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Montolío A, Cegoñino J, Garcia-Martin E, Pérez Del Palomar A. The macular retinal ganglion cell layer as a biomarker for diagnosis and prognosis in multiple sclerosis: A deep learning approach. Acta Ophthalmol 2024; 102:e272-e284. [PMID: 37300357 DOI: 10.1111/aos.15722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/12/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The macular ganglion cell layer (mGCL) is a strong potential biomarker of axonal degeneration in multiple sclerosis (MS). For this reason, this study aims to develop a computer-aided method to facilitate diagnosis and prognosis in MS. METHODS This paper combines a cross-sectional study of 72 MS patients and 30 healthy control subjects for diagnosis and a 10-year longitudinal study of the same MS patients for the prediction of disability progression, during which the mGCL was measured using optical coherence tomography (OCT). Deep neural networks were used as an automatic classifier. RESULTS For MS diagnosis, greatest accuracy (90.3%) was achieved using 17 features as inputs. The neural network architecture comprised the input layer, two hidden layers and the output layer with softmax activation. For the prediction of disability progression 8 years later, accuracy of 81.9% was achieved with a neural network comprising two hidden layers and 400 epochs. CONCLUSION We present evidence that by applying deep learning techniques to clinical and mGCL thickness data it is possible to identify MS and predict the course of the disease. This approach potentially constitutes a non-invasive, low-cost, easy-to-implement and effective method.
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Affiliation(s)
- Alberto Montolío
- Biomaterials Group, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
- Mechanical Engineering Department, University of Zaragoza, Zaragoza, Spain
| | - José Cegoñino
- Biomaterials Group, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
- Mechanical Engineering Department, University of Zaragoza, Zaragoza, Spain
| | - Elena Garcia-Martin
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- GIMSO Research and Innovation Group, Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
| | - Amaya Pérez Del Palomar
- Biomaterials Group, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
- Mechanical Engineering Department, University of Zaragoza, Zaragoza, Spain
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Oertel FC, Hastermann M, Paul F. Delimiting MOGAD as a disease entity using translational imaging. Front Neurol 2023; 14:1216477. [PMID: 38333186 PMCID: PMC10851159 DOI: 10.3389/fneur.2023.1216477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/23/2023] [Indexed: 02/10/2024] Open
Abstract
The first formal consensus diagnostic criteria for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) were recently proposed. Yet, the distinction of MOGAD-defining characteristics from characteristics of its important differential diagnoses such as multiple sclerosis (MS) and aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder (NMOSD) is still obstructed. In preclinical research, MOG antibody-based animal models were used for decades to derive knowledge about MS. In clinical research, people with MOGAD have been combined into cohorts with other diagnoses. Thus, it remains unclear to which extent the generated knowledge is specifically applicable to MOGAD. Translational research can contribute to identifying MOGAD characteristic features by establishing imaging methods and outcome parameters on proven pathophysiological grounds. This article reviews suitable animal models for translational MOGAD research and the current state and prospect of translational imaging in MOGAD.
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Affiliation(s)
- Frederike Cosima Oertel
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Hastermann
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Romahn EF, Wiltgen T, Bussas M, Aly L, Wicklein R, Noll C, Berthele A, Dehmelt V, Mardin C, Zimmer C, Korn T, Hemmer B, Kirschke JS, Mühlau M, Knier B. Association of retinal vessel pathology and brain atrophy in relapsing-remitting multiple sclerosis. Front Immunol 2023; 14:1284986. [PMID: 38090586 PMCID: PMC10715309 DOI: 10.3389/fimmu.2023.1284986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Background Optical coherence tomography angiography (OCTA) allows non-invasive assessment of retinal vessel structures. Thinning and loss of retinal vessels is evident in eyes of patients with multiple sclerosis (MS) and might be associated with a proinflammatory disease phenotype and worse prognosis. We investigated whether changes of the retinal vasculature are linked to brain atrophy and disability in MS. Material and methods This study includes one longitudinal observational cohort (n=79) of patients with relapsing-remitting MS. Patients underwent annual assessment of the expanded disability status scale (EDSS), timed 25-foot walk, symbol digit modalities test (SDMT), retinal optical coherence tomography (OCT), OCTA, and brain MRI during a follow-up duration of at least 20 months. We investigated intra-individual associations between changes in the retinal architecture, vasculature, brain atrophy and disability. Eyes with a history of optic neuritis (ON) were excluded. Results We included 79 patients with a median disease duration of 12 (interquartile range 2 - 49) months and a median EDSS of 1.0 (0 - 2.0). Longitudinal retinal axonal and ganglion cell loss were linked to grey matter atrophy, cortical atrophy, and volume loss of the putamen. We observed an association between vessel loss of the superficial vascular complex (SVC) and both grey and white matter atrophy. Both observations were independent of retinal ganglion cell loss. Moreover, patients with worsening of the EDSS and SDMT revealed a pronounced longitudinal rarefication of the SVC and the deep vascular complex. Discussion ON-independent narrowing of the retinal vasculature might be linked to brain atrophy and disability in MS. Our findings suggest that retinal OCTA might be a new tool for monitoring neurodegeneration during MS.
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Affiliation(s)
- Eva Feodora Romahn
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Tun Wiltgen
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Matthias Bussas
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christina Noll
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Vera Dehmelt
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christian Mardin
- Department of Ophthalmology, University Hospital of Erlangen-Nuremberg, Erlangen, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Jan S. Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Wicklein R, Yam C, Noll C, Aly L, Banze N, Romahn EF, Wolf E, Hemmer B, Oertel FC, Zimmermann H, Albrecht P, Ringelstein M, Baumann C, Feucht N, Penkava J, Havla J, Gernert JA, Mardin C, Vasileiou ES, Van Der Walt A, Al-Louzi O, Cabello S, Vidal-Jordana A, Krämer J, Wiendl H, Preiningerova JL, Ciccarelli O, Garcia-Martin E, Kana V, Calabresi PA, Paul F, Saidha S, Petzold A, Toosy AT, Knier B. The OSCAR-MP Consensus Criteria for Quality Assessment of Retinal Optical Coherence Tomography Angiography. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200169. [PMID: 37813596 PMCID: PMC10574825 DOI: 10.1212/nxi.0000000000200169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Optical coherence tomography angiography (OCTA) is a noninvasive high-resolution imaging technique for assessing the retinal vasculature and is increasingly used in various ophthalmologic, neuro-ophthalmologic, and neurologic diseases. To date, there are no validated consensus criteria for quality control (QC) of OCTA. Our study aimed to develop criteria for OCTA quality assessment. METHODS To establish criteria through (1) extensive literature review on OCTA artifacts and image quality to generate standardized and easy-to-apply OCTA QC criteria, (2) application of OCTA QC criteria to evaluate interrater agreement, (3) identification of reasons for interrater disagreement, revision of OCTA QC criteria, development of OCTA QC scoring guide and training set, and (4) validation of QC criteria in an international, interdisciplinary multicenter study. RESULTS We identified 7 major aspects that affect OCTA quality: (O) obvious problems, (S) signal strength, (C) centration, (A) algorithm failure, (R) retinal pathology, (M) motion artifacts, and (P) projection artifacts. Seven independent raters applied the OSCAR-MP criteria to a set of 40 OCTA scans from people with MS, Sjogren syndrome, and uveitis and healthy individuals. The interrater kappa was substantial (κ 0.67). Projection artifacts were the main reason for interrater disagreement. Because artifacts can affect only parts of OCTA images, we agreed that prior definition of a specific region of interest (ROI) is crucial for subsequent OCTA quality assessment. To enhance artifact recognition and interrater agreement on reduced image quality, we designed a scoring guide and OCTA training set. Using these educational tools, 23 raters from 14 different centers reached an almost perfect agreement (κ 0.92) for the rejection of poor-quality OCTA images using the OSCAR-MP criteria. DISCUSSION We propose a 3-step approach for standardized quality control: (1) To define a specific ROI, (2) to assess the occurrence of OCTA artifacts according to the OSCAR-MP criteria, and (3) to evaluate OCTA quality based on the occurrence of different artifacts within the ROI. OSCAR-MP OCTA QC criteria achieved high interrater agreement in an international multicenter study and is a promising QC protocol for application in the context of future clinical trials and studies.
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Affiliation(s)
- Rebecca Wicklein
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Charmaine Yam
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Christina Noll
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Lilian Aly
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Nicolas Banze
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Eva Feodora Romahn
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Elisabeth Wolf
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Bernhard Hemmer
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Frederike C Oertel
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Hanna Zimmermann
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Philipp Albrecht
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Marius Ringelstein
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Carmen Baumann
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Nikolaus Feucht
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Josef Penkava
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Joachim Havla
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Jonathan A Gernert
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Christian Mardin
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Eleni S Vasileiou
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Anneke Van Der Walt
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Omar Al-Louzi
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Sergio Cabello
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Angela Vidal-Jordana
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Julia Krämer
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Heinz Wiendl
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Jana Lizrova Preiningerova
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Olga Ciccarelli
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Elena Garcia-Martin
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Veronika Kana
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Peter A Calabresi
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Friedemann Paul
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Shiv Saidha
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Axel Petzold
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Ahmed T Toosy
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands
| | - Benjamin Knier
- From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands.
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Naxer S, Schittkowski M. [OCT in Neuroophthalmology]. Klin Monbl Augenheilkd 2023. [PMID: 37236234 DOI: 10.1055/a-1978-5408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Optical coherence tomography (OCT) has become the most important innovation in ophthalmology over the last 30 years and is used routinely, especially in the diagnosis of retinal and glaucomatous diseases. It is fast, non-invasive and reproducible. Since the procedures can offer such a high resolution that the individual retinal layers can be visualised and segmented, this examination technique has also found its way into neuroophthalmology. Especially the peripapillary nerve fibre layer (RNFL) and the ganglion cell layer (GCL) provide valuable diagnostic and prognostic information in cases of visual pathway disease and morphologically unexplained visual disorders. OCT is helpful in determining the cause of optic disc swelling and EDI-OCT can reliably detect buried, non-calcified drusen. This article is intended to provide the reader with an overview of current and future applications of OCT in neuroophthalmology and knowledge of possible pitfalls.
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Oertel FC, Krämer J, Motamedi S, Keihani A, Zimmermann HG, Dimitriou NG, Condor-Montes S, Bereuter C, Cordano C, Abdelhak A, Trip A, Aktas O, Meuth SG, Wiendl H, Ruprecht K, Bellmann-Strobl J, Paul F, Petzold A, Brandt AU, Albrecht P, Green AJ. Visually Evoked Potential as Prognostic Biomarker for Neuroaxonal Damage in Multiple Sclerosis From a Multicenter Longitudinal Cohort. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200092. [PMID: 36878713 PMCID: PMC10026703 DOI: 10.1212/nxi.0000000000200092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND AND OBJECTIVES With the increasing use of visually evoked potentials (VEPs) as quantitative outcome parameters for myelin in clinical trials, an in-depth understanding of longitudinal VEP latency changes and their prognostic potential for subsequent neuronal loss will be required. In this longitudinal multicenter study, we evaluated the association and prognostic potential of VEP latency for retinal neurodegeneration, measured by optical coherence tomography (OCT), in relapsing-remitting MS (RRMS). METHODS We included 293 eyes of 147 patients with RRMS (age [years, median ± SD] 36 ± 10, male sex 35%, F/U [years, median {IQR} 2.1 {1.5-3.9}]): 41 eyes had a history of optic neuritis (ON) ≥6 months before baseline (CHRONIC-ON), and 252 eyes had no history of ON (CHRONIC-NON). P100 latency (VEP), macular combined ganglion cell and inner plexiform layer volume (GCIPL), and peripapillary retinal nerve fiber layer thickness (pRNFL) (OCT) were quantified. RESULTS P100 latency change over the first year predicted subsequent GCIPL loss (36 months) across the entire chronic cohort (p = 0.001) and in (and driven by) the CHRONIC-NON subset (p = 0.019) but not in the CHRONIC-ON subset (p = 0.680). P100 latency and pRNFL were correlated at baseline (CHRONIC-NON p = 0.004, CHRONIC-ON p < 0.001), but change in P100 latency and pRNFL were not correlated. P100 latency did not differ longitudinally between protocols or centers. DISCUSSION VEP in non-ON eyes seems to be a promising marker of demyelination in RRMS and of potential prognostic value for subsequent retinal ganglion cell loss. This study also provides evidence that VEP may be a useful and reliable biomarker for multicenter studies.
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Affiliation(s)
- Frederike Cosima Oertel
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Julia Krämer
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Seyedamirhosein Motamedi
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Azeen Keihani
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Hanna G Zimmermann
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Nikolaos G Dimitriou
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Shivany Condor-Montes
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Charlotte Bereuter
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Christian Cordano
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Ahmed Abdelhak
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Anand Trip
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Orhan Aktas
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Sven G Meuth
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Heinz Wiendl
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Klemens Ruprecht
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Judith Bellmann-Strobl
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Friedemann Paul
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Axel Petzold
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Alexander U Brandt
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Philipp Albrecht
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF)
| | - Ari J Green
- From the Weill Institute for Neurosciences (F.C.C.O., A.K., S.C.-M., C.C., A.A., A.J.G.), Department of Neurology, University of California San Francisco (UCSF); Experimental and Clinical Research Center (F.C.C.O., S.M., H.G.Z., C.B., J.B.-S., F.P., A.U.B.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; University of California Berkeley (A.K.); Department of Neurology (N.G.D., O.A., S.G.M., P.A.), Medical Faculty, Heinrich-Heine University and University Hospital Düsseldorf, Germany; Department of Neurology (P.A.), Maria Hilf Clinic Moenchengladbach, Germany; Queen Square MS Centre (A.T., A.P.), University College London, UK; Department of Neurology (K.R., F.P.),-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Moorfield's Eye Hospital & The National Hospital for Neurology and Neurosurgery (A.P.); Queen Square Institute of Neurology, University College London, UK; Dutch Neuro-ophthalmology Expertise Centre, Amsterdam, NL; Department of Neurology (A.U.B.), University of California Irvine (UCI); and Department of Ophthalmology (A.J.G.), University of California San Francisco (UCSF).
