We present an objective and quantitative approach for diagnosing internuclear ophthalmoplegia (INO) in multiple sclerosis (MS). METHODS A validated standardized infrared oculography protocol (DEMoNS [Demonstrate Eye Movement Networks with Saccades]) was used for quantifying prosaccades in patients with MS and healthy controls (HCs). The versional dysconjugacy index (VDI) was calculated, which describes the ratio between the abducting and adducting eye. The VDI was determined for peak velocity, peak acceleration, peak velocity divided by amplitude, and area under the curve (AUC) of the saccadic trajectory. We calculated the diagnostic accuracy for the several VDI parameters by a receiver operating characteristic analysis comparing HCs and patients with MS. The National Eye Institute Visual Function Questionnaire-25 was used to investigate vision-related quality of life of MS patients with INO. RESULTS Two hundred ten patients with MS and 58 HCs were included. The highest diagnostic accuracy was achieved by the VDI AUC of 15° horizontal prosaccades. Based on a combined VDI AUC and peak velocity divided by amplitude detection, the prevalence of an INO in MS calculated to 34%. In the INO group, 35.2% of the patients with MS reported any complaints of double vision, compared to 18.4% in the non-INO group (p = 0.010). MS patients with an INO had a lower overall vision-related quality of life (median 89.9, interquartile range 12.8) compared to patients without an INO (median 91.8, interquartile range 9.3, p = 0.011). CONCLUSIONS This study provides an accurate quantitative and clinically relevant definition of an INO in MS. This infrared oculography-based INO standard will require prospective validation. The high prevalence of INO in MS provides an anatomically well described and accurately quantifiable model for treatment trials in MS.
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Affiliation(s)
- J A Nij Bijvank
- From Amsterdam UMC (J.A.N.B., L.J.B., A.P.), Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Amsterdam UMC (J.A.N.B., L.J.v.R., H.S.T., A.P.), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Onze Lieve Vrouwe Gasthuis (L.J.v.R., B.M.J.U.), Department of Ophthalmology, Amsterdam, the Netherlands; and Moorfields Eye Hospital and the National Hospital for Neurology and Neurosurgery (A.P.), London, UK.
| | - L J van Rijn
- From Amsterdam UMC (J.A.N.B., L.J.B., A.P.), Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Amsterdam UMC (J.A.N.B., L.J.v.R., H.S.T., A.P.), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Onze Lieve Vrouwe Gasthuis (L.J.v.R., B.M.J.U.), Department of Ophthalmology, Amsterdam, the Netherlands; and Moorfields Eye Hospital and the National Hospital for Neurology and Neurosurgery (A.P.), London, UK
| | - L J Balk
- From Amsterdam UMC (J.A.N.B., L.J.B., A.P.), Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Amsterdam UMC (J.A.N.B., L.J.v.R., H.S.T., A.P.), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Onze Lieve Vrouwe Gasthuis (L.J.v.R., B.M.J.U.), Department of Ophthalmology, Amsterdam, the Netherlands; and Moorfields Eye Hospital and the National Hospital for Neurology and Neurosurgery (A.P.), London, UK
| | - H S Tan
- From Amsterdam UMC (J.A.N.B., L.J.B., A.P.), Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Amsterdam UMC (J.A.N.B., L.J.v.R., H.S.T., A.P.), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Onze Lieve Vrouwe Gasthuis (L.J.v.R., B.M.J.U.), Department of Ophthalmology, Amsterdam, the Netherlands; and Moorfields Eye Hospital and the National Hospital for Neurology and Neurosurgery (A.P.), London, UK
