Reduced Retinal Nerve Fiber Layer Thickness and Macular Volume in Pediatric Multiple Sclerosis

Yılmaz, Ünsal; Gücüyener, Kıvılcım; Erin, Döndü Melek; Yazar, Zeliha; Gürkaş, Esra; Serdaroğlu, Ayşe; Tepe, Nermin; Demir, Ercan

doi:10.1177/0883073812447683

Cited by 19 publications

(14 citation statements)

References 32 publications

(47 reference statements)

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“…2 Also in line with our findings, another study of 14 pediatric patients with MS reported no difference in VEP latencies between MS-ON eyes and MS non-ON eyes ( p = 0.524) or between MS-ON eyes and MS fellow eyes ( p = 0.654). 5 …”

Section: Discussionmentioning

confidence: 99%

“…3 In adults with MS, thinning of the retina has also been documented in the absence of ON, although thinning in non-ON eyes in pediatric MS has been variably detected. 4–6 In pediatric-onset MS, the likelihood of an OCT or VEP abnormality in MS eyes, with or without ON, has not been calculated. We sought to compare OCT and pVEPs in a cohort of pediatric-onset MS participants, with and without a history of ON, in order to inform on the relative utility of these tests in the pediatric context.…”

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confidence: 99%

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Optical coherence tomography and visual evoked potentials in pediatric MS

Waldman

Liu

Lavery

et al. 2017

Neurol Neuroimmunol Neuroinflamm

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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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Optical coherence tomography and visual evoked potentials in pediatric MS

Waldman

Liu

Lavery

et al. 2017

Neurol Neuroimmunol Neuroinflamm

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“…While decreased lowcontrast letter acuity scores and retinal nerve fiber layer (RNFL) thinning have been demonstrated in pediatric patients with MS with a history of ON, 33 there are conflicting data regarding the relationship between deficits in low-contrast visual function and retinal pathology in the eyes of children with MS unaffected by a clinical attack of ON (MS non-ON eyes). 34,35 One study has shown preserved RNFL in MS non-ON eyes, 33 suggesting that OCT may capture only local thinning after ON. However, 2 other studies have shown decreased RNFL in pediatric MS non-ON eyes, suggesting that OCT might capture a more global degenerative component of MS. 34,35 Further validation of OCT as an outcome in pediatric MS is needed.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…34,35 One study has shown preserved RNFL in MS non-ON eyes, 33 suggesting that OCT may capture only local thinning after ON. However, 2 other studies have shown decreased RNFL in pediatric MS non-ON eyes, suggesting that OCT might capture a more global degenerative component of MS. 34,35 Further validation of OCT as an outcome in pediatric MS is needed.…”

Section: Outcome Measuresmentioning

confidence: 99%

Pediatric multiple sclerosis

et al. 2016

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Multiple sclerosis (MS) in children manifests with a relapsing-remitting MS (RRMS) disease course. Acute relapses consist of new neurologic deficits persisting greater than 24 hours, in the absence of intercurrent illness, and occur with a higher frequency early in the disease as compared to adult-onset RRMS. Most pediatric patients with MS recover well from these early relapses, and cumulative physical disability is rare in the first 10 years of disease. Brainstem attacks, poor recovery from a single attack, and a higher frequency of attacks portend a greater likelihood of future disability. Although prospective pediatric-onset MS cohorts have been established in recent years, there remains very limited prospective data detailing the longer-term clinical outcome of pediatric-onset MS into adulthood. Whether the advent of MS therapies, and the largely off-label access to such therapies in pediatric MS, has improved prognosis is unknown. MS onset during the key formative academic years, concurrent with active cognitive maturation, is an important determinant of long-term outcome, and is discussed in detail in another article in this supplement. Finally, increasing recognition of pediatric MS worldwide, recent launch of phase III trials for new agents in the pediatric MS population, and the clear imperative to more fully appreciate health-related quality of life in pediatric MS through adulthood highlight the need for standardized, validated, and robust outcome measures. Neurology ® 2016;87 (Suppl 2):S74-S81

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“…In pediatric MS, eyes with a history of ON have been reported to have 10%-20% thinner RNFL than MS non-ON eyes or control eyes and 6% lower macular volumes. [20][21][22] Using time-domain OCT, severe RNFL thinning may occur after a single episode of ON in certain cases, including ON associated with transverse myelitis and ADEM (67 microns) vs MS (83 microns) and healthy age-and sex-matched controls (107 6 12 microns), suggesting potentially different pathophysiologic processes driving these entities. 22 In recurrent disease in children, stepwise decrease in RNFL (8-10 microns) may be seen following each episode of ON.…”

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confidence: 99%

Pediatric optic neuritis

et al. 2016

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Optic neuritis (ON) is a common presenting symptom in pediatric CNS demyelinating disorders and may be associated with dramatic visual loss. Knowledge regarding clinical presentation, associated diseases, therapy, and outcomes in ON in children has grown over the past decade. These studies have shown that younger children (,10 years of age) are more likely to present with bilateral ON and older children with unilateral ON. Furthermore, studies focusing on visual recovery have shown excellent recovery of high-contrast visual acuity in the majority of children, but functional and structural studies have shown evidence of irreversible injury and functional decline after ON in children. Although randomized controlled treatment trials have not been performed in children and adolescents with ON, standard of care suggests that the use of highdose pulse steroids is safe and likely effective. This article reviews current knowledge about the clinical presentation and management of pediatric ON, with attention to associated syndromes and evaluative tools that may inform diagnosis and interventions. Neurology ® 2016;87 (Suppl 2): S53-S58 GLOSSARY ADEM 5 acute disseminating encephalomyelitis; AQP4 5 aquaporin-4; HCVA 5 high-contrast VA; CRION 5 chronic relapsing inflammatory optic neuropathy; IVIg 5 IV immunoglobulin; LCLA 5 low-contrast letter acuity; LCVA 5 low-contrast VA; MOG 5 myelin oligodendrocyte glycoprotein; MS 5 multiple sclerosis; NMO 5 neuromyelitis optica; NMOSD 5 NMO spectrum disorder; OCT 5 optical coherence tomography; ON 5 optic neuritis; ONTT 5 Optic Neuritis Treatment Trial; RNFL 5 retinal nerve fiber layer; TPE 5 therapeutic plasma exchange; VA 5 visual acuity; VEP 5 visual evoked potential; VF 5 visual field.

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Reduced Retinal Nerve Fiber Layer Thickness and Macular Volume in Pediatric Multiple Sclerosis

Cited by 19 publications

References 32 publications

Optical coherence tomography and visual evoked potentials in pediatric MS

Optical coherence tomography and visual evoked potentials in pediatric MS

Pediatric multiple sclerosis

Pediatric optic neuritis

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