Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography

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Abstract

Neuromyelitis optica (NMO) is an inflammatory autoimmune disease of the central nervous system that preferentially targets the optic nerves and spinal cord. The clinical presentation may suggest multiple sclerosis (MS), but a highly specific serum autoantibody against the astrocytic water channel aquaporin-4 present in up to 80% of NMO patients enables distinction from MS. Optic neuritis may occur in either condition resulting in neuro-anatomical retinal changes. Optical coherence tomography (OCT) has become a useful tool for analyzing retinal damage both in MS and NMO. Numerous studies showed that optic neuritis in NMO typically results in more severe retinal nerve fiber layer (RNFL) and ganglion cell layer thinning and more frequent development of microcystic macular edema than in MS. Furthermore, while patients’ RNFL thinning also occurs in the absence of optic neuritis in MS, subclinical damage seems to be rare in NMO. Thus, OCT might be useful in differentiating NMO from MS and serve as an outcome parameter in clinical studies.

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Most cited references 54

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Prognostic factors and disease course in aquaporin-4 antibody-positive patients with neuromyelitis optica spectrum disorder from the United Kingdom and Japan.

Joanna Kitley, Mark Woodhall, Yoshiki Takai … (2012)

Neuromyelitis optica and neuromyelitis optica spectrum disorders have been recently associated with the disease-specific autoantibody aquaporin-4, thought to be pathogenic. Identifying this antibody has allowed the clinical phenotype to be broadened. It is clear that some patients with similar clinical features do not have this antibody and may have a different condition with different outcomes and prognosis. Previous clinical neuromyelitis optica and neuromyelitis optica spectrum disorder studies have included such patients. We investigated clinical outcomes and prognostic characteristics of 106 aquaporin-4 antibody-seropositive patients from the UK and Japan. We looked at predictors of disability outcomes, namely visual disability (permanent bilateral visual loss with visual acuity of <6/36 in the best eye), motor disability (permanent inability to walk further than 100 m unaided), wheelchair dependence and mortality. Data were collected largely retrospectively through review of case records. After median disease duration of 75 months, 18% had developed permanent bilateral visual disability, 34% permanent motor disability, 23% had become wheelchair dependent and 9% had died. Age at disease onset appeared to be an important predictor of disability type. Young-onset patients in the UK, but not the Japanese cohort, commonly presenting with optic neuritis, had a high risk of visual disability while older patients in both cohorts had a high risk of motor disability, regardless of their onset symptom. Genetic factors also appeared important. The UK cohort seemed to have more severe disease than the Japanese cohort, with more severe onset attacks, a higher relapse frequency and greater disability at follow-up, despite earlier immunosuppression. Moreover, within the UK cohort, there were important differences between ethnic groups, with Afro-Caribbean patients having a younger age at disease onset, more brain and multifocal attacks and higher likelihood of visual disability than Caucasian patients. Thus, age at disease onset and genetic factors are both likely to be important in determining clinical outcomes in aquaporin-4 disease. This has important implications for interpreting clinical neuromyelitis optica and neuromyelitis optica spectrum disorder studies, since clinical features and outcomes appear not to be generic across populations and may need to be tailored to individual groups. These factors need to be explored further in future prospective neuromyelitis optica and neuromyelitis optica spectrum disorder studies.

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Longitudinal study of vision and retinal nerve fiber layer thickness in multiple sclerosis.

Chen-yang Dai, J Ratchford, Laura Balcer … (2010)

Cross-sectional studies of optical coherence tomography (OCT) show that retinal nerve fiber layer (RNFL) thickness is reduced in multiple sclerosis (MS) and correlates with visual function. We determined how longitudinal changes in RNFL thickness relate to visual loss. We also examined patterns of RNFL thinning over time in MS eyes with and without a prior history of acute optic neuritis (ON). Patients underwent OCT measurement of RNFL thickness at baseline and at 6-month intervals during a mean follow-up of 18 months at 3 centers. Low-contrast letter acuity (2.5%, 1.25% contrast) and visual acuity (VA) were assessed. Among 299 patients (593 eyes) with >or=6 months follow-up, eyes with visual loss showed greater RNFL thinning compared to eyes with stable vision (low-contrast acuity, 2.5%: p or=6.6microm) increased from 11% at 0 to 1 year to 44% at 3 to 4.5 years (p < 0.001). Progressive RNFL thinning occurs as a function of time in some patients with MS, even in the absence of ON, and is associated with clinically significant visual loss. These findings are consistent with subclinical axonal loss in the anterior visual pathway in MS, and support the use of OCT and low-contrast acuity as methods to evaluate the effectiveness of putative neuroprotection protocols.