| | - B M J Uitdehaag
- From Amsterdam UMC (J.A.N.B., L.J.B., A.P.), Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Amsterdam UMC (J.A.N.B., L.J.v.R., H.S.T., A.P.), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Onze Lieve Vrouwe Gasthuis (L.J.v.R., B.M.J.U.), Department of Ophthalmology, Amsterdam, the Netherlands; and Moorfields Eye Hospital and the National Hospital for Neurology and Neurosurgery (A.P.), London, UK
| | - A Petzold
- From Amsterdam UMC (J.A.N.B., L.J.B., A.P.), Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Amsterdam UMC (J.A.N.B., L.J.v.R., H.S.T., A.P.), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam; Onze Lieve Vrouwe Gasthuis (L.J.v.R., B.M.J.U.), Department of Ophthalmology, Amsterdam, the Netherlands; and Moorfields Eye Hospital and the National Hospital for Neurology and Neurosurgery (A.P.), London, UK
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Papadopoulou A, Gaetano L, Pfister A, Altermatt A, Tsagkas C, Morency F, Brandt AU, Hardmeier M, Chakravarty MM, Descoteaux M, Kappos L, Sprenger T, Magon S. Damage of the lateral geniculate nucleus in MS: Assessing the missing node of the visual pathway. Neurology 2019; 92:e2240-e2249. [PMID: 30971483 DOI: 10.1212/wnl.0000000000007450] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/10/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study if the thalamic lateral geniculate nucleus (LGN) is affected in multiple sclerosis (MS) due to anterograde degeneration from optic neuritis (ON) or retrograde degeneration from optic radiation (OR) pathology, and if this is relevant for visual function. METHODS In this cross-sectional study, LGN volume of 34 patients with relapsing-remitting MS and 33 matched healthy controls (HC) was assessed on MRI using atlas-based automated segmentation (MAGeT). ON history, thickness of the ganglion cell-inner plexiform layer (GC-IPL), OR lesion volume, and fractional anisotropy (FA) of normal-appearing OR (NAOR-FA) were assessed as measures of afferent visual pathway damage. Visual function was tested, including low-contrast letter acuity (LCLA) and Hardy-Rand-Rittler (HRR) plates for color vision. RESULTS LGN volume was reduced in patients vs HC (165.5 ± 45.5 vs 191.4 ± 47.7 mm3, B = -25.89, SE = 5.83, p < 0.001). It was associated with GC-IPL thickness (B = 0.95, SE = 0.33, p = 0.006) and correlated with OR lesion volume (Spearman ρ = -0.53, p = 0.001), and these relationships remained after adjustment for normalized brain volume. There was no association between NAOR-FA and LGN volume (B = -133.28, SE = 88.47, p = 0.137). LGN volume was not associated with LCLA (B = 5.5 × 10-5, SE = 0.03, p = 0.998), but it correlated with HRR color vision (ρ = 0.39, p = 0.032). CONCLUSIONS LGN volume loss in MS indicates structural damage with potential functional relevance. Our results suggest both anterograde degeneration from the retina and retrograde degeneration from the OR lesions as underlying causes. LGN volume is a promising marker reflecting damage of the visual pathway in MS, with the advantage of individual measurement per patient on conventional MRI.
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Affiliation(s)
- Athina Papadopoulou
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland.
