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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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Visual Evoked Potentials as a Biomarker in Multiple Sclerosis and Associated Optic Neuritis. J Neuroophthalmol 2020; 38:350-357. [PMID: 30106802 DOI: 10.1097/wno.0000000000000704] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
: ABSTRACT:: Multiple sclerosis (MS) is an inflammatory, degenerative disease of the central nervous system (CNS) characterized by progressive neurological decline over time. The need for better "biomarkers" to more precisely capture and track the effects of demyelination, remyelination, and associated neuroaxonal injury is a well-recognized challenge in the field of MS. To this end, visual evoked potentials (VEPs) have a role in assessing the extent of demyelination along the optic nerve, as a functionally eloquent CNS region. Moreover, VEPs testing can be used to predict the extent of recovery after optic neuritis (ON) and capture disabling effects of clinical and subclinical demyelination events in the afferent visual pathway. In this review, the evolving role of VEPs in the diagnosis of patients with ON and MS and the utility of VEPs testing in determining therapeutic benefits of emerging MS treatments is discussed.
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Luo JJ, Bumanlag F, Dun N. Low-contrast visual evoked potential and early detection of optic demyelination. J Neurol Sci 2019; 399:108-110. [PMID: 30798107 DOI: 10.1016/j.jns.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022]
Abstract
Visual Evoked Potential (VEP) is a useful tool in identifying abnormality relative to the integration of optic pathways, and aids the diagnosis of central nervous system demyelinating disorders, such as multiple sclerosis (MS). However, the sensitivity of VEP in detecting early optic abnormality as a visual function surrogate remains questionable. Recent studies showed that low-contrast VEP increases sensitivity in early detection of optic demyelination. In order to evaluate the applicability of low-contrast VEP to our electrodiagnostic protocol, we tested whether low-contrast VEP may provide an improved sensitivity in identifying early optic demyelination. We performed low-contrast VEP with different stimulation intensities in 42 subjects. Twenty-three were patients (age: 44.0 ± 13.6 year-old, range 26-69) with a clinical diagnosis of clinically isolated syndrome, a subtype of MS, and 19 subjects were normal volunteers (age: 34.4 ± 14.3 year-old, range: 18-59) without any neurological disorders. Neither of them had a history of optic neuritis. Our preliminary data indicate that the low-contrast VEP is not superior over the conventional high-contrast VEP, and may not provide improved sensitivity in early detection of optic demyelination.
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Affiliation(s)
- Jin Jun Luo
- Department of Neurology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA.
| | - Favio Bumanlag
- Department of Neurology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Nae Dun
- Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
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Oertel FC, Zimmermann H, Brandt AU, Paul F. [Optical coherence tomography in neuromyelitis optica spectrum disorders]. DER NERVENARZT 2019; 88:1411-1420. [PMID: 29119196 DOI: 10.1007/s00115-017-0444-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are mostly relapsing inflammatory conditions of the central nervous system (CNS). In 55% of the cases of NMOSD optic neuritis (ON) is the most frequent first manifestation and can cause severe damage to the afferent visual system and the retina with resultant severe visual impairment. In recent years, investigations of the retina as part of the CNS by optical coherence tomography (OCT) has been shown to be a valid and efficient method for diagnostics and evaluation of the disease course in NMOSD. In addition, OCT not only shows severe damage of the afferent visual system due to multiple bouts of ON but also reveals NMOSD-specific intraretinal pathologies. The latter could be just as important for future differential diagnostics as for the evaluation of potential therapeutic targets. This article briefly reviews the principles of the OCT technique and describes its relevance for the diagnostics and assessment of disease course in NMOSD.