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Wauschkuhn J, Solorza Buenrostro G, Aly L, Asseyer S, Wicklein R, Hartberger JM, Ruprecht K, Mühlau M, Schmitz-Hübsch T, Chien C, Berthele A, Brandt AU, Korn T, Paul F, Hemmer B, Zimmermann HG, Knier B. Retinal ganglion cell loss is associated with future disability worsening in early relapsing-remitting multiple sclerosis. Eur J Neurol 2023; 30:982-990. [PMID: 36635219 DOI: 10.1111/ene.15681] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/03/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Thinning of the retinal combined ganglion cell and inner plexiform layer (GCIP) as measured by optical coherence tomography (OCT) is a common finding in patients with multiple sclerosis. This study aimed to investigate whether a single retinal OCT analysis allows prediction of future disease activity after a first demyelinating event. METHODS This observational cohort study included 201 patients with recently diagnosed clinically isolated syndrome or relapsing-remitting multiple sclerosis from two German tertiary referral centers. Individuals underwent neurological examination, magnetic resonance imaging, and OCT at baseline and at yearly follow-up visits. RESULTS Patients were included at a median disease duration of 2.0 months. During a median follow-up of 59 (interquartile range = 43-71) months, 82% of patients had ongoing disease activity as demonstrated by failing the no evidence of disease activity 3 (NEDA-3) criteria, and 19% presented with confirmed disability worsening. A GCIP threshold of ≤77 μm at baseline identified patients with a high risk for NEDA-3 failure (hazard ratio [HR] = 1.7, 95% confidence interval [CI] = 1.1-2.8, p = 0.04), and GCIP measures of ≤69 μm predicted disability worsening (HR = 2.2, 95% CI = 1.2-4.3, p = 0.01). Higher rates of annualized GCIP loss increased the risk for disability worsening (HR = 2.5 per 1 μm/year increase of GCIP loss, p = 0.03). CONCLUSIONS Ganglion cell thickness as measured by OCT after the initial manifestation of multiple sclerosis may allow early risk stratification as to future disease activity and progression.
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Affiliation(s)
- Josephine Wauschkuhn
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Gilberto Solorza Buenrostro
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine and the Helmholtz Association, Charité - University Medicine Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Susanna Asseyer
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine and the Helmholtz Association, Charité - University Medicine Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Julia Maria Hartberger
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine and the Helmholtz Association, Charité - University Medicine Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Claudia Chien
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine and the Helmholtz Association, Charité - University Medicine Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander U Brandt
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine and the Helmholtz Association, Charité - University Medicine Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Department of Neurology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology, University of California, Irvine, Irvine, California, USA
| | - Thomas Korn
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine and the Helmholtz Association, Charité - University Medicine Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Department of Neurology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine and the Helmholtz Association, Charité - University Medicine Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
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8
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Borgström M, Fredrikson M, Vrethem M, Mirabelli P, Link H, Huang-link Y. Changes in Retinal Thickness and Brain Volume during 6.8-Year Escalating Therapy for Multiple Sclerosis. Acta Neurol Scand 2023; 2023:1-8. [DOI: 10.1155/2023/7587221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Background. Different disease-modifying therapies (DMT) for multiple sclerosis (MS) have disparate effects on disability outcomes. Sweden has a leading position globally in initiating high-efficacy DMT instead of escalating DMT from 1st-line to high-efficacy DMT. With optical coherence tomography (OCT), retinal changes can be measured at a few micrometer level. OCT has been increasingly applied in diagnosing MS and monitoring disease course and therapeutic effect. Objective. We investigate the effects of 1st-line versus high-efficacy DMT for MS on retinal and brain atrophy and on functional outcomes during 6.8 years of escalating DMT. Materials and Methods. In this prospective longitudinal observational study, 18 MS patients were followed up for 6.8 years. Twelve of the patients were untreated at baseline. All patients underwent 1st-line DMT for median duration of 2.4 years and then switched to high-efficacy DMT for a median duration of 2.9 years. Findings from neurological examinations, MRI, and OCT measures were registered 2-4 times per year. Results. Ganglion cell-inner plexiform layer (GCIPL) thickness was significantly reduced during 1st-line DMT (73.75 μm,
) compared to baseline (76.38 μm). During high-efficacy DMT, thickness reduction was slower (73.27 μm,
), and MRI contrast-loading lesions vanished (
). However, brain parenchymal fraction (BPF) decreased during high-efficacy DMT compared to 1st-line DMT. Estimated models showed similar results. Conclusion. GCIPL decline was most profound during 1st-line DMT and diminished during high-efficacy DMT. MRI contrast lesions vanished during high-efficacy DMT. However, brain atrophy continued regardless of high-efficacy DMT.
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9
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Asseyer S, Asgari N, Bennett J, Bialer O, Blanco Y, Bosello F, Camos-Carreras A, Carnero Contentti E, Carta S, Chen J, Chien C, Chomba M, Dale RC, Dalmau J, Feldmann K, Flanagan EP, Froment Tilikete C, Garcia-Alfonso C, Havla J, Hellmann M, Kim HJ, Klyscz P, Konietschke F, La Morgia C, Lana-Peixoto M, Leite MI, Levin N, Levy M, Llufriu S, Lopez P, Lotan I, Lugaresi A, Marignier R, Mariotto S, Mollan SP, Ocampo C, Cosima Oertel F, Olszewska M, Palace J, Pandit L, Peralta Uribe JL, Pittock S, Ramanathan S, Rattanathamsakul N, Saiz A, Samadzadeh S, Sanchez-Dalmau B, Saylor D, Scheel M, Schmitz-Hübsch T, Shifa J, Siritho S, Sperber PS, Subramanian PS, Tiosano A, Vaknin-Dembinsky A, Mejia Vergara AJ, Wilf-Yarkoni A, Zarco LA, Zimmermann HG, Paul F, Stiebel-Kalish H. The Acute Optic Neuritis Network (ACON): Study protocol of a non-interventional prospective multicenter study on diagnosis and treatment of acute optic neuritis. Front Neurol 2023; 14:1102353. [PMID: 36908609 PMCID: PMC9998999 DOI: 10.3389/fneur.2023.1102353] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/30/2023] [Indexed: 02/26/2023] Open
Abstract
Optic neuritis (ON) often occurs at the presentation of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). The recommended treatment of high-dose corticosteroids for ON is based on a North American study population, which did not address treatment timing or antibody serostatus. The Acute Optic Neuritis Network (ACON) presents a global, prospective, observational study protocol primarily designed to investigate the effect of time to high-dose corticosteroid treatment on 6-month visual outcomes in ON. Patients presenting within 30 days of the inaugural ON will be enrolled. For the primary analysis, patients will subsequently be assigned into the MS-ON group, the aquapotin-4-IgG positive ON (AQP4-IgG+ON) group or the MOG-IgG positive ON (MOG-IgG+ON) group and then further sub-stratified according to the number of days from the onset of visual loss to high-dose corticosteroids (days-to-Rx). The primary outcome measure will be high-contrast best-corrected visual acuity (HC-BCVA) at 6 months. In addition, multimodal data will be collected in subjects with any ON (CIS-ON, MS-ON, AQP4-IgG+ON or MOG-IgG+ON, and seronegative non-MS-ON), excluding infectious and granulomatous ON. Secondary outcomes include low-contrast best-corrected visual acuity (LC-BCVA), optical coherence tomography (OCT), magnetic resonance imaging (MRI) measurements, serum and cerebrospinal fluid (CSF) biomarkers (AQP4-IgG and MOG-IgG levels, neurofilament, and glial fibrillary protein), and patient reported outcome measures (headache, visual function in daily routine, depression, and quality of life questionnaires) at presentation at 6-month and 12-month follow-up visits. Data will be collected from 28 academic hospitals from Africa, Asia, the Middle East, Europe, North America, South America, and Australia. Planned recruitment consists of 100 MS-ON, 50 AQP4-IgG+ON, and 50 MOG-IgG+ON. This prospective, multimodal data collection will assess the potential value of early high-dose corticosteroid treatment, investigate the interrelations between functional impairments and structural changes, and evaluate the diagnostic yield of laboratory biomarkers. This analysis has the ability to substantially improve treatment strategies and the accuracy of diagnostic stratification in acute demyelinating ON. Trial registration ClinicalTrials.gov, identifier: NCT05605951.
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Affiliation(s)
- Susanna Asseyer
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nasrin Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jeffrey Bennett
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Omer Bialer
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yolanda Blanco
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, and Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Francesca Bosello
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Camos-Carreras
- Ophthalmology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Sara Carta
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - John Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, United States
| | - Claudia Chien
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mashina Chomba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Russell C Dale
- Clinical Neuroimmunology Group, Kids Neuroscience Centre, Sydney, NSW, Australia.,Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, NSW, Australia
| | - Josep Dalmau
- ICREA-IDIBAPS, Service of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Kristina Feldmann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Eoin P Flanagan
- Laboratory Medicine and Pathology, Departments of Neurology, Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Caroline Froment Tilikete
- Neuro-Ophthalmology Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, IMPACT Team, Lyon, France
| | | | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mark Hellmann
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ho Jin Kim
- Department of Neurology, National Cancer Center, Goyang, Republic of Korea
| | - Philipp Klyscz
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Konietschke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
| | - Chiara La Morgia
- Neurology Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Lana-Peixoto
- CIEM MS Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Maria Isabel Leite
- Department of Neurology, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Netta Levin
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Michael Levy
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sara Llufriu
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Itay Lotan
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Romain Marignier
- Neuro-Ophthalmology Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, IMPACT Team, Lyon, France
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Translational Brian Science, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, United Kingdom
| | | | - Frederike Cosima Oertel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maja Olszewska
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jacqueline Palace
- Department of Neurology, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Lekha Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, India
| | | | - Sean Pittock
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sudarshini Ramanathan
- Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital Westmead, Sydney, NSW, Australia.,Department of Neurology, Concord Hospital, Sydney, NSW, Australia
| | - Natthapon Rattanathamsakul
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Albert Saiz
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Sara Samadzadeh
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Bernardo Sanchez-Dalmau
- Ophthalmology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Scheel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jemal Shifa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Sasitorn Siritho
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Neuroscience Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Pia S Sperber
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Prem S Subramanian
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Alon Tiosano
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Vaknin-Dembinsky
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Adi Wilf-Yarkoni
- Department of Neurology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Luis Alfonso Zarco
- Pontificia Universidad Javeriana and Hospital Unviersitario San Ignacio, Bogotá, Colombia
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hadas Stiebel-Kalish
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Albano V, Dammacco R, Manni A, Sisto D, Iaffaldano A, Mavilio A, Alessio G, Trojano M, Paolicelli D. Macular ganglion cell-inner plexiform layer defect patterns in multiple sclerosis patients without optic neuritis: A Spectral-Domain-Optical Coherence Tomography Cross-Sectional, Case-Control, Pilot Study. Eur J Ophthalmol 2023; 33:546-555. [PMID: 35799453 DOI: 10.1177/11206721221112803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Spectral-domain optical coherence tomography (SD-OCT) was used to evaluate, in patients with multiple sclerosis without a history of optic neuritis (MSNON), the proportion of the different macular ganglion cell-inner plexiform layer complex (mGCIP) defect patterns. The results were compared with those of healthy controls (HCs). METHODS In this cross-sectional case-control study, 34 eyes of 34 individuals, 17 with MSNON and 17 HCs, were evaluated. All participants underwent mGCIP thickness measurement using SD-OCT (Zeiss Cirrus HD-OCT 4000, macular cube protocol). The mGCIP defect patterns were classified in nine types (minimal, inner, outer, diffuse mild, diffuse severe inferior confined, inferior dominant, superior confined, and superior dominant), according to the shape derived by the deviation map of the instrument, and the proportion of each type was assessed. RESULTS A mGCIP defect pattern was detected in 70.5% of MSNON eyes, with an inner type as the most frequent pattern (47%), followed by the outer type (11.7%) and the inferior confined type (11.7%). No defect was found in Hcs. CONCLUSIONS A significant thinning of the mGCIP with the frequent presence of an inner defect was seen in MSNON patients. The presence of this defect may serve as a biomarker of subclinical optic nerve involvement in MS patients.
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Affiliation(s)
- Valeria Albano
- Department of Neurosciences, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Rosanna Dammacco
- Department of Neurosciences, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Alessia Manni
- Department of Neurosciences, Institute of Neurology, University of Bari, Bari, Italy
| | - Dario Sisto
- Department of Neurosciences, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Antonio Iaffaldano
- Department of Neurosciences, Institute of Neurology, University of Bari, Bari, Italy
| | - Alberto Mavilio
- 27287Local Health Authority Brindisi, Social Health District, Brindisi, Italy
| | - Giovanni Alessio
- Department of Neurosciences, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Maria Trojano
- Department of Neurosciences, Institute of Neurology, University of Bari, Bari, Italy
| | - Damiano Paolicelli
- Department of Neurosciences, Institute of Ophthalmology, University of Bari, Bari, Italy
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11
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Sperber PS, Brandt AU, Zimmermann HG, Bahr LS, Chien C, Rekers S, Mähler A, Böttcher C, Asseyer S, Duchow AS, Bellmann-Strobl J, Ruprecht K, Paul F, Schmitz-Hübsch T. Berlin Registry of Neuroimmunological entities (BERLimmun): protocol of a prospective observational study. BMC Neurol 2022; 22:479. [PMID: 36517734 PMCID: PMC9749207 DOI: 10.1186/s12883-022-02986-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Large-scale disease overarching longitudinal data are rare in the field of neuroimmunology. However, such data could aid early disease stratification, understanding disease etiology and ultimately improve treatment decisions. The Berlin Registry of Neuroimmunological Entities (BERLimmun) is a longitudinal prospective observational study, which aims to identify diagnostic, disease activity and prognostic markers and to elucidate the underlying pathobiology of neuroimmunological diseases. METHODS BERLimmun is a single-center prospective observational study of planned 650 patients with neuroimmunological disease entity (e.g. but not confined to: multiple sclerosis, isolated syndromes, neuromyelitis optica spectrum disorders) and 85 healthy participants with 15 years of follow-up. The protocol comprises annual in-person visits with multimodal standardized assessments of medical history, rater-based disability staging, patient-report of lifestyle, diet, general health and disease specific symptoms, tests of motor, cognitive and visual functions, structural imaging of the neuroaxis and retina and extensive sampling of biological specimen. DISCUSSION The BERLimmun database allows to investigate multiple key aspects of neuroimmunological diseases, such as immunological differences between diagnoses or compared to healthy participants, interrelations between findings of functional impairment and structural change, trajectories of change for different biomarkers over time and, importantly, to study determinants of the long-term disease course. BERLimmun opens an opportunity to a better understanding and distinction of neuroimmunological diseases.