| | - Laura Gaetano
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Armanda Pfister
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Anna Altermatt
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Charidimos Tsagkas
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Felix Morency
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Alexander U Brandt
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Martin Hardmeier
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Mallar M Chakravarty
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Maxime Descoteaux
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Ludwig Kappos
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Till Sprenger
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
| | - Stefano Magon
- From the Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, and Biomedical Engineering (A. Papadopoulou, L.G., A. Pfister, C.T., M.H., L.K., T.S., S.M.), and Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering (A. Papadopoulou, L.G., A.A., C.T., S.M.), University Hospital Basel and University of Basel, Switzerland; NeuroCure Clinical Research Center (NCRC) (A. Papadopoulou, A.U.B.), and Experimental and Clinical Research Center (A. Papadopoulou, A.U.B.), Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Image Analysis Center (MIAC) (L.G., A.A., C.T., S.M.), Basel, Switzerland; Imeka Solutions (F.M.), Sherbrooke, Canada; Department of Neurology (A.U.B.), University of California Irvine; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health University Institute; Departments of Psychiatry and Biomedical Engineering (M.M.C.), McGill University, Montreal; University of Sherbrooke (M.D.), Canada; and Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany. The present address for L.G. is F. Hoffmann-La Roche, Basel, Switzerland
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Seay M, Akhand O, Galetta MS, Cobbs L, Hasanaj L, Amorapanth P, Rizzo JR, Nolan R, Serrano L, Rucker JC, Galetta SL, Balcer LJ. Mobile Universal Lexicon Evaluation System (MULES) in MS: Evaluation of a new visual test of rapid picture naming. J Neurol Sci 2018; 394:1-5. [PMID: 30193154 DOI: 10.1016/j.jns.2018.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/02/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The Mobile Universal Lexicon Evaluation System (MULES) is a test of rapid picture naming that is under investigation for concussion. MULES captures an extensive visual network, including pathways for eye movements, color perception, memory and object recognition. The purpose of this study was to introduce the MULES to visual assessment of patients with MS, and to examine associations with other tests of afferent and efferent visual function. METHODS We administered the MULES in addition to binocular measures of low-contrast letter acuity (LCLA), high-contrast visual acuity (VA) and the King-Devick (K-D) test of rapid number naming in an MS cohort and in a group of disease-free controls. RESULTS Among 24 patients with MS (median age 36 years, range 20-72, 64% female) and 22 disease-free controls (median age 34 years, range 19-59, 57% female), MULES test times were greater (worse) among the patients (60.0 vs. 40.0 s). Accounting for age, MS vs. control status was a predictor of MULES test times (P = .01, logistic regression). Faster testing times were noted among patients with MS who had greater (better) performance on binocular LCLA at 2.5% contrast (P < .001, linear regression, accounting for age), binocular high-contrast VA (P < .001), and K-D testing (P < .001). Both groups demonstrated approximately 10-s improvements in MULES test times between trials 1 and 2 (P < .0001, paired t-tests). CONCLUSION The MULES test, a complex task of rapid picture naming involves an extensive visual network that captures eye movements, color perception and the characterization of objects. Color recognition, a key component of this novel assessment, is early in object processing and requires area V4 and the inferior temporal projections. MULES scores reflect performance of LCLA, a widely-used measure of visual function in MS clinical trials. These results provide evidence that the MULES test can add efficient visual screening to the assessment of patients with MS.
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Affiliation(s)
- Meagan Seay
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA.
| | - Omar Akhand
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA.
| | - Matthew S Galetta
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA.
| | - Lucy Cobbs
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA.
| | - Lisena Hasanaj
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA.
| | - Prin Amorapanth
- Physical Medicine and Rehabilitation, New York University School of Medicine, New York, NY, USA.
| | - John-Ross Rizzo
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA; Physical Medicine and Rehabilitation, New York University School of Medicine, New York, NY, USA.
| | - Rachel Nolan
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA.
| | - Liliana Serrano
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA.
| | - Janet C Rucker
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA; Ophthalmology, New York University School of Medicine, New York, NY, USA.
| | - Steven L Galetta
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA; Ophthalmology, New York University School of Medicine, New York, NY, USA.
| | - Laura J Balcer
- Departments of Neurolog, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA; Ophthalmology, New York University School of Medicine, New York, NY, USA.
