The rapid assessment of visual dysfunction in multiple sclerosis.

Sala, Sergio Della; Comı, Gıancarlo; Martinelli, Vittorio; Somazzi, L; Wilkins, Arnold J.

doi:10.1136/jnnp.50.7.840

Cited by 13 publications

(6 citation statements)

References 29 publications

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“…The sample size was based on the normal distribution of the VEP P100 mean (SD) latency of 100 (5) milliseconds. 16,[30][31][32] The upper limit of the normal distribution is commonly defined as 2 SDs above the mean, 16,30,32 or 110 milliseconds. The estimated clinically significant difference between the 2 groups was hypothesized to be 1 SD.…”

Section: Discussionmentioning

confidence: 99%

Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids

et al. 2018

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IMPORTANCE Intravenous (IV) administration of corticosteroids is the standard of care in the treatment of acute optic neuritis. However, it is uncertain whether a bioequivalent dose of corticosteroid administered orally, which may be more cost-efficient and convenient for patients, is as effective as IV administration in the treatment of acute optic neuritis. OBJECTIVE To determine whether recovery of vision following treatment of acute optic neuritis with a high-dose IV corticosteroid is superior to that with a bioequivalent dose of an oral corticosteroid. DESIGN, SETTING, AND PARTICIPANTS This single-blind (participants unblinded) randomized clinical trial with 6-month follow-up was conducted at a single tertiary care center in London, Ontario, Canada. Participants were enrolled from March 2012 to May 2015, with the last participant's final visit occurring November 2015. Patients 18 to 64 years of age presenting within 14 days of acute optic neuritis onset, without any recovery at time of randomization and without history of optic neuritis in the same eye, were screened. Inclusion criteria included best-corrected visual acuity (BCVA) of 20/40 or worse and corticosteroids deemed required by treating physician. In total, 89 participants were screened; 64 were eligible, but 9 declined to participate. Thus, 55 participants were enrolled and randomized. Primary analysis was unadjusted and according to the intention-to-treat principle. INTERVENTIONS Participants were randomized 1:1 to the IV methylprednisolone sodium succinate (1000-mg) or oral prednisone (1250-mg) group. MAIN OUTCOMES AND MEASURES Primary outcome was recovery of the latency of the P100 component of the visual evoked potential at 6 months. Secondary outcomes were the P100 latency at 1 month and BCVA as assessed with Early Treatment Diabetic Retinopathy Study letter scores on the alphabet chart and scores on low-contrast letters at 1 and 6 months. RESULTS Of 55 randomized participants, the final analyzed cohort comprised 23 participants in the IV and 22 in the oral treatment groups. The mean (SD) age of the cohort was 34.6 (9.5) years, and there were 28 women (62.2%). At 6 months' recovery, P100 latency in the IV group improved by 62.9 milliseconds (from a mean [SD] of 181.9 [53.6] to 119.0 [16.5] milliseconds), and the oral group improved by 66.7 milliseconds (from a mean [SD] of 200.5 [67.2] to 133.8 [31.5] milliseconds), with no significant difference between groups (P = .07). Similarly, no significant group difference was found in the mean P100 latency recovery at 1 month. For BCVA, recovery between the groups did not reach statistical significance at 1 month or 6 months. In addition, improvements in low-contrast (1.25% and 2.5%) BCVA were not significantly different between treatment groups at 1 or 6 months' recovery. CONCLUSIONS AND RELEVANCE This study finds that bioequivalent doses of oral corticosteroids may be used as an alternative to IV corticosteroids to treat acute optic neuritis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT0152...

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Section: Discussionmentioning

confidence: 99%

Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids

et al. 2018

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“…This idea is also expressed by several authors, who refers to CS evaluation as the most sensitive technique for subclinical visual loss detection, when compared to other visual tests, such as color vision analysis and visual evoked potentials (VEP). [ 8 15 16 ] However, others suggest that this visual test is not useful for the evaluation of these subjects. [ 17 ] This may occur because of a lack of uniformity between evaluation techniques and selection of the spatial frequencies band to be evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of studies evaluates only a single spatial frequency, with 4 cpd being the most frequent one. [ 15 17 18 ] In clinical studies, where several spatial frequencies are evaluated, usually not enough frequencies are assessed for the trace of the complete CS curve. The most common case is the absence of a high-frequency or a low-frequency.…”

Section: Discussionmentioning

confidence: 99%

Influence of multiple sclerosis, age and degree of disability, in the position of the contrast sensitivity curve peak