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Affiliation(s)
- Pia S. Sperber
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Disease (DZHK), Berlin, Germany
| | - Alexander U. Brandt
- grid.266093.80000 0001 0668 7243Department of Neurology, University of California, CA Irvine, USA
| | - Hanna G. Zimmermann
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lina S. Bahr
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Claudia Chien
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sophia Rekers
- grid.7468.d0000 0001 2248 7639Berlin School of Mind and Brain, Humboldt Universität Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anja Mähler
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Chotima Böttcher
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Neuropsychiatry and Laboratory of Molecular Psychiatry, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanna Asseyer
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ankelien Solveig Duchow
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Judith Bellmann-Strobl
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Klemens Ruprecht
- grid.6363.00000 0001 2218 4662Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany ,grid.7468.d0000 0001 2248 7639NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.419491.00000 0001 1014 0849Experimental and Clinical Research Center, Clinical Neuroimmunology Group, Lindenberger Weg 80, 13125 Berlin, Germany
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12
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Noll C, Hiltensperger M, Aly L, Wicklein R, Afzali AM, Mardin C, Gasperi C, Berthele A, Hemmer B, Korn T, Knier B. Association of the retinal vasculature, intrathecal immunity, and disability in multiple sclerosis. Front Immunol 2022; 13:997043. [PMID: 36439131 PMCID: PMC9695398 DOI: 10.3389/fimmu.2022.997043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/20/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Optical coherence tomography angiography (OCT-A) is a novel technique allowing non-invasive assessment of the retinal vasculature. During relapsing remitting multiple sclerosis (RRMS), retinal vessel loss occurs in eyes suffering from acute optic neuritis and recent data suggest that retinal vessel loss might also be evident in non-affected eyes. We investigated whether alterations of the retinal vasculature are linked to the intrathecal immunity and whether they allow prognostication of the future disease course. MATERIAL AND METHODS This study includes two different patient cohorts recruited at a tertiary German academic multiple sclerosis center between 2018 and 2020 and a cohort of 40 healthy controls. A total of 90 patients with RRMS undergoing lumbar puncture and OCT-A analysis were enrolled into a cross-sectional cohort study to search for associations between the retinal vasculature and the intrathecal immune compartment. We recruited another 86 RRMS patients into a prospective observational cohort study who underwent clinical examination, OCT-A and cerebral magnetic resonance imaging at baseline and during annual follow-up visits to clarify whether alterations of the retinal vessels are linked to RRMS disease activity. Eyes with a history of optic neuritis were excluded from the analysis. RESULTS Rarefication of the superficial vascular complex occured during RRMS and was linked to higher frequencies of activated B cells and higher levels of the pro-inflammatory cytokines interferon-γ, tumor necrosis factor α and interleukin-17 in the cerebrospinal fluid. During a median follow-up of 23 (interquartile range 14 - 25) months, vessel loss within the superficial (hazard ratio [HR] 1.6 for a 1%-point decrease in vessel density, p=0.01) and deep vascular complex (HR 1.6 for a 1%-point decrease, p=0.05) was associated with future disability worsening. DISCUSSION Optic neuritis independent rarefication of the retinal vasculature might be linked to neuroinflammatory processes during RRMS and might predict a worse disease course. Thus, OCT-A might be a novel biomarker to monitor disease activity and predict future disability.
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Affiliation(s)
- Christina Noll
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Hiltensperger
- Institute for Experimental Neuroimmunology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Ali Maisam Afzali
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Christian Mardin
- Department of Ophthalmology, University Hospital of Erlangen-Nuremberg, Erlangen, Germany
| | - Christiane Gasperi
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
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13
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Chien C, Seiler M, Eitel F, Schmitz-Hübsch T, Paul F, Ritter K. Prediction of high and low disease activity in early MS patients using multiple kernel learning identifies importance of lateral ventricle intensity. Mult Scler J Exp Transl Clin 2022; 8:20552173221109770. [PMID: 35815061 PMCID: PMC9260586 DOI: 10.1177/20552173221109770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/10/2022] [Indexed: 11/15/2022] Open
Abstract
Background Lack of easy-to-interpret disease activity prediction methods in early MS can lead to worse patient prognosis. Objectives Using machine learning (multiple kernel learning – MKL) models, we assessed the prognostic value of various clinical and MRI measures for disease activity. Methods Early MS patients ( n = 148) with at least two associated clinical and MRI visits were investigated. T2-weighted MRIs were cropped to contain mainly the lateral ventricles (LV). High disease activity was defined as surpassing NEDA-3 Criteria more than once per year. Clinical demographic, MRI-extracted image-derived phenotypes (IDP), and MRI data were used as inputs for separate kernels to predict future disease activity with MKL. Model performance was compared using bootstrapped effect size analysis of mean differences. Results A total of 681 visits were included, where 81 (55%) patients had high disease activity in a combined end point measure using all follow-up visits. MKL model discrimination performance was moderate (AUC ≥ 0.62); however, modelling with combined clinical and cropped LV kernels gave the highest prediction performance (AUC = 0.70). Conclusions MRIs contain valuable information on future disease activity, especially in and around the LV. MKL techniques for combining different data types can be used for the prediction of disease activity in a relatively small MS cohort.
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Affiliation(s)
- Claudia Chien
- Claudia Chien,
Charité-Universitätsmedizin Berlin, NeuroCure Clinical Research Center,
Charitéplatz 1, 10117 Berlin, Germany.
| | | | - Fabian Eitel
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin,
Department of Psychiatry and Neurosciences, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin,
Bernstein Center for Computational Neuroscience, Berlin Center for Advanced
Neuroimaging, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC
Experimental and Clinical Research Center, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin,
NeuroCure Clinical Research Center, Berlin, Germany
| | - Friedemann Paul
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC
Experimental and Clinical Research Center, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin,
NeuroCure Clinical Research Center, Berlin, Germany
- Charité – Universitätsmedizin Berlin,
corporate member of Freie Universität Berlin and Humboldt-Universität zu
Berlin, Department of Neurology, Berlin, Germany
| | - Kerstin Ritter
- Charité – Universitätsmedizin Berlin,
corporate member of Freie Universität Berlin and Humboldt-Universität zu
Berlin, Department of Psychiatry and Neurosciences, Berlin, Germany
- Charité – Universitätsmedizin Berlin,
corporate member of Freie Universität Berlin and Humboldt-Universität zu
Berlin, Bernstein Center for Computational Neuroscience, Berlin Center for
Advanced Neuroimaging, Berlin, Germany
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14
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Chen Y, Larraz J, Wong M, Kearns P, Brown F, Martin SJ, Connick P, MacDougall N, Weaver C, Dhillon B, Chandran S. Longitudinal retinal imaging study of newly diagnosed relapsing-remitting multiple sclerosis in Scottish population: baseline and 12 months follow-up profile of FutureMS retinal imaging cohort. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001024. [PMID: 36161838 PMCID: PMC9315911 DOI: 10.1136/bmjophth-2022-001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/03/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveMultiple sclerosis (MS) is an inflammatory degenerative condition of central nervous system. The disease course and presentation of MS is highly heterogeneous. Advanced retinal imaging techniques such as optic coherence tomography (OCT) can capture abnormalities of anterior visual pathway with high resolution, which may contribute greater insights into the pathophysiology of MS.MethodsPeople with newly diagnosed relapsing-remitting MS were recruited for FutureMS retinal imaging study from two study centres in Scotland. The baseline visit was completed within 6 months of diagnosis with initial follow-up 12 months after the baseline visit. The assessments included in FutureMS retinal imaging study were visual acuity test, self-reported eye questionnaire and OCT scan.ResultsA total of 196 FutureMS participants completed the retinal imaging study of FutureMS with 185 participants at M0 and 155 at M12. A total of 144 participants completed both M0 and M12 visits. At the whole cohort level, the distribution of retinal measures is generally consistent between baseline and follow-up.ConclusionThe FutureMS retinal imaging study aims to demonstrate that patient with MS present with different extent of retinal abnormalities that can be captured by retinal imaging modalities such as OCT soon after diagnosis. These changes may sensitively mirror the brain atrophy or serve as predictors for disease activity. By developing sensitive, quantifiable and objective retinal biomarkers, FutureMS retinal imaging study will provide an opportunity to stratify patient with MS at an early stage and support future therapeutic strategies for a better outcome.
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Affiliation(s)
- Yingdi Chen
- The Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, EdinburghUK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Juan Larraz
- The Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, EdinburghUK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Michael Wong
- The Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, EdinburghUK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Patrick Kearns
- The Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, EdinburghUK
- MRC Human Genetics Unit, Chromatin Lab, Genome Regulation Section, University of Edinburgh, Edinburgh, UK
| | - Fraser Brown
- The Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, EdinburghUK
| | - Sarah-Jane Martin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Neurology, Institute of Neurological Sciences,Queen Elizabeth University Hospital-, University of Glasgow, Glasgow, UK
| | - Peter Connick
- The Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, EdinburghUK
- Department of Clinical Neurosciences, Edinburgh Royal Infirmary, NHS Lothian, EdinburghUK
| | - Niall MacDougall
- Department of Neurology, Institute of Neurological Sciences,Queen Elizabeth University Hospital-, University of Glasgow, Glasgow, UK
- Department of Neurology, University Hospital Hairmyres, East Kilbride, UK
| | - Christine Weaver
- The Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, EdinburghUK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Princess Alexandra Eye Pavilion, NHS Lothian, EdinburghUK
| | - Siddharthan Chandran
- The Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, EdinburghUK
- Department of Clinical Neurosciences, Edinburgh Royal Infirmary, NHS Lothian, EdinburghUK
- UK Dementia Research Institue, The University of Edinburgh, Edinburgh, UK
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15
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Al-Hawasi A, Lagali N. Retinal ganglion cell layer thickness and volume measured by OCT changes with age, sex, and axial length in a healthy population. BMC Ophthalmol 2022; 22:278. [PMID: 35751115 PMCID: PMC9233375 DOI: 10.1186/s12886-022-02488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background The ganglion cell layer (GCL) measurements with Optical Coherence Tomography (OCT) are important for both ophthalmologists and neurologists because of their association with many ophthalmic and neurological diseases. Different factors can affect these measurements, such as brain pathologies, ocular axial length (AL) as well as age and sex. Studies conducted to measure the GCL have overlooked many of these factors. The purpose of this study is to examine the effect of age, sex, and AL on normal retinal GCL thickness and volume in a healthy population without any neurological diseases. Methods A prospective cross-sectional study was designed to measure GCL thickness and total volume with OCT with automated segmentation and manual correction where needed. Visual acuity, AL, and autorefraction were also measured. A mixed linear model was used to determine the association of the effect of the various parameters on the GCL thickness and volume. Results One hundred and sixteen eyes of 60 subjects (12–76 years of age, 55% female) were examined of which 77% had 0 ± 2 D of spherical equivalent, and mean axial length was 23.86 mm. About 25% of the OCT-automated GCL measurements required manual correction. GCL thickness did not differ in similar anatomic regions in right and left eyes (P > 0.05). GCL volume was greater in males relative to females after adjustment for age and axial length (1.13 ± 0.07 mm3 for males vs 1.09 ± 0.09 mm3 for females; P = 0.031). GCL thickness differed between males and females in the inner retinal ring (P = 0.025) but not in the outer ring (P = 0.66). GCL volume declined with age (P = 0.031) but not after adjustment for sex and axial length (P = 0.138). GCL volume declined with longer axial length after adjustment for age and sex (P = 0.048). Conclusion Age, sex and axial length should be taken into consideration when measuring the GCL thickness and volume with OCT. Automated OCT segmentation should be reviewed for manual adjustments.
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Affiliation(s)
- Abbas Al-Hawasi
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, 581 83, Linköping, Sweden.
| | - Neil Lagali
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, 581 83, Linköping, Sweden
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16
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Brune S, Høgestøl EA, de Rodez Benavent SA, Berg-Hansen P, Beyer MK, Leikfoss IS, Bos SD, Sowa P, Brunborg C, Andorra M, Pulido Valdeolivas I, Asseyer S, Brandt A, Chien C, Scheel M, Blennow K, Zetterberg H, Kerlero de Rosbo N, Paul F, Uccelli A, Villoslada P, Berge T, Harbo HF. Serum neurofilament light chain concentration predicts disease worsening in multiple sclerosis. Mult Scler 2022; 28:1859-1870. [PMID: 35658739 PMCID: PMC9493412 DOI: 10.1177/13524585221097296] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Serum neurofilament light (sNfL) chain is a promising biomarker reflecting
neuro-axonal injury in multiple sclerosis (MS). However, the ability of sNfL
to predict outcomes in real-world MS cohorts requires further
validation. Objective: The aim of the study is to investigate the associations of sNfL
concentration, magnetic resonance imaging (MRI) and retinal optical
coherence tomography (OCT) markers with disease worsening in a longitudinal
European multicentre MS cohort. Methods: MS patients (n = 309) were prospectively enrolled at four
centres and re-examined after 2 years (n = 226). NfL
concentration was measured by single molecule array assay in serum. The
patients’ phenotypes were thoroughly characterized with clinical
examination, retinal OCT and MRI brain scans. The primary outcome was
disease worsening at median 2-year follow-up. Results: Patients with high sNfL concentrations (⩾8 pg/mL) at baseline had increased
risk of disease worsening at median 2-year follow-up (odds ratio (95%
confidence interval) = 2.8 (1.5–5.3), p = 0.001). We found
no significant associations of MRI or OCT measures at baseline with risk of
disease worsening. Conclusion: Serum NfL concentration was the only factor associated with disease
worsening, indicating that sNfL is a useful biomarker in MS that might be
relevant in a clinical setting.