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Affiliation(s)
- F C Oertel
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Deutschland
| | - H Zimmermann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Deutschland
| | - A U Brandt
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Deutschland
| | - F Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Deutschland. .,Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland. .,Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
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Oertel FC, Zimmermann HG, Brandt AU, Paul F. Novel uses of retinal imaging with optical coherence tomography in multiple sclerosis. Expert Rev Neurother 2018; 19:31-43. [PMID: 30587061 DOI: 10.1080/14737175.2019.1559051] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Multiple Sclerosis (MS) is the most common chronic autoimmune neuroinflammatory condition in young adults. It is often accompanied by optic neuritis (ON) and retinal neuro-axonal damage causing visual disturbances. Optical coherence tomography (OCT) is a sensitive non-invasive method for quantifying intraretinal layer volumes. Recently, OCT not only showed to be a reliable marker for ON-associated damage, but also proved its high prognostic value for functional outcome and disability accrual in patients with MS. Consequently, OCT is discussed as a potential marker for monitoring disease severity and therapeutic response in individual patients. Areas covered: This article summarizes our current understanding of structural retinal changes in MS and describes the future potential of OCT for differential diagnosis, monitoring of the disease course and for clinical trials. Expert commentary: Today, OCT is used in clinical practice in specialized MS centers. Standardized parameters across devices are urgently needed for supporting clinical utility. Novel parameters are desirable to increase sensitivity and specificity in terms of MS.
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Affiliation(s)
- Frederike C Oertel
- a 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
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Alexander U Brandt
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,b Department of Neurology , University of California Irvine , Irvine , CA , USA
| | - Friedemann Paul
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,c Department of Neurology , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,d Experimental and Clinical Research Center , Max-Delbrück-Centrum für Molekulare Medizin and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
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Oertel FC, Zimmermann H, Paul F, Brandt AU. Optical coherence tomography in neuromyelitis optica spectrum disorders: potential advantages for individualized monitoring of progression and therapy. EPMA J 2018; 9:21-33. [PMID: 29515685 PMCID: PMC5833887 DOI: 10.1007/s13167-017-0123-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are mostly relapsing inflammatory disorders of the central nervous system (CNS). Optic neuritis (ON) is the first NMOSD-related clinical event in 55% of the patients, which causes damage to the optic nerve and leads to visual impairment. Retinal optical coherence tomography (OCT) has emerged as a promising method for diagnosis of NMOSD and potential individual monitoring of disease course and severity. OCT not only detects damage to the afferent visual system caused by ON but potentially also NMOSD-specific intraretinal pathology, i.e. astrocytopathy. This article summarizes retinal involvement in NMOSD and reviews OCT methods that could be used now and in the future, for differential diagnosis, for monitoring of disease course, and in clinical trials.
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Affiliation(s)
- Frederike C. Oertel
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 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
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin und Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander U. Brandt
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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Meltzer E, Sguigna PV, Subei A, Beh S, Kildebeck E, Conger D, Conger A, Lucero M, Frohman BS, Frohman AN, Saidha S, Galetta S, Calabresi PA, Rennaker R, Frohman TC, Kardon RH, Balcer LJ, Frohman EM. Retinal Architecture and Melanopsin-Mediated Pupillary Response Characteristics: A Putative Pathophysiologic Signature for the Retino-Hypothalamic Tract in Multiple Sclerosis. JAMA Neurol 2017; 74:574-582. [PMID: 28135360 PMCID: PMC5822208 DOI: 10.1001/jamaneurol.2016.5131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/21/2016] [Indexed: 12/19/2022]
Abstract
Importance A neurophysiologic signature of the melanopsin-mediated persistent constriction phase of the pupillary light reflex may represent a surrogate biomarker for the integrity of the retinohypothalamic tract, with potential utility for investigating alterations in homeostatic mechanisms associated with brain disorders and implications for identifying new treatments. Objective To characterize abnormalities of retinal architecture in patients with multiple sclerosis (MS) and corresponding alterations in the melanopsin-mediated sustained pupillary constriction response. Design, Setting, and Participants The case-control study was an experimental assessment of various stimulus-induced pupillary response characteristics and was conducted at a university clinical center for MS from September 6, 2012, to February 2015. Twenty-four patients with MS (48 eyes) and 15 individuals serving as controls (30 eyes) participated. The melanopsin-mediated, sustained pupillary constriction phase response following cessation of a blue light stimulus was compared with the photoreceptor-mediated pupillary constriction phase response following cessation of a red light stimulus. Optical coherence tomography was used to characterize the association between pupillary response characteristics and alterations in retinal architecture, specifically, the thickness of the retinal ganglion cell layer and inner plexiform layer (GCL + IPL). Main Outcomes and Measures Association of pupillary response characteristics with alterations in retinal architecture. Results Of 24 patients with MS included in the analysis, 17 were women (71%); mean (SD) age was 47 (11) years. Compared with eyes from individuals with MS who had normal optical coherence tomography-derived measures of retinal GCL + IPL thickness, eyes of patients who had GCL + IPL thickness reductions to less than the first percentile exhibited a correspondingly significant attenuation of the melanopsin-mediated sustained pupillary response (mean [SD] pupillary diameter ratios at a point in time, 0.18 [0.1] vs 0.33 [0.09]; P < .001, generalized estimating equation models accounting for age and within-patient intereye correlations). Conclusions and Relevance In this case-control study, attenuation of the melanopsin-mediated sustained pupillary constriction response was significantly associated with thinning of the GCL + IPL sector of the retina in the eyes of patients with MS, particularly those with a history of acute optic neuritis. Melanopsin-containing ganglion cells in the retina represent, at least in part, the composition of the retinohypothalamic tract. As such, our findings may signify the ability to elucidate a putative surrogate neurophysiologic signature that correlates with a constellation of homeostatic mechanisms in both health and illness.