Nunes

Monteiro²,

Pato³

2014

Indian J Ophthalmol

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Context:Contrast sensitivity (CS) function is one of the most important tests available for evaluating visual impairment. Multiple sclerosis (MS) can produce highly selective losses in visual function and psychophysical studies have demonstrated CS deficits for some spatial frequencies.Aims:This work studies the differences in CS between a group of controls and a group of MS patients, focusing on the location of the maximum sensitivity peak, shape of the curve, and determination of the most affected spatial frequencies.Materials and Methods:Using a sinusoidal stimulus the authors assessed CS function in 28 subjects with definitive relapsing remitting MS, and in 50 controls with acuities of 20/25 or better. The peaks of the CS curves were studied by fitting third degree polynomials to individual sets of data.Results:Compared with the control group, the CS function curve for MS subjects showed more deficits in extreme points (low- and high-spatial frequencies). Our results display significant CS losses, at the high-frequencies band level, in the beginning of the disease. When the disease progresses and the disabilities appear, there are greater losses at the low-frequencies band level. In average, the CS curve peaks for the MS group were shifted in relation to the control group.Conclusions:CS losses in the MS group suggest an association with ageing and disability level in the expanded disability status scale. The position of the CS function peak is influenced by MS, age, and degree of disability.

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“…Abnormal VERs were found in 100 per cent of symptomatic optic nerves by Miller et af. (1988), and in 72 per cent and 83 per cent by Bewermeyer et al (1986) and Della-Sala et al (1987), respectively. However, the demyelinating process in the brain sometimes is not disseminated into areas involving the VERs, so normal VERS cannot exclude MS. VER examination was normal for our case 2, with blurred vision as the initial symptom, but concurrent computerized perimetry was markedly abnormal (see Table I and Fig.…”

Section: The Fema1e:male Ratio In Adults Withmentioning

confidence: 92%

Multiple Sclerosis In Childhood: Contribution Of Serial Mri To Earlier Diagnosis

Millner¹,

Ebner²,

Justich

et al. 1990

Develop Med Child Neuro

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SUMMARY The authors report six children (five girls, one boy) aged 11 to 13 years, of whom four had clinically definite multiple sclerosis (MS) and two had laboratory‐supported definite MS. All had brain white matter abnormalities indicative of MS. In three cases, positive findings on the first MRI contributed significantly to their early diagnosis. Follow‐up MRI studies over an average period of five months detected morphological changes in three of the children, although there was no concomitant clinical evidence. This raises the question of whether changes in clinically ‘silent’ lesions on follow‐up MRI are antecedents of the essential MS criterion of dissemination over time, which could lead to earlier diagnosis of childhood MS. With cranial computerized tomography (CT) during the first clinical attack, a large focus with a lamellar structure mimicked a brain tumour in two patients. As CT also misses additional small lesions, it should no longer be used as the primary diagnostic method. RÉSUMÉ Sclérose en plaques de I'enfance. Intérêt des IRM en série pour un diagnostic précoce Les auteurs rapportent les cas de six enfants (cinq filles et un garĉon), gês de 11 à 13 ans dont quatre présentaient des signes cliniques manifestes de Sclérose en plaque (SEP) et deux avaient le même diagnostic porté sur examens de laboratoire. Tous présentaient des anomalies de la substance blanche évocatrice de DEP. Dans trois cas, les résultats positifs d'une première IRM contribuèrent significativement au diagnostic précoce. Le suivi IRM sur une période moyenne de cinq mois détecta des modifications morphologiques chez trois de enfants, bien qu'il n'y eu pas d'évidence clinique concomittante. Cela pose la question de savoir si les lésions au suivi IRM, cliniquement ‘silencieuses’, sont les antécédents des critères de dissémination en fonction du temps essentiels au diagnostic de SEP et qui pourraient conduire au diagnostic précoce de SEP infantile. Chez deux patients, un large foyer de structure lamellaire simulait une tumeur cérébrale au scanner cranien. Le scanner ne relevant pas les petites lésions associées, ne devrait plus être utilisé comme méthode primaire de diagnostic. ZUSAMMENFASSUNG Multiple Sklerose im Kindesalter: frühere Diagnose durch MRI‐Untersuchungen Die Autoren berichten über sechs Kinder (fünf Mädchen, ein Junge) im Alter zwischen 11 und 13 Jahren, von denen vier klinisch eine eindeutige Multiple Sklerose (MS) und zwei eine durch Laboruntersuchungen gesicherte MS hatten. Alle hatten die für die MS typischen Veränderungen der weißen Hirnsubstanz. In drei Fällen haben positive Befunde bei der ersten MRI‐Untersuchung zur Frühdiagnose beigetragen. Kontroll‐MRI‐Untersuchungen über einen durchschnittlichen Zeitraum von fünf Monaten zeigten morphologische Veränderungen bei drei Kindern, obwohl es keine entsprechenden klinischen Anzeichen gab. Dies erhebt die Frage, ob Veränderungen der klinisch “stummen” Läsionen im Kontroll‐MRI Vorläufer der mit der Zeit fortschreitenden Disseminierung sind, die das wesentliche Krit...

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The rapid assessment of visual dysfunction in multiple sclerosis.

Cited by 13 publications

References 29 publications

Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids

Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids

Influence of multiple sclerosis, age and degree of disability, in the position of the contrast sensitivity curve peak

Multiple Sclerosis In Childhood: Contribution Of Serial Mri To Earlier Diagnosis

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