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Affiliation(s)
- Synne Brune
- Institute of clinical Medicine, University of Oslo, Oslo, Norway/Department of Neurology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Einar A Høgestøl
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway/Department of Neurology, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Pål Berg-Hansen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona K Beyer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway/Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingvild Sørum Leikfoss
- Department of Neurology, Oslo University Hospital, Oslo, Norway/Department of Research, Innovation and Education, Oslo University Hospital, Oslo, Norway
| | - Steffan D Bos
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway/Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Magi Andorra
- Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
| | | | - Susanna Asseyer
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Alexander Brandt
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitaetsmedizin Berlin, Berlin, Germany/NeuroCure Clinical Research Center, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Chien
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitaetsmedizin Berlin, Berlin, Germany/NeuroCure Clinical Research Center, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Scheel
- NeuroCure Clinical Research Center, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany/Department of Neuroradiology, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden/Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden/Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK/UK Dementia Research Institute at UCL, London, UK/Hong Kong Center for Neurodegenerative Diseases, Shatin, Hong Kong, China
| | - Nicole Kerlero de Rosbo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitaetsmedizin Berlin, Berlin, Germany/NeuroCure Clinical Research Center, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy/Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pablo Villoslada
- Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
| | - Tone Berge
- Department of Research, Innovation and Education, Oslo University Hospital, Oslo, Norway/Department of Mechanical, Electronic and Chemical Engineering, Oslo Metropolitan University, Oslo, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway/Department of Neurology, Oslo University Hospital, Oslo, Norway
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Graves J. Identifying Multiple Sclerosis Activity: Do the Eyes Have It? Neurology 2022; 99:269-270. [PMID: 35618437 DOI: 10.1212/wnl.0000000000200903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/13/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jennifer Graves
- Department of Neurosciences, University of California, San Diego
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Yadav SK, Kafieh R, Zimmermann HG, Kauer-Bonin J, Nouri-Mahdavi K, Mohammadzadeh V, Shi L, Kadas EM, Paul F, Motamedi S, Brandt AU. Intraretinal Layer Segmentation Using Cascaded Compressed U-Nets. J Imaging 2022; 8:139. [PMID: 35621903 PMCID: PMC9146486 DOI: 10.3390/jimaging8050139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 05/03/2022] [Indexed: 12/24/2022] Open
Abstract
Reliable biomarkers quantifying neurodegeneration and neuroinflammation in central nervous system disorders such as Multiple Sclerosis, Alzheimer's dementia or Parkinson's disease are an unmet clinical need. Intraretinal layer thicknesses on macular optical coherence tomography (OCT) images are promising noninvasive biomarkers querying neuroretinal structures with near cellular resolution. However, changes are typically subtle, while tissue gradients can be weak, making intraretinal segmentation a challenging task. A robust and efficient method that requires no or minimal manual correction is an unmet need to foster reliable and reproducible research as well as clinical application. Here, we propose and validate a cascaded two-stage network for intraretinal layer segmentation, with both networks being compressed versions of U-Net (CCU-INSEG). The first network is responsible for retinal tissue segmentation from OCT B-scans. The second network segments eight intraretinal layers with high fidelity. At the post-processing stage, we introduce Laplacian-based outlier detection with layer surface hole filling by adaptive non-linear interpolation. Additionally, we propose a weighted version of focal loss to minimize the foreground-background pixel imbalance in the training data. We train our method using 17,458 B-scans from patients with autoimmune optic neuropathies, i.e., multiple sclerosis, and healthy controls. Voxel-wise comparison against manual segmentation produces a mean absolute error of 2.3 μm, outperforming current state-of-the-art methods on the same data set. Voxel-wise comparison against external glaucoma data leads to a mean absolute error of 2.6 μm when using the same gold standard segmentation approach, and 3.7 μm mean absolute error in an externally segmented data set. In scans from patients with severe optic atrophy, 3.5% of B-scan segmentation results were rejected by an experienced grader, whereas this was the case in 41.4% of B-scans segmented with a graph-based reference method. The validation results suggest that the proposed method can robustly segment macular scans from eyes with even severe neuroretinal changes.
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Affiliation(s)
- Sunil Kumar Yadav
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany; (S.K.Y.); (R.K.); (H.G.Z.); (J.K.-B.); (F.P.); (S.M.)
- Nocturne GmbH, 10119 Berlin, Germany;
| | - Rahele Kafieh
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany; (S.K.Y.); (R.K.); (H.G.Z.); (J.K.-B.); (F.P.); (S.M.)
| | - Hanna Gwendolyn Zimmermann
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany; (S.K.Y.); (R.K.); (H.G.Z.); (J.K.-B.); (F.P.); (S.M.)
| | - Josef Kauer-Bonin
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany; (S.K.Y.); (R.K.); (H.G.Z.); (J.K.-B.); (F.P.); (S.M.)
- Nocturne GmbH, 10119 Berlin, Germany;
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (K.N.-M.); (V.M.); (L.S.)
| | - Vahid Mohammadzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (K.N.-M.); (V.M.); (L.S.)
| | - Lynn Shi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (K.N.-M.); (V.M.); (L.S.)
| | | | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany; (S.K.Y.); (R.K.); (H.G.Z.); (J.K.-B.); (F.P.); (S.M.)
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10098 Berlin, Germany
| | - Seyedamirhosein Motamedi
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany; (S.K.Y.); (R.K.); (H.G.Z.); (J.K.-B.); (F.P.); (S.M.)
| | - Alexander Ulrich Brandt
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany; (S.K.Y.); (R.K.); (H.G.Z.); (J.K.-B.); (F.P.); (S.M.)
- Department of Neurology, University of California Irvine, Irvine, CA 92697, USA
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Backner Y, Zamir S, Petrou P, Paul F, Karussis D, Levin N. Anatomical and functional visual network patterns in progressive multiple sclerosis. Hum Brain Mapp 2021; 43:1590-1597. [PMID: 34931352 PMCID: PMC8886643 DOI: 10.1002/hbm.25744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022] Open
Abstract
The gradual accrual of disability over time in progressive multiple sclerosis is believed to be driven by widespread degeneration. Yet another facet of the problem may reside in the loss of the brain's ability to adapt to the damage incurred as the disease progresses. In this study, we attempted to examine whether changes associated with optic neuritis in the structural and functional visual networks can still be discerned in progressive patients even years after the acute insult. Forty-eight progressive multiple sclerosis patients, 21 with and 27 without prior optic neuritis, underwent structural and functional MRI, including DTI and resting state fMRI. Anatomical and functional visual networks were analyzed using graph theory-based methods. While no functional metrics were significantly different between the two groups, anatomical global efficiency and density were significantly lower in the optic neuritis group, despite no significant difference in lesion load between the groups. We conclude that long-standing distal damage to the optic nerve causes trans-synaptic effects and the early ability of the cortex to adapt may be altered, or possibly nullified. We suggest that this limited ability of the brain to compensate should be considered when attempting to explain the accumulation of disability in progressive multiple sclerosis patients.
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Affiliation(s)
- Yael Backner
- The fMRI Unit, Department of Neurology, Hadassah Medical Organization, Jerusalem, Israel.,The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sol Zamir
- The fMRI Unit, Department of Neurology, Hadassah Medical Organization, Jerusalem, Israel.,The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Panayiota Petrou
- Multiple Sclerosis Center, Department of Neurology, Hadassah Medical Organization, Jerusalem, Israel
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dimitrios Karussis
- Multiple Sclerosis Center, Department of Neurology, Hadassah Medical Organization, Jerusalem, Israel
| | - Netta Levin
- The fMRI Unit, Department of Neurology, Hadassah Medical Organization, Jerusalem, Israel.,The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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20
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Lin TY, Chien C, Lu A, Paul F, Zimmermann HG. Retinal optical coherence tomography and magnetic resonance imaging in neuromyelitis optica spectrum disorders and MOG-antibody associated disorders: an updated review. Expert Rev Neurother 2021; 21:1101-1123. [PMID: 34551653 DOI: 10.1080/14737175.2021.1982697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein IgG antibody-associated disorders (MOGAD) comprise two groups of rare neuroinflammatory diseases that cause attack-related damage to the central nervous system (CNS). Clinical attacks are often characterized by optic neuritis, transverse myelitis, and to a lesser extent, brainstem encephalitis/area postrema syndrome. Retinal optical coherence tomography (OCT) is a non-invasive technique that allows for in vivo thickness quantification of the retinal layers. Apart from OCT, magnetic resonance imaging (MRI) plays an increasingly important role in NMOSD and MOGAD diagnosis based on the current international diagnostic criteria. Retinal OCT and brain/spinal cord/optic nerve MRI can help to distinguish NMOSD and MOGAD from other neuroinflammatory diseases, particularly from multiple sclerosis, and to monitor disease-associated CNS-damage. AREAS COVERED This article summarizes the current status of imaging research in NMOSD and MOGAD, and reviews the clinical relevance of OCT, MRI and other relevant imaging techniques for differential diagnosis, screening and monitoring of the disease course. EXPERT OPINION Retinal OCT and MRI can visualize and quantify CNS damage in vivo, improving our understanding of NMOSD and MOGAD pathology. Further efforts on the standardization of these imaging techniques are essential for implementation into clinical practice and as outcome parameters in clinical trials.
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Affiliation(s)
- Ting-Yi Lin
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Chien
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Angelo Lu
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 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 and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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21
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Cellerino M, Priano L, Bruschi N, Boffa G, Petracca M, Novi G, Lapucci C, Sbragia E, Uccelli A, Inglese M. Relationship Between Retinal Layer Thickness and Disability Worsening in Relapsing-Remitting and Progressive Multiple Sclerosis. J Neuroophthalmol 2021; 41:329-334. [PMID: 33399416 DOI: 10.1097/wno.0000000000001165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data regarding the predictive value of optical coherence tomography (OCT)-derived measures are lacking, especially in progressive multiple sclerosis (PMS). Accordingly, we aimed at investigating whether a single OCT assessment can predict a disability risk in both relapsing-remitting MS (RRMS) and PMS. METHODS One hundred one patients with RRMS and 79 patients with PMS underwent Spectral-Domain OCT, including intraretinal layer segmentation. All patients had at least 1 Expanded Disability Status Scale (EDSS) measurement during the subsequent follow-up (FU). Differences in terms of OCT metrics and their association with FU disability were assessed by analysis of covariance and linear regression models, respectively. RESULTS The median FU was 2 years (range 1-5.5 years). The baseline peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell + inner plexiform layer (GCIPL) were thinner in PMS compared with RRMS (P = 0.02 and P = 0.003, respectively). In the RRMS population, multivariable models showed that the GCIPL significantly correlated with FU disability (0.04 increase in the EDSS for each 1-μm decrease in the baseline GCIPL, 95% confidence interval: 0.006-0.08; P = 0.02). The baseline GCIPL was thinner in patients with RRMS with FU-EDSS >4 compared with those with FU-EDSS ≤4, and individuals in the highest baseline GCIPL tertile had a significantly lower FU-EDSS score than those in the middle and lowest tertile (P = 0.01 and P = 0.001, respectively). These findings were not confirmed in analyses restricted to patients with PMS. CONCLUSIONS Among OCT-derived metrics, GCIPL thickness had the strongest association with short-medium term disability in patients with RRMS. The predictive value of OCT metrics in the longer term will have to be further investigated, especially in PMS.
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Affiliation(s)
- Maria Cellerino
- Department of Neuroscience (MC, LP, NB, GB, GN, CL, ES, AU, MI), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy ; Departments of Neurology (MP, MI), Icahn School of Medicine at Mount Sinai, New York, New York; and Department of Neurology (AU, MI) Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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22
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Lin TY, Vitkova V, Asseyer S, Martorell Serra I, Motamedi S, Chien C, Ditzhaus M, Papadopoulou A, Benkert P, Kuhle J, Bellmann-Strobl J, Ruprecht K, Paul F, Brandt AU, Zimmermann HG. Increased Serum Neurofilament Light and Thin Ganglion Cell-Inner Plexiform Layer Are Additive Risk Factors for Disease Activity in Early Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/5/e1051. [PMID: 34348969 PMCID: PMC8362351 DOI: 10.1212/nxi.0000000000001051] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
Objective To investigate the association of combined serum neurofilament light chain (sNfL) and retinal optical coherence tomography (OCT) measurements with future disease activity in patients with early multiple sclerosis (MS). Methods We analyzed sNfL by single molecule array technology and performed OCT measurements in a prospective cohort of 78 patients with clinically isolated syndrome and early relapsing-remitting MS with a median (interquartile range) follow-up of 23.9 (23.3–24.7) months. Patients were grouped into those with abnormal or normal sNfL levels, defined as sNfL ≥/<80th percentile of age-corrected reference values. Likewise, patients were grouped by a median split into those with thin or thick ganglion cell and inner plexiform layer (GCIP), peripapillary retinal nerve fiber layer, and inner nuclear layer in nonoptic neuritis eyes. Outcome parameters were violation of no evidence of disease activity (NEDA-3) criteria or its components. Results Patients with abnormal baseline sNfL had a higher risk of violating NEDA-3 (hazard ratio [HR] 2.28, 95% CI 1.27–4.09, p = 0.006) and developing a new brain lesion (HR 2.47, 95% CI 1.30–4.69, p = 0.006), but not for a new relapse (HR 2.21, 95% CI 0.97–5.03, p = 0.058). Patients with both abnormal sNfL and thin GCIP had an even higher risk for NEDA-3 violation (HR 3.61, 95% CI 1.77–7.36, p = 4.2e−4), new brain lesion (HR 3.19, 95% CI 1.51–6.76, p = 0.002), and new relapse (HR 5.38, 95% CI 1.61–17.98, p = 0.006) than patients with abnormal sNfL alone. Conclusions In patients with early MS, the presence of both abnormal sNfL and thin GCIP is a stronger risk factor for future disease activity than the presence of each parameter alone.
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Affiliation(s)
- Ting-Yi Lin
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Viktoriya Vitkova
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Susanna Asseyer
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Ivette Martorell Serra
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Seyedamirhosein Motamedi
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Claudia Chien
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Marc Ditzhaus
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Athina Papadopoulou
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Pascal Benkert
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Jens Kuhle
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Judith Bellmann-Strobl
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Klemens Ruprecht
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Friedemann Paul
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Alexander U Brandt
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine
| | - Hanna G Zimmermann
- From the Experimental and Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), 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; NeuroCure Clinical Research Center (T.-Y.L., V.V., S.A., I.M.S., S.M., C.C., A.P., J.B.-S., F.P., A.U.B., H.G.Z.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Psychiatry and Psychotherapy (C.C.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Statistics (M.D.), TU Dortmund University, Germany; Neurology Clinic and Policlinic (A.P., J.K.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Neurology (K.R., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine.
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Abstract
Multiple sclerosis (MS) is a neurological inflammatory disorder known to attack the heavily myelinated regions of the nervous system including the optic nerves, cerebellum, brainstem and spinal cord. This review will discuss the clinical manifestations and investigations for MS and other similar neurological inflammatory disorders affecting vision, as well as the effects of MS treatments on vision. Assessment of visual pathways is critical, considering MS can involve multiple components of the visual pathway, including optic nerves, uvea, retina and occipital cortex. Optical coherence tomography is increasingly being recognised as a highly sensitive tool in detecting subclinical optic nerve changes. Magnetic resonance imaging (MRI) is critical in MS diagnosis and in predicting long-term disability. Optic neuritis in MS involves unilateral vision loss, with characteristic pain on eye movement. The visual loss in neuromyelitis optica spectrum disorder tends to be more severe with preferential altitudinal field loss, chiasmal and tract lesions are also more common. Other differential diagnoses include chronic relapsing inflammatory optic neuropathy and giant cell arteritis. Leber's hereditary optic neuropathy affects young males and visual loss tends to be painless and subacute, typically involving both optic nerves. MS lesions in the vestibulocerebellum, brainstem, thalamus and basal ganglia may lead to abnormalities of gaze, saccades, pursuit and nystagmus which can be identified on eye examination. Medial longitudinal fasciculus lesions can cause another frequent presentation of MS, internuclear ophthalmoplegia, with failure of ipsilateral eye adduction and contralateral eye abduction nystagmus. Treatments for MS include high-dose corticosteroids for acute relapses and disease-modifying medications for relapse prevention. These therapies may also have adverse effects on vision, including central serous retinopathy with corticosteroid therapy and macular oedema with fingolimod.
