Optical coherence tomography and visual evoked potentials in pediatric MS

Abstract

Objective:To determine the relative ability of optical coherence tomography (OCT) and pattern-reversal visual evoked potentials (pVEPs) to detect visual pathway involvement in pediatric-onset MS.Methods:Pediatric-onset MS participants (onset <18 years) and healthy controls (HCs) underwent OCT (Cirrus HD-OCT) and pVEPs. Retinal nerve fiber layer (RNFL), ganglion cell layer to inner plexiform layer (GCL-IPL), and P100 pVEP latency were measured. Generalized estimating equation models were used to compare the groups, adjusting for age and intereye correlations.Results:Twenty-four pediatric MS participants, 14 with a history of remote (>6 months) optic neuritis (ON) in one eye (8 participants) or both the eyes (6 participants), and 24 HCs were enrolled. RNFL thinning (<83 μm, 2 SDs below HC eyes) occurred in 50% of ON eyes vs 5% of non-ON eyes. Prolonged VEP latency (>109 msec) occurred in 58% of ON eyes and 55% of non-ON eyes. A clinical history of ON predicted RNFL (p < 0.001) and GCL-IPL thinning (p = 0.011), whereas prolonged pVEP latency in children with MS occurred independent of ON history.Conclusions:OCT and pVEPs provide complementary but distinct insights. OCT is sensitive to retinal changes in the context of clinical ON, whereas pVEPs are useful to detect disseminated lesions of the visual pathway in children with MS.

Retinal nerve fibre layer thinning is associated with worse visual outcome after optic neuritis in children with a relapsing demyelinating syndrome

“…A key finding in this study was the absence of any correlation between number of relapses and visual outcome, alongside a significant correlation between RNFL thinning and worse visual outcome. We detected RNFL thinning on OCT in 56% of MS‐ON eyes and 75% of Ab‐ON eyes, similar to a recent study identifying RNFL thinning in 50% of children with multiple sclerosis and a history of optic neuritis . OCT offers an opportunity to monitor disease activity and progression non‐invasively; in adults with multiple sclerosis, RNFL thinning is a sensitive and specific predictor of clinical disease activity, independent of lesion accumulation on brain MRI .…”

“…Our finding of clinically silent disease by electrodiagnostic teststhat is, abnormal VEP in 'non-optic-neuritis' eyesis consistent with previous reports. 14,15 It provides further support to the recent Magnetic Resonance Imaging In Multiple Sclerosis (MAGNIMS) recommendation that the inclusion of optic nerve disease (identified clinically, radiologically, or electrophysiologically) increases the sensitivity of dissemination-in-space criteria for multiple sclerosis. 30 There was a low rate of VEP normalization in eyes with optic neuritis across all groups, even in those with recovered HCVA; the time course of remyelination after optic neuritis has yet to be fully elucidated.…”

Effects of Optic Neuritis, T2 Lesions, and Microstructural Diffusion Integrity in the Visual Pathway on Cortical Thickness in Pediatric‐Onset Multiple Sclerosis

“…Optic neuritis (ON) is a common feature of adult‐ and pediatric‐onset multiple sclerosis (POMS). Inflammatory damage of the optic nerves leads to retrograde retinal atrophy, as measured by thinning of the retinal nerve fiber (RNFL) and ganglion cell layer‐inner plexiform layer (GCL‐IPL) . This axonal loss in the afferent visual pathway could also lead to anterograde reduction in neuronal density, quantifiable as a reduction in visual cortical mantle thickness, as has been documented in adults with MS .…”

Structural correlates of atypical visual and motor cortical oscillations in pediatric‐onset multiple sclerosis

“…As in adults with MS, retrograde RNFL damage from acute ON has been demonstrated in POMS (Graves et al, 2017;Waldman et al, 2017;Waldman, Ghezzi, et al, 2014;Waldman, Hiremath, et al, 2014). Interestingly, following acute ON in children, only about 50% of affected eyes demonstrate RNFL thinning, suggestive of some measure of resilience or greater reparative capacity in children relative to adult MS patients (Waldman et al, 2017;Waldman, Ghezzi, et al, 2014;Waldman, Hiremath, et al, 2014;Yeh et al, 2009). In our recent work, we demonstrated thinning of the visual cortex in 20 POMS subjects compared to 22 age-and sexmatched healthy controls; however, cortical thinning was not associated with RNFL thinning or a history of ON (Datta et al, 2019).…”

“…Our previous work has focused on defining and quantifying the extent of axonal and neuronal loss of the visual system in POMS and understanding the subsequent functional outcomes in children (Datta et al, 2019;Waldman, Ghezzi, et al, 2014;Waldman, Hiremath, et al, 2014). As in adults with MS, retrograde RNFL damage from acute ON has been demonstrated in POMS (Graves et al, 2017;Waldman et al, 2017;Waldman, Ghezzi, et al, 2014;Waldman, Hiremath, et al, 2014). Interestingly, following acute ON in children, only about 50% of affected eyes demonstrate RNFL thinning, suggestive of some measure of resilience or greater reparative capacity in children relative to adult MS patients (Waldman et al, 2017;Waldman, Ghezzi, et al, 2014;Waldman, Hiremath, et al, 2014;Yeh et al, 2009).…”