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Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: multicenter study of treatment efficacy.

Maureen Mealy, Dean Wingerchuk, Jacqueline Palace … (2014)

Neuromyelitis optica (NMO) is an inflammatory disease of the optic nerves and spinal cord that leads to blindness and paralysis. Effective immunosuppression is the standard of care for relapse prevention.

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Author and article information

Contributors

JL Bennett

J de Seze

M Lana-Peixoto

J Palace

A Waldman

S Schippling

S Tenembaum

B Banwell

B Greenberg

M Levy

K Fujihara

KH Chan

HJ Kim

N Asgari

DK Sato

A Saiz

J Wuerfel

H Zimmermann

A Green

P Villoslada

F Paul

Journal

Journal ID (nlm-ta): Mult Scler

Journal ID (iso-abbrev): Mult. Scler

Journal ID (publisher-id): MSJ

Journal ID (hwp): spmsj

Title: Multiple Sclerosis (Houndmills, Basingstoke, England)

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 1352-4585

ISSN (Electronic): 1477-0970

Publication date (Print and electronic): May 2015

Publication date (Print): May 2015

Volume: 21

Issue: 6

Pages: 678-688

Affiliations

[1-1352458514567216]Departments of Neurology and Ophthalmology, University of Colorado, Denver, Colorado, USA

[2-1352458514567216]Neurology Service, University Hospital of Strasbourg, France

[3-1352458514567216]CIEM MS Research Center, University of Minas Gerais Medical School, Belo Horizonte Brazil

[4-1352458514567216]Department of Neurology, Oxford University Hospitals National Health Service Trust, Oxford, UK

[5-1352458514567216]Division of Neurology, Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania, USA

[6-1352458514567216]Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Switzerland

[7-1352458514567216]Department of Neurology, National Pediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina

[8-1352458514567216]Division of Neurology, Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania, USA

[9-1352458514567216]Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Texas, USA

[10-1352458514567216]Department of Neurology, Johns Hopkins University, Baltimore, Maryland USA

[11-1352458514567216]Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan

[12-1352458514567216]University Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong

[13-1352458514567216]Research Institute and Hospital of National Cancer Center Goyang Republic of Korea

[14-1352458514567216]Institute of Molecular Medicine, University of Southern Denmark, and Department of Neurology, Vejle Hospital, Odense, Denmark

[15-1352458514567216]Department of Neurology, Tohoku University School of Medicine, Sendai, Japan

[16-1352458514567216]Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain

[17-1352458514567216]NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, and Institute of Interventional and Diagnostic Neuroradiology, University Medicine Göttingen, Germany

[18-1352458514567216]NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Germany

[19-1352458514567216]Multiple Sclerosis Center, UCSF Department of Neurology and Neuro-ophthalmology Service, UCSF Department of Ophthalmology, San Francisco, USA

[20-1352458514567216]Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain

[21-1352458514567216]NeuroCure Clinical Research and Department of Neurology, Charité – Universitätsmedizin Berlin and Experimental and Clinical Research Center, Charité – Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine, Berlin, Germany

Author notes

[*]NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Germany; Department of Neurology, Charité – Universitätsmedizin Berlin, Germany and Experimental and Clinical Research Center, Charité – Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine, Charitéplatz 1, D-10117 Berlin, Germany. friedemann.paul@ 123456charite.de

Article

Publisher ID: 10.1177_1352458514567216

DOI: 10.1177/1352458514567216

PMC ID: 4425816

PubMed ID: 25662342

SO-VID: 1fb3abe8-8528-4269-bfc7-6d24de0783e4

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( http://www.uk.sagepub.com/aboutus/openaccess.htm).

History

Date received : 2 November 2014

Date revision received : 20 November 2014

Date accepted : 27 November 2014

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Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography

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Most cited references 54

Prognostic factors and disease course in aquaporin-4 antibody-positive patients with neuromyelitis optica spectrum disorder from the United Kingdom and Japan.

Longitudinal study of vision and retinal nerve fiber layer thickness in multiple sclerosis.

Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: multicenter study of treatment efficacy.

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