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Affiliation(s)
- Roshan Dhanapalaratnam
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
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Krämer J, Wiendl H, Meuth SG, Albrecht P. Combined Neurofilament Light and Optical Coherence Tomography Better Predicts Multiple Sclerosis Disease Activity Than Either Measure Alone. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/5/e1054. [PMID: 34348970 PMCID: PMC8362346 DOI: 10.1212/nxi.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Julia Krämer
- From the Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; and Department of Neurology (S.G.M., P.A.), University Hospital Düsseldorf, Germany.
| | - Heinz Wiendl
- From the Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; and Department of Neurology (S.G.M., P.A.), University Hospital Düsseldorf, Germany
| | - Sven G Meuth
- From the Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; and Department of Neurology (S.G.M., P.A.), University Hospital Düsseldorf, Germany
| | - Philipp Albrecht
- From the Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; and Department of Neurology (S.G.M., P.A.), University Hospital Düsseldorf, Germany.
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25
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Klumbies K, Rust R, Dörr J, Konietschke F, Paul F, Bellmann-Strobl J, Brandt AU, Zimmermann HG. Retinal Thickness Analysis in Progressive Multiple Sclerosis Patients Treated With Epigallocatechin Gallate: Optical Coherence Tomography Results From the SUPREMES Study. Front Neurol 2021; 12:615790. [PMID: 33995239 PMCID: PMC8113620 DOI: 10.3389/fneur.2021.615790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Epigallocatechin gallate (EGCG) is an anti-inflammatory agent and has proven neuroprotective properties in animal models of multiple sclerosis (MS). Optical coherence tomography (OCT) assessed retinal thickness analysis can reflect treatment responses in MS. Objective: To analyze the influence of EGCG treatment on retinal thickness analysis as secondary and exploratory outcomes of the randomized controlled Sunphenon in Progressive Forms of MS trial (SUPREMES, NCT00799890). Methods: SUPREMES patients underwent OCT with the Heidelberg Spectralis device at a subset of visits. We determined peripapillary retinal nerve fiber layer (pRNFL) thickness from a 12° ring scan around the optic nerve head and thickness of the ganglion cell/inner plexiform layer (GCIP) and inner nuclear layer (INL) within a 6 mm diameter grid centered on the fovea from a macular volume scan. Longitudinal OCT data were available for exploratory analysis from 31 SUPREMES participants (12/19 primary/secondary progressive MS (PPMS/SPMS); mean age 51 ± 7 years; 12 female; mean time since disease onset 16 ± 11 years). We tested the null hypothesis of no treatment*time interaction using nonparametric analysis of longitudinal data in factorial experiments. Results: After 2 years, there were no significant differences in longitudinal retinal thickness changes between EGCG treated and placebo arms in any OCT parameter (Mean change [confidence interval] ECGC vs. Placebo: pRNFL: -0.83 [1.29] μm vs. -0.64 [1.56] μm, p = 0.156; GCIP: -0.67 [0.67] μm vs. -0.14 [0.47] μm, p = 0.476; INL: -0.06 [0.58] μm vs. 0.22 [0.41] μm, p = 0.455). Conclusion: Retinal thickness analysis did not reveal a neuroprotective effect of EGCG. While this is in line with the results of the main SUPREMES trial, our study was probably underpowered to detect an effect. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT00799890.
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Affiliation(s)
- Katharina Klumbies
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Rebekka Rust
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jan Dörr
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Neurology Department, Oberhavel Clinic, Hennigsdorf, Germany
| | - Frank Konietschke
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander U Brandt
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Schurz N, Sariaslani L, Altmann P, Leutmezer F, Mitsch C, Pemp B, Rommer P, Zrzavy T, Berger T, Bsteh G. Evaluation of Retinal Layer Thickness Parameters as Biomarkers in a Real-World Multiple Sclerosis Cohort. Eye Brain 2021; 13:59-69. [PMID: 33737853 PMCID: PMC7966301 DOI: 10.2147/eb.s295610] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Retinal layer thickness parameters measured by optical coherence tomography (OCT) are emerging biomarkers of neuroaxonal degeneration and inflammation in multiple sclerosis (MS). We aimed to evaluate the value of retinal layer thickness for prediction of disability worsening and relapse in a real-world MS cohort. Patients and Methods For this longitudinal observational study, we included MS patients with spectral-domain OCT scans available and ≥1 year of clinical follow-up. The value of peripapillary retinal nerve fiber layer (pRNFL), macular ganglion-cell-and-inner-plexiform-layer (GCIPL) and inner nuclear layer (INL) thickness for prediction of disability worsening and relapse during the observation period was tested by multivariate models. Results We analyzed 60 MS patients during a mean observation period of 2.9 years (SD 1.8). Lower baseline thickness of GCIPL (cut-off <77µm; HR 4.1, p=0.001) and pRNFL (cut-off ≤88µm; HR 3.1, p=0.019) were associated with an increased risk of disability worsening. Longitudinally, mean thinning rates were −0.8µm/year (SD 1.6) for GCIPL, −0.6µm/year (SD 3.5) for pRNFL. GCIPL thinning ≥1.0µm/year and pRNFL >1.5µm/year is associated with higher likelihood of disability worsening (HR 5.7, p=0.009 and HR 6.8, p=0.003, respectively). INL thickened in patients with relapse by a mean 0.9µm while thinning by 0.3µm in patients without relapse (p=0.04). In multivariate analyses, INL thickening was associated with an increased probability of relapse (OR 17.8, p=0.023). Conclusion Cross-sectional and longitudinal measurement of GCIPL and pRNFL thinning is reliable as a biomarker of disability worsening in a real-world setting. Change of INL thickness is a promising marker of relapse, i.e. inflammatory activity.
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Affiliation(s)
- Natascha Schurz
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Lydia Sariaslani
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Patrick Altmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Christoph Mitsch
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Tobias Zrzavy
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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27
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De Meo E, Bonacchi R, Moiola L, Colombo B, Sangalli F, Zanetta C, Amato MP, Martinelli V, Rocca MA, Filippi M. Early Predictors of 9-Year Disability in Pediatric Multiple Sclerosis. Ann Neurol 2021; 89:1011-1022. [PMID: 33598931 DOI: 10.1002/ana.26052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to assess early predictors of 9-year disability in pediatric patients with multiple sclerosis. METHODS Clinical and magnetic resonance imaging (MRI) assessments of 123 pediatric patients with multiple sclerosis were obtained at disease onset and after 1 and 2 years. A 9-year clinical follow-up was also performed. Cox proportional hazard and multivariable regression models were used to assess independent predictors of time to first relapse and 9-year outcomes. RESULTS Time to first relapse was predicted by optic nerve lesions (hazard ratio [HR] = 2.10, p = 0.02) and high-efficacy treatment exposure (HR = 0.31, p = 0.005). Predictors of annualized relapse rate were: at baseline, presence of cerebellar (β = -0.15, p < 0.001), cervical cord lesions (β = 0.16, p = 0.003), and high-efficacy treatment exposure (β = -0.14, p = 0.01); considering also 1-year variables, number of relapses (β = 0.14, p = 0.002), and the previous baseline predictors; considering 2-year variables, time to first relapse (2-year: β = -0.12, p = 0.01) entered, whereas high-efficacy treatment exposure exited the model. Predictors of 9-year disability worsening were: at baseline, presence of optic nerve lesions (odds ratio [OR] = 6.45, p = 0.01); considering 1-year and 2-year variables, Expanded Disability Status Scale (EDSS) changes (1-year: OR = 26.05, p < 0.001; 2-year: OR = 16.38, p = 0.02), and ≥ 2 new T2-lesions in 2 years (2-year: OR = 4.91, p = 0.02). Predictors of higher 9-year EDSS score were: at baseline, EDSS score (β = 0.58, p < 0.001), presence of brainstem lesions (β = 0.31, p = 0.04), and number of cervical cord lesions (β = 0.22, p = 0.05); considering 1-year and 2-year variables, EDSS changes (1-year: β = 0.79, p < 0.001; 2-year: β = 0.55, p < 0.001), and ≥ 2 new T2-lesions (1-year: β = 0.28, p = 0.03; 2-year: β = 0.35, p = 0.01). INTERPRETATION A complete baseline MRI assessment and an accurate clinical and MRI monitoring during the first 2 years of disease contribute to predict 9-year prognosis in pediatric patients with multiple sclerosis. ANN NEUROL 2021;89:1011-1022.
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Affiliation(s)
- Ermelinda De Meo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Raffaello Bonacchi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Chiara Zanetta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Allen CM, Mowry E, Tintore M, Evangelou N. Prognostication and contemporary management of clinically isolated syndrome. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-323087. [PMID: 33361410 DOI: 10.1136/jnnp-2020-323087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022]
Abstract
Clinically isolated syndrome (CIS) patients present with a single attack of inflammatory demyelination of the central nervous system. Recent advances in multiple sclerosis (MS) diagnostic criteria have expanded the number of CIS patients eligible for a diagnosis of MS at the onset of the disease, shrinking the prevalence of CIS. MS treatment options are rapidly expanding, which is driving the need to recognise MS at its earliest stages. In CIS patients, finding typical MS white matter lesions on the patient's MRI scan remains the most influential prognostic investigation for predicting subsequent diagnosis with MS. Additional imaging, cerebrospinal fluid and serum testing, information from the clinical history and genetic testing also contribute. For those subsequently diagnosed with MS, there is a wide spectrum of long-term clinical outcomes. Detailed assessment at the point of presentation with CIS provides fewer clues to calculate a personalised risk of long-term severe disability.Clinicians should select suitable CIS cases for steroid treatment to speed neurological recovery. Unfortunately, there are still no neuroprotection or remyelination strategies available. The use of MS disease modifying therapy for CIS varies among clinicians and national guidelines, suggesting a lack of robust evidence to guide practice. Clinicians should focus on confirming MS speedily and accurately with appropriate investigations. Diagnosis with CIS provides an opportune moment to promote a healthy lifestyle, in particular smoking cessation. Patients also need to understand the link between CIS and MS. This review provides clinicians an update on the contemporary evidence guiding prognostication and management of CIS.
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Affiliation(s)
- Christopher Martin Allen
- Department of Clinical Neurology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Ellen Mowry
- Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mar Tintore
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
- Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Nikos Evangelou
- Department of Clinical Neurology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Vidal-Jordana A, Rovira A, Arrambide G, Otero-Romero S, Río J, Comabella M, Nos C, Castilló J, Galan I, Cabello S, Moncho D, Rahnama K, Thonon V, Rodríguez-Acevedo B, Zabalza A, Midaglia L, Auger C, Sastre-Garriga J, Montalban X, Tintoré M. Optic Nerve Topography in Multiple Sclerosis Diagnosis: The Utility of Visual Evoked Potentials. Neurology 2020; 96:e482-e490. [PMID: 33328323 PMCID: PMC7905792 DOI: 10.1212/wnl.0000000000011339] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria. Methods From the Barcelona clinically isolated syndrome (CIS) cohort, patients with complete information to assess dissemination in space (DIS), the optic nerve region, and dissemination in time at baseline (n = 388) were selected. Modified DIS (modDIS) criteria were constructed by adding the optic nerve to the current DIS regions. The DIS and modDIS criteria were evaluated with univariable Cox proportional hazard regression analyses with the time to the second attack as the outcome. A subset of these patients who had at least 10 years of follow-up or a second attack occurring within 10 years (n = 151) were selected to assess the diagnostic performance. The analyses were also performed according to CIS topography (optic neuritis vs non–optic neuritis). Results The addition of the optic nerve as a fifth region improved the diagnostic performance by slightly increasing the accuracy (2017 DIS 75.5%, modDIS 78.1%) and the sensitivity (2017 DIS 79.2%, modDIS 82.3%) without lowering the specificity (2017 DIS 52.4%, modDIS 52.4%). When the analysis was conducted according to CIS topography, the modDIS criteria performed similarly in both optic neuritis and non–optic neuritis CIS. Conclusion The addition of the optic nerve, assessed by VEP, as a fifth region in the current DIS criteria slightly improves the diagnostic performance because it increases sensitivity without losing specificity.
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Affiliation(s)
- Angela Vidal-Jordana
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada.
| | - Alex Rovira
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Georgina Arrambide
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Susana Otero-Romero
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Jordi Río
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Manuel Comabella
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Carlos Nos
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Joaquin Castilló
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Ingrid Galan
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Sergio Cabello
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Dulce Moncho
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Kimia Rahnama
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Vanessa Thonon
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Breogan Rodríguez-Acevedo
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Ana Zabalza
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Luciana Midaglia
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Cristina Auger
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Jaume Sastre-Garriga
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Xavier Montalban
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Mar Tintoré
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
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Sá MJ, Soares Dos Reis R, Altintas A, Celius EG, Chien C, Comi G, Graus F, Hillert J, Hobart J, Khan G, Kissani N, Langdon D, Leite MI, Okuda DT, Palace J, Papais-Alvarenga RM, Mendes-Pinto I, Shi FD. State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis. Neurol Ther 2020; 9:281-300. [PMID: 32666470 PMCID: PMC7606370 DOI: 10.1007/s40120-020-00202-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
The 5th International Porto Congress of Multiple Sclerosis took place between the 14th and 16th of February 2019 in Porto, Portugal. Its intensive programme covered a wide-range of themes-including many of the hot topics, challenges, pitfalls and yet unmet needs in the field of multiple sclerosis (MS)-led by a number of well-acknowledged world experts. This meeting review summarizes the talks that took place during the congress, which focussed on issues in MS as diverse as the development and challenges of progressive MS, epidemiology, differential diagnosis, medical management, molecular research and imaging tools.
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Affiliation(s)
- María José Sá
- Department of Neurology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernáni Monteiro, Porto, Portugal.
- Faculty of Health Sciences, University Fernando Pessoa, Rua Carlos da Maia, Porto, Portugal.
| | - Ricardo Soares Dos Reis
- Department of Neurology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernáni Monteiro, Porto, Portugal.