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Affiliation(s)
- Ethan Meltzer
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Peter V. Sguigna
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Adnan Subei
- Department of Neurology, Michigan State University, East Lansing
| | - Shin Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Eric Kildebeck
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
- Center for Engineering Innovation, University of Texas at Dallas
| | - Darrel Conger
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Amy Conger
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Marlen Lucero
- Student, Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Benjamin S. Frohman
- Student, Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Ashley N. Frohman
- Student, Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Steven Galetta
- Department of Neurology, Population Health, New York University School of Medicine, New York
| | | | | | - Teresa C. Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Randy H. Kardon
- Department of Ophthalmology, University of Iowa, Iowa City
- Iowa City Veterans Affairs Center for Prevention and Treatment of Visual Loss, Iowa City
| | - Laura J. Balcer
- Department of Neurology, Population Health, New York University School of Medicine, New York
- Department of Ophthalmology, New York University School of Medicine, New York
| | - Elliot M. Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
- Department of Bioengineering, University of Texas at Dallas
- Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas
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Pihl-Jensen G, Schmidt MF, Frederiksen JL. Multifocal visual evoked potentials in optic neuritis and multiple sclerosis: A review. Clin Neurophysiol 2017; 128:1234-1245. [PMID: 28531809 DOI: 10.1016/j.clinph.2017.03.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/21/2022]
Abstract
Multifocal visual evoked potential (mf-VEP) represents a new approach to the classical full field (ff-)VEP with separate responses from up to 60 sectors of the visual field. A thorough literature survey of the use of mf-VEP in optic neuritis (ON) and multiple sclerosis (MS) is presented (38 published studies were retrieved). Mf-VEP provides direct topographical information of specific lesions and facilitates investigations on structural-functional correlations thus providing new methods for exploring the interplay between demyelination, atrophy and remyelination in MS. Good correlation was shown between mf-VEP and OCT, ff-VEP, MRI (MTR, DTI), 30-2 standard automated perimetry and low-contrast-visual acuity. All but one study showed superior sensitivity and specificity compared to ff-VEP, especially with regards to small, peripheral lesions or lesions of the upper visual field. Mf-VEP has shown superior sensitivity and specificity than established methods in diagnosing optic nerve lesions and tracking functional recovery following lesions. Abnormal mf-VEP responses in the fellow, non-ON afflicted eye may predict MS risk in ON patients. No standardization currently exists and no direct comparisons in ON and MS between at least 5 different commercially available mf-VEP systems have so far been published. Despite these limitations, mf-VEP is a promising new tool of diagnostic and prognostic value of mf-VEP in ON and MS.