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Dale GH, Petersen T, Bacher Svendsen K, Christensen T, Houen G, Bek T. Time to steroid treatment in severe acute optic neuritis. Brain Behav 2018; 8:e01032. [PMID: 29931830 PMCID: PMC6085902 DOI: 10.1002/brb3.1032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Steroid treatment can accelerate visual recovery in patients with optic neuritis (ON), but it is unknown whether the timing of the start of treatment influences the outcome. The main purpose of this observational study was to assess the effect of early onset steroid treatment of ON on visual prognosis and retinal morphology. METHODS Forty-nine patients with acute mild/moderate (n = 21) or severe (n = 28) ON, and an equal number of healthy controls were enrolled. Patients with severe ON either received early onset steroid treatment (initiated within 1 week of presentation with visual loss) (n = 9), late-onset treatment (initiated after 1 week) (n = 13), or no treatment (n = 6). Visual function and retinal morphology was studied after 6 and 12 months. RESULTS All measures of visual function had improved after 6 months (p ≤ 0.03) in the three groups with severe ON. This was not the case for Rayleigh match setting range (SR) in the nontreated group (p = 0.24), or for SR (p = 0.08) and latency to P100 of visual evoked potential (p = 0.08) in the late-onset treated group. After 12 months, further improvement occurred in the nontreated and late-treated groups, but not in the early treated group. Macular retinal nerve fiber layer (mRNFL) and ganglion cell plus inner plexiform layer had decreased significantly (p ≤ 0.001) in all three groups with severe ON after 6 months. After 12 months, only mRNFL had further significantly decreased and only in the late-onset treated group (p = 0.02). CONCLUSION The beneficial effects of early onset steroid treatment of ON is limited to a few months whereas the long-term prognosis is independent of the timing of treatment.
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Affiliation(s)
- Gro Helen Dale
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Thor Petersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Gunnar Houen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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Treatment of progressive multiple sclerosis: Challenges and promising perspectives. Rev Neurol (Paris) 2018; 174:441-448. [DOI: 10.1016/j.neurol.2018.01.370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/04/2018] [Indexed: 11/21/2022]
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De Angelis F, Plantone D, Chataway J. Pharmacotherapy in Secondary Progressive Multiple Sclerosis: An Overview. CNS Drugs 2018; 32:499-526. [PMID: 29968175 DOI: 10.1007/s40263-018-0538-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Multiple sclerosis is an immune-mediated inflammatory disease of the central nervous system characterised by demyelination, neuroaxonal loss and a heterogeneous clinical course. Multiple sclerosis presents with different phenotypes, most commonly a relapsing-remitting course and, less frequently, a progressive accumulation of disability from disease onset (primary progressive multiple sclerosis). The majority of people with relapsing-remitting multiple sclerosis, after a variable time, switch to a stage characterised by gradual neurological worsening known as secondary progressive multiple sclerosis. We have a limited understanding of the mechanisms underlying multiple sclerosis, and it is believed that multiple genetic, environmental and endogenous factors are elements driving inflammation and ultimately neurodegeneration. Axonal loss and grey matter damage have been regarded as amongst the leading causes of irreversible neurological disability in the progressive stages. There are over a dozen disease-modifying therapies currently licenced for relapsing-remitting multiple sclerosis, but none of these has provided evidence of effectiveness in secondary progressive multiple sclerosis. Recently, there has been some early modest success with siponimod in secondary progressive multiple sclerosis and ocrelizumab in primary progressive multiple sclerosis. Finding treatments to delay or prevent the courses of secondary progressive multiple sclerosis is an unmet and essential goal of the research in multiple sclerosis. In this review, we discuss new findings regarding drugs with immunomodulatory, neuroprotective or regenerative properties and possible treatment strategies for secondary progressive multiple sclerosis. We examine the field broadly to include trials where participants have progressive or relapsing phenotypes. We summarise the most relevant results from newer investigations from phase II and III randomised controlled trials over the past decade, with particular attention to the last 5 years.
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Affiliation(s)
- Floriana De Angelis
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK.