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ayse Altintas
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
| | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claudia Chien
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Giancarlo Comi
- Department of Neurology, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesc Graus
- Department of Neurology, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Hospital Clínic, Barcelona, Spain
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jeremy Hobart
- Department of Neurology, University Hospitals Plymouth, Plymouth, UK
- Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Najib Kissani
- Neurology Department, Marrakech University Hospital Mohammed VI, Marrakech, Morocco
- Neuroscience Research Laboratory, Marrakesh Medical School, Cadi Ayyad University, Marrakech, Morocco
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Fu-Dong Shi
- Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
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Borgström M, Tisell A, Link H, Wilhelm E, Lundberg P, Huang‐Link Y. Retinal thinning and brain atrophy in early MS and CIS. Acta Neurol Scand 2020; 142:418-427. [PMID: 32416627 DOI: 10.1111/ane.13282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) could be complementary to magnetic resonance imaging (MRI) of the brain in monitoring course of multiple sclerosis (MS) and clinically isolated syndrome (CIS). Thinning of neurons in ganglion cell-inner plexiform layer (GCIPL) measured by OCT is assumed to be associated with brain atrophy. OBJECTIVES To evaluate association of GCIPL with brain parameters detected by quantitative MRI (qMRI) and MR-spectroscopy (MRS) in early MS and CIS. METHODS Seventeen newly diagnosed MS and 18 CIS patients were prospectively included. The patients were assessed at baseline as well as at 1 year follow-up by OCT, qMRI and MRS. Brain parenchymal and myelin volumes (BPV, MYV respectively) and the corresponding fractions (BPF, MYF) were measured with qMRI. Metabolites including myo-inositol (myo-Ins) were measured in the normal-appearing white matter (NAWM) using MRS. T-tests and ANOVA were used to analyze group differences, and linear regression models to evaluate association of GCIPL with BPV, MYV and myo-Ins after correlation analysis. RESULTS Disease activity reflected by lesions on MRI and presence of CSF oligoclonal IgG bands were more prominent in MS compared to CIS. GCIPL, BPV, MYV, BPF and MYF were reduced, while concentration of myo-Ins was increased in MS compared to CIS. Follow-up showed consistency of thinner GCIPL in MS compared to CIS. GCIPL thinning correlated with reduced BPV and MYV (P < .05 for both), but with increased myo-Ins (P < .01). CONCLUSIONS Significant GCIPL thinning occurs in early MS and is associated with enhanced brain inflammation and atrophy.
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Affiliation(s)
- Max Borgström
- Division of Neurology Department of Biomedical and Clinical Sciences Faculty of Medicine and Health Sciences Linköping University Linköping Sweden
| | - Anders Tisell
- Department of Radiation Physics Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
- Centre for Medical Image Science and Visualization (CMIV) Linköping University Linköping Sweden
| | - Hans Link
- Department of Clinical Neuroscience Karolinska Institute Stockholm Sweden
| | - Elisabeth Wilhelm
- Division of Society and Health, Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Peter Lundberg
- Department of Radiation Physics Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
- Centre for Medical Image Science and Visualization (CMIV) Linköping University Linköping Sweden
| | - Yumin Huang‐Link
- Division of Neurology Department of Biomedical and Clinical Sciences Faculty of Medicine and Health Sciences Linköping University Linköping Sweden
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Kleiter I, Ayzenberg I, Havla J, Lukas C, Penner IK, Stadelmann C, Linker RA. The transitional phase of multiple sclerosis: Characterization and conceptual framework. Mult Scler Relat Disord 2020; 44:102242. [DOI: 10.1016/j.msard.2020.102242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
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Outteryck O, Lopes R, Drumez É, Labreuche J, Lannoy J, Hadhoum N, Boucher J, Vermersch P, Zedet M, Pruvo JP, Zéphir H, Leclerc X. Optical coherence tomography for detection of asymptomatic optic nerve lesions in clinically isolated syndrome. Neurology 2020; 95:e733-e744. [DOI: 10.1212/wnl.0000000000009832] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/06/2020] [Indexed: 12/24/2022] Open
Abstract
ObjectiveTo evaluate the ability of intereye retinal thickness difference (IETD) measured by optical coherence tomography (OCT) to detect asymptomatic optic nerve involvement in clinically isolated syndrome (CIS).MethodsWe conducted a cross-sectional study of patients who recently presented a CIS (≤4.5 months). All patients underwent OCT and brain/optic nerve MRI. Optic nerve involvement was defined clinically (episode of optic neuritis [ON] or not) and radiologically (optic nerve hypersignal on 3D double inversion recovery [3D-DIR]). We evaluated the sensitivity and specificity of previously published IETD thresholds and report the observed optimal thresholds for identifying symptomatic optic nerve involvement but also for identifying asymptomatic optic nerve involvement (optic nerve hypersignal without ON history). Primary outcomes were ganglion cell–inner plexiform layer (GC-IPL) and peripapillary retinal nerve fiber layer IETD.ResultsThe study group consisted of 130 patients. In the CIS with ON group, 3D-DIR showed a hypersignal in all 41 symptomatic optic nerves and in 11 asymptomatic optic nerves. In the CIS without ON group, 3D-DIR showed a unilateral optic nerve hypersignal in 22 patients and a bilateral optic nerve hypersignal in 7 patients. For the detection of symptomatic and asymptomatic optic nerve lesion, GC-IPL IETD had better performance. We found an optimal GC-IPL IETD threshold ≥2.83 µm (sensitivity 88.2, specificity 83.3%) for the detection of symptomatic lesions and an optimal GC-IPL IETD ≥1.42 µm (sensitivity 89.3%, specificity 72.6%) for the detection of asymptomatic lesions.ConclusionsDetection of asymptomatic optic nerve lesions in CIS requires lower IETD thresholds than previously reported. GC-IPL IETD represents an alternative biomarker to MRI for the detection of asymptomatic optic nerve lesions.Classification of evidenceThis study provides Class I evidence that OCT accurately identifies asymptomatic optic nerve involvement in patients with CIS.
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Aly L, Havla J, Lepennetier G, Andlauer TFM, Sie C, Strauß EM, Hoshi MM, Kümpfel T, Hiltensperger M, Mitsdoerffer M, Mühlau M, Zimmer C, Hemmer B, Korn T, Knier B. Inner retinal layer thinning in radiologically isolated syndrome predicts conversion to multiple sclerosis. Eur J Neurol 2020; 27:2217-2224. [PMID: 32589804 DOI: 10.1111/ene.14416] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with radiologically isolated syndrome (RIS) are at increased risk of converting to multiple sclerosis (MS). Early identification of later converters is crucial for optimal treatment decisions. The purpose of this study was to assess the predictive potential of optical coherence tomography (OCT) measures in individuals with RIS regarding conversion to MS. METHODS This prospective observational cohort study included 36 individuals with RIS and 36 healthy controls recruited from two German MS centers. All individuals received baseline OCT and clinical examination and were longitudinally followed over up to 6 years. The primary outcome measure was the conversion to MS. RESULTS During clinical follow-up of 46 (26-58) months (median, 25%-75% interquartile range), eight individuals with RIS converted to MS. Individuals converting to MS showed a thinning of the peripapillary retinal nerve fiber layer (pRNFL) and the common ganglion cell and inner plexiform layer (GCIP) at baseline and during follow-up. Individuals with a pRNFL of 99 µm or lower or a GCIP of 1.99 mm3 or lower were at a 7.5- and 8.0-fold risk for MS conversion, respectively, compared to individuals with higher measures. After correction for other known risk factors, Cox proportional hazards regression revealed a hazard ratio of 1.08 for conversion to MS for each 1 µm decline in pRNFL. CONCLUSIONS Reduction of the pRNFL might be a novel and independent risk factor for conversion to MS in individuals with RIS. OCT might be useful for risk stratification and therapeutic decision-making in individuals with RIS.
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Affiliation(s)
- L Aly
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - J Havla
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Technical University of Munich and Ludwig-Maximilians University, Munich, Germany
| | - G Lepennetier
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - T F M Andlauer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Sie
- Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - E-M Strauß
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M-M Hoshi
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Marianne-Strauß-Klinik, Berg, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
| | - M Hiltensperger
- Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M Mitsdoerffer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M Mühlau
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Technical University of Munich and Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - T Korn
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - B Knier
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
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Filippi M, Preziosa P, Langdon D, Lassmann H, Paul F, Rovira À, Schoonheim MM, Solari A, Stankoff B, Rocca MA. Identifying Progression in Multiple Sclerosis: New Perspectives. Ann Neurol 2020; 88:438-452. [PMID: 32506714 DOI: 10.1002/ana.25808] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 01/10/2023]
Abstract
The identification of progression in multiple sclerosis is typically retrospective. Given the profound burden of progressive multiple sclerosis, and the recent development of effective treatments for these patients, there is a need to establish measures capable of identifying progressive multiple sclerosis early in the disease course. Starting from recent pathological findings, this review assesses the state of the art of potential measures able to predict progressive multiple sclerosis. Future promising biomarkers that might shed light on mechanisms of progression are also discussed. Finally, expansion of the concept of progressive multiple sclerosis, by including an assessment of cognition, patient-reported outcomes, and comorbidities, is considered. ANN NEUROL 2020;88:438-452.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dawn Langdon
- Royal Holloway, University of London, London, United Kingdom
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Àlex Rovira
- Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital and Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, Multiple Sclerosis Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bruno Stankoff
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute - ICM, Inserm, CNRS, APHP, Paris, France
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Kuchling J, Paul F. Visualizing the Central Nervous System: Imaging Tools for Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders. Front Neurol 2020; 11:450. [PMID: 32625158 PMCID: PMC7311777 DOI: 10.3389/fneur.2020.00450] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are autoimmune central nervous system conditions with increasing incidence and prevalence. While MS is the most frequent inflammatory CNS disorder in young adults, NMOSD is a rare disease, that is pathogenetically distinct from MS, and accounts for approximately 1% of demyelinating disorders, with the relative proportion within the demyelinating CNS diseases varying widely among different races and regions. Most immunomodulatory drugs used in MS are inefficacious or even harmful in NMOSD, emphasizing the need for a timely and accurate diagnosis and distinction from MS. Despite distinct immunopathology and differences in disease course and severity there might be considerable overlap in clinical and imaging findings, posing a diagnostic challenge for managing neurologists. Differential diagnosis is facilitated by positive serology for AQP4-antibodies (AQP4-ab) in NMOSD, but might be difficult in seronegative cases. Imaging of the brain, optic nerve, retina and spinal cord is of paramount importance when managing patients with autoimmune CNS conditions. Once a diagnosis has been established, imaging techniques are often deployed at regular intervals over the disease course as surrogate measures for disease activity and progression and to surveil treatment effects. While the application of some imaging modalities for monitoring of disease course was established decades ago in MS, the situation is unclear in NMOSD where work on longitudinal imaging findings and their association with clinical disability is scant. Moreover, as long-term disability is mostly attack-related in NMOSD and does not stem from insidious progression as in MS, regular follow-up imaging might not be useful in the absence of clinical events. However, with accumulating evidence for covert tissue alteration in NMOSD and with the advent of approved immunotherapies the role of imaging in the management of NMOSD may be reconsidered. By contrast, MS management still faces the challenge of implementing imaging techniques that are capable of monitoring progressive tissue loss in clinical trials and cohort studies into treatment algorithms for individual patients. This article reviews the current status of imaging research in MS and NMOSD with an emphasis on emerging modalities that have the potential to be implemented in clinical practice.
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Affiliation(s)
- Joseph Kuchling
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, 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
- Berlin Institute of Health, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, 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
- Berlin Institute of Health, Berlin, Germany
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Pihl-Jensen G, Wanscher B, Frederiksen JL. Predictive value of optical coherence tomography, multifocal visual evoked potentials, and full-field visual evoked potentials of the fellow, non-symptomatic eye for subsequent multiple sclerosis development in patients with acute optic neuritis. Mult Scler 2020; 27:391-400. [PMID: 32507033 DOI: 10.1177/1352458520917924] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Diagnosis of multiple sclerosis (MS) may sometimes be ascertained at the time of optic neuritis (ON) but other times require the advent of new disease activity. OBJECTIVES The aim of this study was to examine the predictive value of optical coherence tomography (OCT) and visual evoked potential (VEP) measurements of the non-symptomatic, fellow eye of ON patients, for conversion to MS. METHODS This is a prospective cohort study in patients with acute ON. OCT thickness measurements of peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell layer-inner plexiform layer (GCLIPL), and multifocal (mf) VEP and full-field (ff) VEP, were performed. Univariate and multivariate Cox regression examined the value of predictors for the conversion to MS. RESULTS A total of 79 unilateral, acute ON patients, with no MS diagnosis or prior demyelination, were included. Of which, 28 patients developed MS during follow-up. Inferonasal GCLIPL, mean GCLIPL, and pRNFL thickness significantly predicted MS development in multivariate analysis (hazard ratio (HR) = 0.922-0.939, p = 0.0172-0.021). MfVEP mean latency (HR = 1.052, p = 0.006) only predicted MS conversion in univariate analysis. No significant predictive value was shown for the other parameters (p > 0.2). CONCLUSION While both mfVEP and OCT are useful tools in the evaluation of acute ON patients, only OCT measurements of fellow eyes may serve as an independent predictor of MS development.
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Affiliation(s)
- Gorm Pihl-Jensen
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet-Glostrup, Glostrup, Denmark/University of Copenhagen, Copenhagen, Denmark
| | - Benedikte Wanscher
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet-Glostrup, Glostrup, Denmark/University of Copenhagen, Copenhagen, Denmark
| | - Jette Lautrup Frederiksen
- Department of Clinical Neurophysiology, Rigshospitalet-Glostrup, Glostrup, Denmark/Department of Neurology, Slagelse Hospital, Slagelse, Denmark
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Bittner S, Steffen F, Uphaus T, Muthuraman M, Fleischer V, Salmen A, Luessi F, Berthele A, Klotz L, Meuth SG, Bayas A, Paul F, Hartung HP, Linker R, Heesen C, Stangel M, Wildemann B, Then Bergh F, Tackenberg B, Kuempfel T, Weber F, Zettl UK, Ziemann U, Tumani H, Groppa S, Mühlau M, Lukas C, Hemmer B, Wiendl H, Gold R, Zipp F. Clinical implications of serum neurofilament in newly diagnosed MS patients: A longitudinal multicentre cohort study. EBioMedicine 2020; 56:102807. [PMID: 32460167 PMCID: PMC7251380 DOI: 10.1016/j.ebiom.2020.102807] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022] Open
Abstract
Background We aim to evaluate serum neurofilament light chain (sNfL), indicating neuroaxonal damage, as a biomarker at diagnosis in a large cohort of early multiple sclerosis (MS) patients. Methods In a multicentre prospective longitudinal observational cohort, patients with newly diagnosed relapsing-remitting MS (RRMS) or clinically isolated syndrome (CIS) were recruited between August 2010 and November 2015 in 22 centers. Clinical parameters, MRI, and sNfL levels (measured by single molecule array) were assessed at baseline and up to four-year follow-up. Findings Of 814 patients, 54.7% (445) were diagnosed with RRMS and 45.3% (369) with CIS when applying 2010 McDonald criteria (RRMS[2010] and CIS[2010]). After reclassification of CIS[2010] patients with existing CSF analysis, according to 2017 criteria, sNfL levels were lower in CIS[2017] than RRMS[2017] patients (9.1 pg/ml, IQR 6.2–13.7 pg/ml, n = 45; 10.8 pg/ml, IQR 7.4–20.1 pg/ml, n = 213; p = 0.036). sNfL levels correlated with number of T2 and Gd+ lesions at baseline and future clinical relapses. Patients receiving disease-modifying therapy (DMT) during the first four years had higher baseline sNfL levels than DMT-naïve patients (11.8 pg/ml, IQR 7.5-20.7 pg/ml, n = 726; 9.7 pg/ml, IQR 6.4–15.3 pg/ml, n = 88). Therapy escalation decisions within this period were reflected by longitudinal changes in sNfL levels. Interpretation Assessment of sNfL increases diagnostic accuracy, is associated with disease course prognosis and may, particularly when measured longitudinally, facilitate therapeutic decisions. Funding Supported the German Federal Ministry for Education and Research, the German Research Council, and Hertie-Stiftung.