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Affiliation(s)
- Gorm Pihl-Jensen
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
| | - Mathias Falck Schmidt
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
| | - Jette Lautrup Frederiksen
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
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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: 127] [Impact Index Per Article: 18.1] [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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Qureshi SS, Frohman EM. Acute optic neuritis: a clinical paradigm for evaluation of neuroprotective and restorative strategies? Neural Regen Res 2015; 10:1599-601. [PMID: 26692855 PMCID: PMC4660751 DOI: 10.4103/1673-5374.165286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sara S Qureshi
- Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
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Bennett JL, Nickerson M, Costello F, Sergott RC, Calkwood JC, Galetta SL, Balcer LJ, Markowitz CE, Vartanian T, Morrow M, Moster ML, Taylor AW, Pace TWW, Frohman T, Frohman EM. Re-evaluating the treatment of acute optic neuritis. J Neurol Neurosurg Psychiatry 2015; 86:799-808. [PMID: 25355373 PMCID: PMC4414747 DOI: 10.1136/jnnp-2014-308185] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/28/2014] [Indexed: 12/28/2022]
Abstract
Clinical case reports and prospective trials have demonstrated a reproducible benefit of hypothalamic-pituitary-adrenal (HPA) axis modulation on the rate of recovery from acute inflammatory central nervous system (CNS) demyelination. As a result, corticosteroid preparations and adrenocorticotrophic hormones are the current mainstays of therapy for the treatment of acute optic neuritis (AON) and acute demyelination in multiple sclerosis.Despite facilitating the pace of recovery, HPA axis modulation and corticosteroids have failed to demonstrate long-term benefit on functional recovery. After AON, patients frequently report visual problems, motion perception difficulties and abnormal depth perception despite 'normal' (20/20) vision. In light of this disparity, the efficacy of these and other therapies for acute demyelination require re-evaluation using modern, high-precision paraclinical tools capable of monitoring tissue injury.In no arena is this more amenable than AON, where a new array of tools in retinal imaging and electrophysiology has advanced our ability to measure the anatomic and functional consequences of optic nerve injury. As a result, AON provides a unique clinical model for evaluating the treatment response of the derivative elements of acute inflammatory CNS injury: demyelination, axonal injury and neuronal degeneration.In this article, we examine current thinking on the mechanisms of immune injury in AON, discuss novel technologies for the assessment of optic nerve structure and function, and assess current and future treatment modalities. The primary aim is to develop a framework for rigorously evaluating interventions in AON and to assess their ability to preserve tissue architecture, re-establish normal physiology and restore optimal neurological function.
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Affiliation(s)
- Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, University of Colorado, Denver, Colorado, USA
| | - Molly Nickerson
- Department of Medical Affairs, Questcor Pharmaceuticals, Inc., Hayward, California, USA
| | - Fiona Costello
- Departments of Clinical Neurosciences and Surgery, University of Calgary, Hotchkiss Brain Institute, Alberta, Canada
| | - Robert C Sergott
- Neuro-Ophthalmology Service, Wills Eye Institute, Thomas Jefferson University Medical College, Philadelphia, Pennsylvania, USA
| | | | - Steven L Galetta
- Department of Neurology, Division of Neuro-Ophthalmology, NYU Langone Medical Center, New York, USA
| | - Laura J Balcer
- Department of Neurology, Division of Neuro-Ophthalmology, NYU Langone Medical Center, New York, USA
| | - Clyde E Markowitz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy Vartanian
- Rockefeller University and Memorial Sloan-Kettering Hospital, Weill Cornell Medical College, New York, USA
| | - Mark Morrow
- Department of Neurology, Harbor-University of California Los Angeles Medical Center, Torrance, California, USA
| | - Mark L Moster
- Neuro-Ophthalmology Service, Wills Eye Institute, Thomas Jefferson University Medical College, Philadelphia, Pennsylvania, USA
| | - Andrew W Taylor
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thaddeus W W Pace
- College of Nursing at the University of Arizona, Tucson, Arizona, USA
| | - Teresa Frohman
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elliot M Frohman
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Schnurman ZS, Frohman TC, Beh SC, Conger D, Conger A, Saidha S, Galetta S, Calabresi PA, Green AJ, Balcer LJ, Frohman EM. Retinal architecture and mfERG: Optic nerve head component response characteristics in MS. Neurology 2014; 82:1888-96. [PMID: 24789865 DOI: 10.1212/wnl.0000000000000447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To describe a novel neurophysiologic signature of the retinal ganglion cell and to elucidate its relationship to abnormalities in validated structural and functional measures of the visual system. METHODS We used multifocal electroretinogram-generated optic nerve head component (ONHC) responses from normal subjects (n = 18), patients with multiple sclerosis (MS) (n = 18), and those with glaucoma (n = 3). We then characterized the relationship between ONHC response abnormalities and performance on low-contrast visual acuity, multifocal visual-evoked potential-induced cortical responses, and average and quadrant retinal nerve fiber layer (RNFL) thicknesses, as measured by spectral-domain optical coherence tomography. RESULTS Compared with the eyes of normal subjects, the eyes of patients with MS exhibited an increased number of abnormal or absent ONHC responses (p < 0.0001). For every 7-letter reduction in low-contrast letter acuity, there were corresponding 4.6 abnormal ONHC responses at 2.5% contrast (p < 0.0001) and 6.6 abnormalities at the 1.25% contrast level (p < 0.0001). Regarding average RNFL thickness, for each 10-μm thickness reduction, we correspondingly observed 6.8 abnormal ONHC responses (p = 0.0002). The most robust association was between RNFL thinning in the temporal quadrant and ONHC response abnormalities (p < 0.0001). CONCLUSION Further characterization of ONHC abnormalities (those that are reversible and irreversible) may contribute to the development of novel neurotherapeutic strategies aimed at achieving neuroprotective, and perhaps even neurorestorative, effects in disorders that target the CNS in general, and MS in particular.