| | - Domenico Plantone
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
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The value of tests evaluating visual functions in detecting overt or subclinical optic neuritis in multiple sclerosis. Mult Scler Relat Disord 2018; 21:63-68. [PMID: 29471193 DOI: 10.1016/j.msard.2018.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 01/13/2018] [Accepted: 01/30/2018] [Indexed: 11/22/2022]
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Højsgaard Chow H, Schreiber K, Magyari M, Ammitzbøll C, Börnsen L, Romme Christensen J, Ratzer R, Soelberg Sørensen P, Sellebjerg F. Progressive multiple sclerosis, cognitive function, and quality of life. Brain Behav 2018; 8:e00875. [PMID: 29484253 PMCID: PMC5822575 DOI: 10.1002/brb3.875] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 09/22/2017] [Accepted: 10/10/2017] [Indexed: 01/18/2023] Open
Abstract
Background Patients with progressive multiple sclerosis (MS) often have cognitive impairment in addition to physical impairment. The burden of cognitive and physical impairment progresses over time, and may be major determinants of quality of life. The aim of this study was to assess to which degree quality of life correlates with physical and cognitive function in progressive MS. Methods This is a retrospective study of 52 patients with primary progressive (N = 18) and secondary progressive MS (N = 34). Physical disability was assessed using the Expanded Disability Status Scale, Timed 25 Foot Walk (T25FW) test and 9-Hole Peg Test (9HPT). Cognitive function was assessed using Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test, and Trail Making Test B (TRAIL-B). In addition, quality of life was assessed by the Short Form 36 (SF-36) questionnaire. Results Only measures of cognitive function correlated with the overall SF-36 quality of life score and the Mental Component Summary score from the SF-36. The only physical measure that correlated with a measure of quality of life was T25FW test, which correlated with the Physical Component Summary from the SF-36. We found no other significant correlations between the measures of cognitive function and the overall physical measures but interestingly, we found a possible relationship between the 9HPT score for the nondominant hand and the SDMT and TRAIL-B. Conclusion Our findings support inclusion of measures of cognitive function in the assessment of patients with progressive MS as these correlated closer with quality of life than measures of physical impairment.
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Affiliation(s)
- Helene Højsgaard Chow
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Karen Schreiber
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Melinda Magyari
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Cecilie Ammitzbøll
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Lars Börnsen
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Jeppe Romme Christensen
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Rikke Ratzer
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Per Soelberg Sørensen
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Finn Sellebjerg
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
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LaRocca NG, Hudson LD, Rudick R, Amtmann D, Balcer L, Benedict R, Bermel R, Chang I, Chiaravalloti ND, Chin P, Cohen JA, Cutter GR, Davis MD, DeLuca J, Feys P, Francis G, Goldman MD, Hartley E, Kapoor R, Lublin F, Lundstrom G, Matthews PM, Mayo N, Meibach R, Miller DM, Motl RW, Mowry EM, Naismith R, Neville J, Panagoulias J, Panzara M, Phillips G, Robbins A, Sidovar MF, Smith KE, Sperling B, Uitdehaag BM, Weaver J. The MSOAC approach to developing performance outcomes to measure and monitor multiple sclerosis disability. Mult Scler 2017; 24:1469-1484. [PMID: 28799444 PMCID: PMC6174619 DOI: 10.1177/1352458517723718] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) was formed by
the National MS Society to develop improved measures of multiple sclerosis
(MS)-related disability. Objectives: (1) To assess the current literature and available data on functional
performance outcome measures (PerfOs) and (2) to determine suitability of
using PerfOs to quantify MS disability in MS clinical trials. Methods: (1) Identify disability dimensions common in MS; (2) conduct a comprehensive
literature review of measures for those dimensions; (3) develop an MS
Clinical Data Interchange Standards Consortium (CDISC) data standard; (4)
create a database of standardized, pooled clinical trial data; (5) analyze
the pooled data to assess psychometric properties of candidate measures; and
(6) work with regulatory agencies to use the measures as primary or
secondary outcomes in MS clinical trials. Conclusion: Considerable data exist supporting measures of the functional domains
ambulation, manual dexterity, vision, and cognition. A CDISC standard for MS
(http://www.cdisc.org/therapeutic#MS) was published, allowing
pooling of clinical trial data. MSOAC member organizations contributed
clinical data from 16 trials, including 14,370 subjects. Data from
placebo-arm subjects are available to qualified researchers. This
integrated, standardized dataset is being analyzed to support qualification
of disability endpoints by regulatory agencies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Peter Feys