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Affiliation(s)
- Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Germany.
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Germany
| | - Timo Uphaus
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Germany
| | - Anke Salmen
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Luisa Klotz
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Antonios Bayas
- Department of Neurology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité, Universitätsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ralf Linker
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Christoph Heesen
- Institute for Neuroimmunology and Multiple Sclerosis, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Stangel
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | | | - Björn Tackenberg
- Center of Neuroimmunology, Philipps-University Marburg, Marburg, Germany
| | - Tania Kuempfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Frank Weber
- Max-Planck Institute of Psychiatry, Munich, Germany; Neurological Clinic, Sana Kliniken des Landkreises Cham, Cham, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Ulf Ziemann
- Department of Neurology, University of Tuebingen, Tuebingen, Germany
| | - Hayrettin Tumani
- Department of Neurology, University of Ulm, Ulm, Germany; Clinic of Neurology Dietenbronn, Schwendi, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Carsten Lukas
- Department of Radiology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Germany.
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Abdelhak A, Huss A, Stahmann A, Senel M, Krumbholz M, Kowarik MC, Havla J, Kümpfel T, Kleiter I, Wüstinger I, Zettl UK, Schwartz M, Roesler R, Friede T, Ludolph AC, Ziemann U, Tumani H. Explorative study of emerging blood biomarkers in progressive multiple sclerosis (EmBioProMS): Design of a prospective observational multicentre pilot study. Contemp Clin Trials Commun 2020; 18:100574. [PMID: 32478196 PMCID: PMC7251538 DOI: 10.1016/j.conctc.2020.100574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/04/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background Defining clinical and subclinical progression in multiple sclerosis (MS) is challenging. Patient history, expanded disability status scale (EDSS), and magnetic resonance imaging (MRI) all have shortcomings and may underestimate disease dynamics. Emerging serum biomarkers such as glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) proved useful in many cross-sectional studies. However, longitudinal data on patients with progressive MS is scarce. Objectives To assess whether the serum biomarkers GFAP and NfL might differentiate between patients with progressive vs. non-progressive disease stages and predict the disease course according to the Lublin criteria. Methods EmBioProMS is a pilot, observational, prospective, multicentric study funded by the German Multiple Sclerosis Society (DMSG). 200 patients with MS according to the 2017 McDonald criteria and history of relapse-independent progression at any time (progressive MS, PMS), younger than 65 years, and with EDSS ≤ 6.5 will be recruited in 6 centres in Germany. At baseline, month 6, and 18, medical history, EDSS, Nine-Hole-Peg-Test (9-HPT), Timed-25-Foot-Walk-Test (T-25FW), Symbol-Digit-Modalities-Test (SDMT), serum GFAP, and NfL, MRI (at least baseline and month 18) and optional optical coherence tomography (OCT) will be performed. Disease progression before and during the study is defined by confirmed EDSS progression, increase by ≥ 20% in 9-HPT or T-25FW time. Conclusions This longitudinal multicentre study will reveal to what extent the prediction of disease progression in patients with PMS will be improved by the analysis of serum biomarkers in conjunction with routine clinical data and neuroimaging measures.
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Affiliation(s)
- Ahmed Abdelhak
- Department of Neurology & Stroke, University Hospital of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | - Andre Huss
- Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | - Alexander Stahmann
- MS Forschungs- und Projektentwicklungs-gGmbH, MS-Registry by the German MS-Society, Hanover, Germany
| | - Makbule Senel
- Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | - Markus Krumbholz
- Department of Neurology & Stroke, University Hospital of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Markus C. Kowarik
- Department of Neurology & Stroke, University Hospital of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
- St. Josef-Hospital, Department of Neurology, Ruhr-University, Bochum, Germany
| | - Isabella Wüstinger
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Uwe K. Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Margit Schwartz
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Romy Roesler
- Fachklinik für Neurologie Dietenbronn, Schwendi, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | | | - Ulf Ziemann
- Department of Neurology & Stroke, University Hospital of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Hayrettin Tumani
- Department of Neurology, University Hospital of Ulm, Ulm, Germany
- Fachklinik für Neurologie Dietenbronn, Schwendi, Germany
- Corresponding author. Universitäts- und Rehabilitationskliniken Ulm (RKU), Oberer Eselsberg 45, 89081, Ulm, Germany.
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Esmael A, Elsherif M, Abdelsalam M, Sabry D, Mamdouh M, Belal T. Retinal thickness as a potential biomarker of neurodegeneration and a predictor of early cognitive impairment in patients with multiple sclerosis. Neurol Res 2020; 42:564-574. [PMID: 32370626 DOI: 10.1080/01616412.2020.1761174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this research is to predict the cognitive impairment and to determine its correlation with retinal thickness, mainly (RFNL and GCIPL) in cases of multiple sclerosis. METHODS 60 multiple sclerosis patients and 30 age and sex-matched healthy controls were included in this study. Cognitive functions were evaluated in all study participants by the Montreal Cognitive Assessment (MoCA). OCT imaging was done to determine the thickness. The correlation between the cognitive domains of MoCA and the thickness of the retinal nerve fiber layers was analyzed by Spearman correlation. ROC curve was constructed to determine the cut-off points for retinal thickness, and a binary logistic regression was performed to determine the independent predictive capacity of established cut-off points. RESULTS Impaired cognition was found in 26 MS patients (43.3%). Cognitively impaired patients were significantly older (P < 0.05), had significantly longer disease duration (P < 0.05), had higher average EDSS scores (4.3 ± 1.22 vs 3.1 ± 1.45, P < 0.001), and occurred more in progressive types of MS (P < 0.001). A significant positive correlation was found between cognitive function and RNFL thickness and GCIPL (P < 0.001). The retinal thickness (RNFL and GCIPL) cut-off points established for the prediction of cognitive impairment in MS patients were 79 μm and 76 μm, respectively. CONCLUSION The clear correlation between cognitive impairment and atrophy of inner retinal layers (RNFL and GCIPL) proposes that OCT is valuable in evaluating the neurodegeneration and prediction of early cognitive impairment in MS. ABBREVIATIONS EDSS: Expanded Disability Status Scale; HCs: Healthy controls; GCIPL: Ganglion cell-inner plexiform layer; ILM: Internal limiting membrane; INL: Inner nuclear layer; MoCA: Montreal Cognitive Assessment; MS: Multiple sclerosis; PPMS: Primary progressive multiple sclerosis; RNFL: Retinal nerve fiber layer; RRMS: Relapsing-remitting multiple sclerosis; SD: Standard deviations; SPMS: Secondary progressive multiple sclerosis; SPSS: Statistical Package for the Social Sciences.
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Affiliation(s)
- Ahmed Esmael
- Neurology Department, Mansoura University Hospital
| | | | | | - Dalia Sabry
- Ophthalmic Center, Mansoura University , Mansoura, Egypt
| | | | - Tamer Belal
- Neurology Department, Mansoura University Hospital
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Raeesmohammadi L, Esmaeili S, Abbasi MH, Mehrpour M, Mirzaasgari Z, Baradaran HR, Deilami P, Motamed MR. Transbulbar B-mode sonography in multiple sclerosis without optic neuritis; clinical relevance. Brain Res 2020; 1734:146723. [PMID: 32057807 DOI: 10.1016/j.brainres.2020.146723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Trans bulbar B-mode sonography (TBS) is a recently proposed method but there is little known about its diagnostic accuracy in patients with multiple sclerosis without acute optic neuritis. Therefore we assessed the correlation between OND, ONSD and OND/ONSD ratio with clinical/para clinical parameters. METHODS In a comparative study, we intended to examine possible differences in optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) between 60 patients with multiple sclerosis (MS) and 60 individuals as matched healthy controls. RESULTS The OND, ONSD and OND/ONSD ratio in both eyes showed significantly lower amounts in patients compared to healthy controls (p < 0.05). There were no correlations, between either OND or ONSD and factors including gender, age, P100 amplitude, disease duration, history of optic neuritis and number of T2 lesions in MRI (P ≥ 0.05). Expanded disability status scale (EDSS) and p100 Latency were correlated with both OND and ONSD values (P < 0.05). CONCLUSIONS TBS showed significantly lower amounts of OND, ONSD and OND/ONSD ratio in MS patients without current attack compared to their healthy controls indicating a subclinical axonal loss over time. It is suggested that TBS could be an applicable tool for early detection of optic nerve damages along with clinical and para-clinical findings.
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Affiliation(s)
- Leila Raeesmohammadi
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Sara Esmaeili
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohammad Hossein Abbasi
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Masoud Mehrpour
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences(IUMS), Tehran, Iran
| | - Parvaneh Deilami
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohammad Reza Motamed
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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Grzegorski T, Losy J. What do we currently know about the clinically isolated syndrome suggestive of multiple sclerosis? An update. Rev Neurosci 2020; 31:335-349. [DOI: 10.1515/revneuro-2019-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/22/2019] [Indexed: 12/31/2022]
Abstract
AbstractMultiple sclerosis (MS) is a chronic, demyelinating, not fully understood disease of the central nervous system. The first demyelinating clinical episode is called clinically isolated syndrome (CIS) suggestive of MS. Although the most common manifestations of CIS are long tracts dysfunction and unilateral optic neuritis, it can also include isolated brainstem syndromes, cerebellar involvement, and polysymptomatic clinical image. Recently, the frequency of CIS diagnosis has decreased due to the more sensitive and less specific 2017 McDonald criteria compared with the revisions from 2010. Not all patients with CIS develop MS. The risk of conversion can be estimated based on many predictive factors including epidemiological, ethnical, clinical, biochemical, radiological, immunogenetic, and other markers. The management of CIS is nowadays widely discussed among clinicians and neuroscientists. To date, interferons, glatiramer acetate, teriflunomide, cladribine, and some other agents have been evaluated in randomized, placebo-controlled, double-blind studies relying on large groups of patients with the first demyelinating event. All of these drugs were shown to have beneficial effects in patients with CIS and might be used routinely in the future. The goal of this article is to explore the most relevant topics regarding CIS as well as to provide the most recent information in the field. The review presents CIS definition, classification, clinical image, predictive factors, and management. What is more, this is one of very few reviews summarizing the topic in the light of the 2017 McDonald criteria.
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Affiliation(s)
- Tomasz Grzegorski
- Department of Clinical Neuroimmunology, Chair of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355Poznan, Poland
| | - Jacek Losy
- Department of Clinical Neuroimmunology, Chair of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355Poznan, Poland
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Balcer LJ, Balk LJ, Brandt AU, Calabresi PA, Martinez-Lapiscina EH, Nolan RC, Paul F, Petzold A, Saidha S. The International Multiple Sclerosis Visual System Consortium: Advancing Visual System Research in Multiple Sclerosis. J Neuroophthalmol 2018; 38:494-501. [PMID: 30418332 DOI: 10.1097/WNO.0000000000000732] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The International Multiple Sclerosis Visual System Consortium (IMSVISUAL) was formed in November 2014 with the primary goal of improving research, care, and education regarding the role of the visual system in multiple sclerosis (MS) and related disorders. METHODS In this review, we describe the formation, goals, activities, and structure of IMSVISUAL, as well as the relationship of IMSVISUAL with the Americas Committee for Treatment and Research in MS (ACTRIMS). Finally, we provide an overview of the work IMSVISUAL has completed to date, as well as an outline of research projects ongoing under the auspices of IMSVISUAL. RESULTS IMSVISUAL has 140 members worldwide and continues to grow. Through IMSVISUAL-related research, optical coherence tomography (OCT)-derived peripapillary retinal nerve fiber layer (pRNFL) thinning has been established as a predictor of future disability in MS. IMSVISUAL has also developed guidelines for reporting OCT studies in MS. Moreover, a systematic review performed by IMSVISUAL found that not only are pRNFL and ganglion cell + inner plexiform layer (GCIPL) thicknesses reduced in patients with MS (particularly in eyes with prior optic neuritis [ON]), but that inner nuclear layer measures may be higher among MS ON eyes, relative to healthy control eyes. Currently, there are several ongoing IMSVISUAL projects that will establish a role for visual outcomes in diagnosing MS and quantifying the effects of emerging therapies in clinical trials. CONCLUSIONS The development of IMSVISUAL represents a major collaborative commitment to defining the role of visual outcomes in high-quality, large-scale studies that generate definitive and instructive findings in the field of MS. As a consortium, IMSVISUAL has completed several international collaborative projects, is actively engaged in numerous ongoing research studies, and is committed to expanding the role of vision research in MS and related disorders.