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Affiliation(s)
- Zane S Schnurman
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Teresa C Frohman
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Shin C Beh
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Darrel Conger
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Amy Conger
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Shiv Saidha
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Steven Galetta
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Peter A Calabresi
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Ari J Green
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco
| | - Laura J Balcer
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco.
| | - Elliot M Frohman
- From the Departments of Neurology (Z.S.S., T.C.F., S.C.B., D.C., A.C., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology (S.S., P.A.C.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.S.), Beaumont University Hospital, Dublin, Ireland; Department of Neurology (S.G., L.J.B.), New York University Langone Medical Center; and Departments of Neurology (A.J.G.) and Ophthalmology (A.J.G.), University of California at San Francisco.
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Hardmeier M, Hatz F, Naegelin Y, Hight D, Schindler C, Kappos L, Seeck M, Michel CM, Fuhr P. Improved characterization of visual evoked potentials in multiple sclerosis by topographic analysis. Brain Topogr 2013; 27:318-27. [PMID: 24085573 PMCID: PMC3921459 DOI: 10.1007/s10548-013-0318-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 09/20/2013] [Indexed: 11/09/2022]
Abstract
In multiple sclerosis (MS), the combination of visual, somatosensory and motor evoked potentials (EP) has been shown to be highly correlated with the Expanded Disability Severity Scale (EDSS) and to predict the disease course. In the present study, we explored whether the significance of the visual EP (VEP) can be improved with multichannel recordings (204 electrodes) and topographic analysis (tVEP). VEPs were analyzed in 83 MS patients (median EDSS 2.0; 52 % with history of optic neuritis; hON) and 47 healthy controls (HC). TVEP components were automatically defined on the basis of spatial similarity between the scalp potential fields (topographic maps) of single subjects’ VEPs and reference maps generated from HC. Non-ambiguous measures of latency, amplitude and configuration were derived from the maps reflecting the P100 component. TVEP was compared to conventional analysis (cVEP) with respect to reliability in HC, validity using descriptors of logistic regression models, and sensitivity derived from receiver operating characteristics curves. In tVEP, reliability tended to be higher for measurement of amplitude (p = 0.06). Regression models on diagnosis (MS vs. HC) and hON were more favorable using tVEP- versus cVEP-predictors. Sensitivity was increased in tVEP versus cVEP: 72 % versus 60 % for diagnosis, and 88 % versus 77 % for hON. The advantage of tVEP was most pronounced in pathological VEPs, in which cVEPs were often ambiguous. TVEP is a reliable, valid, and sensitive method of objectively quantifying pathological VEP in particular. In combination with other EP modalities, tVEP may improve the monitoring of disease course in MS.
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Affiliation(s)
- Martin Hardmeier
- Department of Neurology, Hospital of the University of Basel, Petersgraben 4, 4031, Basel, Switzerland,
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Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that is pathologically characterized by inflammatory demyelination and neurodegeneration. Axonal damage, along with neuronal loss, occurs from disease onset and may lead to progressive and permanent disability. In contrast with the inflammatory pathways, the molecular mechanisms leading to MS neurodegeneration remain largely elusive. With improved understanding of these mechanisms, new potential therapeutic targets for neuroprotection have emerged. We review the current understanding of neurodegenerative processes at play in MS and discuss potential outcome measures and targets for neuroprotection trials.
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Affiliation(s)
- Amir-Hadi Maghzi
- Multiple Sclerosis Center, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, 2nd floor, Room 221F, Box 3206, 94158, San Francisco, CA, USA,
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