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | | | | | | | - Fred Lublin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Robert W Motl
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rob Naismith
- Washington University in St. Louis, St. Louis, MO, USA
| | | | | | | | | | | | - Matthew F Sidovar
- Acorda Therapeutics, Inc., Ardsley, NY, USA; KES Business Consulting LLC, Lyme, CT, USA
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How does performance of the Friedreich Ataxia Functional Composite compare to rating scales? J Neurol 2017; 264:1768-1776. [DOI: 10.1007/s00415-017-8566-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/02/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
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Balk LJ, Coric D, Nij Bijvank JA, Killestein J, Uitdehaag BM, Petzold A. Retinal atrophy in relation to visual functioning and vision-related quality of life in patients with multiple sclerosis. Mult Scler 2017; 24:767-776. [PMID: 28511578 PMCID: PMC5971367 DOI: 10.1177/1352458517708463] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Inner retinal layer atrophy in patients with multiple sclerosis (MS) has been validated as a structural imaging biomarker for neurodegeneration. Objective: To determine how retinal layer thickness relates to high-contrast visual acuity (HCVA), low-contrast visual acuity (LCVA) and vision-related quality of life (QoL) and to investigate the effect of previous episodes on MS-associated optic neuritis (MSON). Methods: Spectral-domain optical coherence tomography (SD-OCT) was performed in 267 patients with MS. Images were segmented for the peripapillary retinal nerve fiber layer (pRNFL) and the macular ganglion cell inner plexiform layer (GCIPL). Ophthalmological evaluations included history of MSON, HCVA, LCVA, and vision-related QoL. Results: Independent of MSON, HCVA and LCVA were significantly associated with pRNFL and GCIPL thicknesses. Vision-related QoL was positively associated with pRNFL (β = 0.92, p = 0.06) and GCIPL (β = 0.93, p = 0.02) thicknesses. These associations were independent of MSON. Not only binocular but also monocular atrophy of the inner retinal layers was associated with lower vision-related QoL. Conclusion: This study showed that retinal atrophy has a significant impact on visual functioning in patients with MS. OCT may therefore provide useful insight to patients with visual dysfunction, and our findings support including OCT and vision-related QoL measures into optic neuritis treatment trials.
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Affiliation(s)
- Lisanne J Balk
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Danko Coric
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jenny A Nij Bijvank
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Ophthalmology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Axel Petzold
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Ophthalmology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/UCL Institute of Neurology, University College London (UCL), London, UK/Moorfields Eye Hospital, London, UK
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Balcer LJ, Raynowska J, Nolan R, Galetta SL, Kapoor R, Benedict R, Phillips G, LaRocca N, Hudson L, Rudick R. Validity of low-contrast letter acuity as a visual performance outcome measure for multiple sclerosis. Mult Scler 2017; 23:734-747. [PMID: 28206829 PMCID: PMC5407511 DOI: 10.1177/1352458517690822] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Low-contrast letter acuity (LCLA) has emerged as the leading outcome measure to assess visual disability in multiple sclerosis (MS) research. As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Low-contrast acuity captures visual loss not seen in high-contrast visual acuity (HCVA) measurements. These issues are addressed by the MS Outcome Assessments Consortium (MSOAC), including representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are clinically meaningful. This review shows that MS and disease-free controls have similar median HCVA, while MS patients have significantly lower LCLA. Deficits in LCLA and vision-specific quality of life are found many years after an episode of acute optic neuritis, even when HCVA has recovered. Studies reveal correlations between LCLA and the Expanded Disability Status Score (EDSS), Multiple Sclerosis Functional Composite (MSFC), retinal nerve fiber layer (RNFL) and ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness on optical coherence tomography (OCT), brain magnetic resonance imaging (MRI), visual evoked potential (VEP), electroretinogram (ERG), pupillary function, and King-Devick testing. This review also concludes that a 7-point change in LCLA is clinically meaningful. The overall goal of this review is to describe and characterize the LCLA metric for research and clinical use among persons with MS.
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Affiliation(s)
- Laura J Balcer
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Jenelle Raynowska
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Rachel Nolan
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Raju Kapoor
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Ralph Benedict
- Department of Neurology, University at Buffalo, Buffalo, NY, USA
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- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
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