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Saidha S, Naismith RT. Author response: Optical coherence tomography for diagnosing optic neuritis: Are we there yet? Neurology 2020; 94:47. [PMID: 31889015 DOI: 10.1212/wnl.0000000000008709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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London F, Zéphir H, Drumez E, Labreuche J, Hadhoum N, Lannoy J, Hodel J, Vermersch P, Pruvo JP, Leclerc X, Outteryck O. Optical coherence tomography: a window to the optic nerve in clinically isolated syndrome. Brain 2019; 142:903-915. [PMID: 30847470 DOI: 10.1093/brain/awz038] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/19/2018] [Accepted: 12/31/2018] [Indexed: 12/25/2022] Open
Abstract
In this study, we aimed to evaluate the association of asymptomatic optic nerve demyelinating lesion in patients presenting a clinically isolated syndrome with the asymptomatic retinal neuro-axonal loss previously reported at clinically isolated syndrome. We prospectively recruited 66 patients presenting a clinically isolated syndrome and 66 healthy control subjects matched according to age and gender. All patients underwent brain magnetic resonance imaging including 3D-double inversion recovery (DIR) sequence, optical coherence tomography examination and visual function evaluation, at 2.5-4.5 months after CIS. Evaluation criteria were presence and length of optic nerve DIR hypersignal, retinal layers (including ganglion cell inner plexiform layer and inner nuclear layer) thickness/volume, and low contrast monocular vision acuity (number of letters correctly identified). All clinically isolated syndrome eyes with past history of optic neuritis (CIS-ON) presented an optic nerve DIR hypersignal. We observed asymptomatic optic nerve DIR hypersignal in 22.2% of clinically isolated syndrome eyes without optic neuritis (CIS-NON). In comparison with healthy control, GCIPL volume (in mm3) was significantly lower in CIS-ON eyes [β (95% confidence interval, CI) = -0.121 (-0.168 to -0.074); P < 0.0001], and to a lesser extent in CIS-NON [β (95% CI) = -0.023 (-0.039 to -0.008); P = 0.004]. In comparison to healthy controls, eyes with asymptomatic optic nerve DIR hypersignal presented significantly lower macular ganglion cell inner plexiform layer volume [β (95% CI) = -0.043 (-0.068 to -0.019); P = 0.001], and eyes without did not [β (95% CI) = -0.016 (-0.034 to 0.003); P = 0.083]. Among CIS-NON, macular ganglion cell inner plexiform layer volume decrease was associated with asymptomatic optic nerve DIR hypersignal independently of optic radiations T2 lesions and primary visual cortex volumes (P = 0.012). Symptomatic optic nerve DIR hypersignal were significantly longer (13.8 ± 6.7 mm) than asymptomatic optic nerve hypersignal (10.0 ± 5.5 mm; P = 0.047). Length of optic nerve DIR hypersignal was significantly associated with thinner inner retinal layers (P ≤ 0.001), thicker inner nuclear layer (P = 0.017) and lower low contrast monocular vision acuity (P < 0.05). Compared to healthy control, low contrast monocular vision acuity was significantly lower in CIS-ON eyes (P < 0.0001) and CIS-NON eyes with (P = 0.03) or without asymptomatic optic nerve DIR hypersignal (P = 0.0005). Asymptomatic demyelinating optic nerve DIR hypersignal at the earliest clinical stage of multiple sclerosis is frequent and associated with asymptomatic retinal neuro-axonal loss reported at clinically isolated syndrome stage. Length of optic nerve DIR hypersignal is a biomarker of retinal neuro-axonal loss and visual disability at clinically isolated syndrome stage. Visual disability of clinically isolated syndrome eyes without clinical and subclinical optic nerve involvement might be due to missed optic nerve lesions on MRI. At the earliest clinical stage of multiple sclerosis, our results support considering optical coherence tomography as a window to the optic nerve rather than to the brain.
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Affiliation(s)
- Frédéric London
- University of Lille (UMR995), Department of Neurology, Roger Salengro Hospital, Lille, France
| | - Hélène Zéphir
- University of Lille (UMR995), Department of Neurology, Roger Salengro Hospital, Lille, France
| | - Elodie Drumez
- University of Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000 Lille, France
| | - Julien Labreuche
- University of Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000 Lille, France
| | - Nawal Hadhoum
- University of Lille (UMR995), Department of Neurology, Roger Salengro Hospital, Lille, France
| | - Julien Lannoy
- University of Lille (UMR995), Department of Neurology, Roger Salengro Hospital, Lille, France
| | - Jérôme Hodel
- University of Lille (UMR1171), Department of Neuroradiology, Roger Salengro Hospital, Lille, France.,University of Paris Est Créteil, Department of Neuroradiology, Hopital Henri Mondor, Créteil, Paris, France
| | - Patrick Vermersch
- University of Lille (UMR995), Department of Neurology, Roger Salengro Hospital, Lille, France
| | - Jean-Pierre Pruvo
- University of Lille (UMR1171), Department of Neuroradiology, Roger Salengro Hospital, Lille, France
| | - Xavier Leclerc
- University of Lille (UMR1171), Department of Neuroradiology, Roger Salengro Hospital, Lille, France
| | - Olivier Outteryck
- University of Lille (UMR1171), Department of Neuroradiology, Roger Salengro Hospital, Lille, France
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Yap TE, Balendra SI, Almonte MT, Cordeiro MF. Retinal correlates of neurological disorders. Ther Adv Chronic Dis 2019; 10:2040622319882205. [PMID: 31832125 PMCID: PMC6887800 DOI: 10.1177/2040622319882205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/20/2019] [Indexed: 12/11/2022] Open
Abstract
Considering the retina as an extension of the brain provides a platform from which to study diseases of the nervous system. Taking advantage of the clear optical media of the eye and ever-increasing resolution of modern imaging techniques, retinal morphology can now be visualized at a cellular level in vivo. This has provided a multitude of possible biomarkers and investigative surrogates that may be used to identify, monitor and study diseases until now limited to the brain. In many neurodegenerative conditions, early diagnosis is often very challenging due to the lack of tests with high sensitivity and specificity, but, once made, opens the door to patients accessing the correct treatment that can potentially improve functional outcomes. Using retinal biomarkers in vivo as an additional diagnostic tool may help overcome the need for invasive tests and histological specimens, and offers the opportunity to longitudinally monitor individuals over time. This review aims to summarise retinal biomarkers associated with a range of neurological conditions including Alzheimer’s disease (AD), Parkinson’s disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) and prion diseases from a clinical perspective. By comparing their similarities and differences according to primary pathological processes, we hope to show how retinal correlates can aid clinical decisions, and accelerate the study of this rapidly developing area of research.
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Affiliation(s)
- Timothy E Yap
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
| | - Shiama I Balendra
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - Melanie T Almonte
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, UK
| | - M Francesca Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, NW1 5QH, UK
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Motamedi S, Gawlik K, Ayadi N, Zimmermann HG, Asseyer S, Bereuter C, Mikolajczak J, Paul F, Kadas EM, Brandt AU. Normative Data and Minimally Detectable Change for Inner Retinal Layer Thicknesses Using a Semi-automated OCT Image Segmentation Pipeline. Front Neurol 2019; 10:1117. [PMID: 31824393 PMCID: PMC6886563 DOI: 10.3389/fneur.2019.01117] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/07/2019] [Indexed: 01/12/2023] Open
Abstract
Neurodegenerative and neuroinflammatory diseases regularly cause optic nerve and retinal damage. Evaluating retinal changes using optical coherence tomography (OCT) in diseases like multiple sclerosis has thus become increasingly relevant. However, intraretinal segmentation, a necessary step for interpreting retinal changes in the context of these diseases, is not standardized and often requires manual correction. Here we present a semi-automatic intraretinal layer segmentation pipeline and establish normative values for retinal layer thicknesses at the macula, including dependencies on age, sex, and refractive error. Spectral domain OCT macular 3D volume scans were obtained from healthy participants using a Heidelberg Engineering Spectralis OCT. A semi-automated segmentation tool (SAMIRIX) based on an interchangeable third-party segmentation algorithm was developed and employed for segmentation, correction, and thickness computation of intraretinal layers. Normative data is reported from a 6 mm Early Treatment Diabetic Retinopathy Study (ETDRS) circle around the fovea. An interactive toolbox for the normative database allows surveying for additional normative data. We cross-sectionally evaluated data from 218 healthy volunteers (144 females/74 males, age 36.5 ± 12.3 years, range 18-69 years). Average macular thickness (MT) was 313.70 ± 12.02 μm, macular retinal nerve fiber layer thickness (mRNFL) 39.53 ± 3.57 μm, ganglion cell and inner plexiform layer thickness (GCIPL) 70.81 ± 4.87 μm, and inner nuclear layer thickness (INL) 35.93 ± 2.34 μm. All retinal layer thicknesses decreased with age. MT and GCIPL were associated with sex, with males showing higher thicknesses. Layer thicknesses were also positively associated with each other. Repeated-measurement reliability for the manual correction of automatic intraretinal segmentation results was excellent, with an intra-class correlation coefficient >0.99 for all layers. The SAMIRIX toolbox can simplify intraretinal segmentation in research applications, and the normative data application may serve as an expandable reference for studies, in which normative data cannot be otherwise obtained.
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Affiliation(s)
- Seyedamirhosein Motamedi
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kay Gawlik
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Noah Ayadi
- 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
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanna Asseyer
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Charlotte Bereuter
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Janine Mikolajczak
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 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, Berlin, Germany.,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.,Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ella Maria Kadas
- 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 Ulrich Brandt
- 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, Irvine, CA, United States
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Gehr S, Kaiser T, Kreutz R, Ludwig WD, Paul F. Suggestions for improving the design of clinical trials in multiple sclerosis-results of a systematic analysis of completed phase III trials. EPMA J 2019; 10:425-436. [PMID: 31832116 PMCID: PMC6883016 DOI: 10.1007/s13167-019-00192-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/18/2019] [Indexed: 12/13/2022]
Abstract
This manuscript reviews the primary and secondary endpoints of pivotal phase III trials with immunomodulatory drugs in multiple sclerosis (MS). Considering the limitations of previous trial designs, we propose new standards for the planning of clinical trials, taking into account latest insights into MS pathophysiology and patient-relevant aspects. Using a systematic overview of published phase III (pivotal) trials performed as part of application for drug market approval, we evaluate the following characteristics: trial duration, number of trial participants, comparators, and endpoints (primary, secondary, magnetic resonance imaging outcome, and patient-reported outcomes). From a patient perspective, the primary and secondary endpoints of clinical trials are only partially relevant. High-quality trial data pertaining to efficacy and safety that stretch beyond the time frame of pivotal trials are almost non-existent. Understanding of long-term benefits and risks of disease-modifying MS therapy is largely lacking. Concrete proposals for the trial designs of relapsing (remitting) multiple sclerosis/clinically isolated syndrome, primary progressive multiple sclerosis, and secondary progressive multiple sclerosis (e.g., study duration, mechanism of action, and choice of endpoints) are presented based on the results of the systematic overview. Given the increasing number of available immunotherapies, the therapeutic strategy in MS has shifted from a mere “relapse-prevention” approach to a personalized provision of medical care as to the choice of the appropriate drugs and their sequential application over the course of the disease. This personalized provision takes patient preferences as well as disease-related factors into consideration such as objective clinical and radiographic findings but also very burdensome symptoms such as fatigue, depression, and cognitive impairment. Future trial designs in MS will have to assign higher relevance to these patient-reported outcomes and will also have to implement surrogate measures that can serve as predictive markers for individual treatment response to new and investigational immunotherapies. This is an indispensable prerequisite to maximize the benefit of individual patients when participating in clinical trials. Moreover, such appropriate trial designs and suitable enrolment criteria that correspond to the mode of action of the study drug will facilitate targeted prevention of adverse events, thus mitigating risks for individual study participants.
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Affiliation(s)
- Sinje Gehr
- Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Kaiser
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (Institute for Quality and Efficiency in Health Care) (IQWiG), Im Mediapark 8, 50670 Köln, Germany
| | - Reinhold Kreutz
- Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Wolf-Dieter Ludwig
- Arzneimittelkommission der deutschen Ärzteschaft (Drug Commission of the German Medical Association), Herbert-Lewin-Platz 1, 10623 Berlin, Germany
| | - Friedemann Paul
- Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Pfuhl C, Grittner U, Gieß RM, Scheel M, Behrens JR, Rasche L, Pache FC, Wenzel R, Brandt AU, Bellmann-Strobl J, Paul F, Ruprecht K, Oechtering J. Intrathecal IgM production is a strong risk factor for early conversion to multiple sclerosis. Neurology 2019; 93:e1439-e1451. [PMID: 31501228 DOI: 10.1212/wnl.0000000000008237] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 05/10/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To evaluate intrathecal immunoglobulin M (IgM) production, as compared to previously established risk factors, as risk factor for conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) and to explore the association of intrathecal IgM production with onset age and radiologic and CSF findings in CIS/early MS. METHODS Comprehensive CSF data, including oligoclonal immunoglobulin G (IgG) bands (OCB) and calculated intrathecal IgM and IgG production, were collected in a prospective study of 150 patients with CIS/early MS with regular clinical and MRI assessments. RESULTS Intrathecal IgM production >0% occurred in 23.2% (33/142) of patients, who were on average 5 years younger at disease onset (p = 0.013) and more frequently had infratentorial lesions (18/32, 56.3%) than patients without intrathecal IgM production (33/104, 31.7%, p = 0.021). In multivariable Cox regression analyses, intrathecal IgM production in patients with a CIS (n = 93, median clinical and MRI follow-up 24 and 21 months) was strongly associated with conversion to MS according to the McDonald 2010 criteria (hazard ratio [95% confidence interval] 3.05 [1.45-6.44], p = 0.003) after adjustment for age (0.96 [0.93-1.00], p = 0.059), OCB (0.92 [0.33-2.61], p = 0.879), intrathecal IgG production (0.98 [0.48-1.99], p = 0.947), and radiologic evidence of dissemination in space (2.63 [1.11-6.22], p = 0.028). CONCLUSION Intrathecal IgM production is a strong independent risk factor for early conversion to MS and may thus represent a clinically meaningful marker for predicting future disease activity in patients with a CIS.
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Affiliation(s)
- Catherina Pfuhl
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - Ulrike Grittner
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - René M Gieß
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - Michael Scheel
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - Janina R Behrens
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - Ludwig Rasche
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - Florence C Pache
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - Rüdiger Wenzel
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - Alexander U Brandt
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - Judith Bellmann-Strobl
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - Friedemann Paul
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
| | - Klemens Ruprecht
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland.
| | - Johanna Oechtering
- From the Department of Neurology (C.P., J.R.B., F.C.P., R.W., F.P., K.R., J.O.), NeuroCure Clinical Research Center (C.P., R.M.G., M.S., J.R.B., L.R., F.C.P., A.U.B., J.B.-S., F.P.), Institute for Biometry and Clinical Epidemiology (U.G.), and Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (U.G.), Berlin; Department of Neurology (A.U.B.), University of California Irvine; Experimental and Clinical Research Center (J.B.-S., F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany; and Neurological Clinic and Policlinic (J.O.), Basel University Hospital, Basel, Switzerland
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50
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Abstract
Optical coherence tomography (OCT) has emerged as a fast, non-invasive, inexpensive, high-resolution imaging technique in multiple sclerosis (MS). Retinal layer quantification by OCT facilitates a 'window' into not only local retinal pathology but also global neurodegenerative processes, recognised to be the principal substrates of disability accumulation in MS. While OCT measures in MS have been demonstrated to reflect visual function, inflammatory activity outside of the visual pathways, disability measures including the prediction of disability progression, whole brain atrophy, and the differential neuroprotective effects of disease-modifying therapies, debate continues regarding the clinical utility of OCT in everyday practice. This review presents an overview of the evidence supporting OCT, with particular focus on its application in the MS clinic. We will also discuss the role of OCT in MS clinical trials to develop novel neuroprotective and potential remyelinating therapies.
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Affiliation(s)
- Jeffrey Lambe
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, Ohio, USA
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