Continuing Optic Nerve Atrophy Following Optic Neuritis: A Serial MRI Study
Hickman SJ, Brierley CM, Brex PA, MacManus DG, Scolding NJ, Compston DA, Miller DH
Mult Scler 2002 Aug;8(4):339-42
NMR Research Unit, Institute of Neurology, University College London, UK
To investigate Optic Neuritis as a model for Atrophy in Multiple Sclerosis (MS) lesions we performed serial Magnetic Resonance Imaging (MRI) on 10 patients with a history of Optic Neuritis using a fat saturated short-echo fast Fluid-Attenuated Inversion Recovery (sTE fFLAIR) sequence.
The first study was performed a median of 19.5 months after the onset of Optic Neuritis and the second 1 year later. Using a computer-assisted contouring technique, a blinded observer calculated the mean area of the intro-orbital Optic Nerves.
The mean area of affected Optic Nerves decreased over 1 year by 0.9 mm2 from 11.1 to 10.2 mm2 (p = 0.01). Poor Visual Acuity and decreased Visual-Evoked Potential (VEP) amplitude were associated with Atrophy.
These findings suggest that Atrophy is a feature of focal DeMyelinating lesions, it may evolve over several years, and may have functional significance.
Optic Neuritis provides a model to study the effect of inflammatory DeMyelination through the ability to accurately measure Visual function and to visualize and measure the Optic Nerves using Magnetic Resonance Imaging.
Autonomic Instability, As Measured By Pupillary Unrest, Is Not Associated With Multiple Sclerosis Fatigue Severity
Egg R, Hogl B, Glatzl S, Beer R, Berger T
Mult Scler 2002 May;8(3):256-60
University Hospital Innsbruck, Department of Neurology, Austria
Multiple Sclerosis (MS) Fatigue is one of the most common symptoms in MS, but its PathoPhysiology is still not understood SympathoVagal imbalance was suggested as a reason for Fatigue in Chronic Fatigue Syndrome.
We examined the role of an imbalance in the Central Autonomic Nervous System (ANS) as a cause of MS Fatigue in 51 MS patients and a control group of 22 healthy volunteers.
Fatigue was assessed with the revised MS Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). Depression was evaluated with the Beck Depression Inventory (BDI).
Disintegration of the Central ANS expressed by Pupillary Fatigue waves was measured with Pupillography and documented in the Pupillary Unrest Index (PUI). All subjects had less than five points on the seven-point Stanford Sleepiness Scale and were therefore not sleepy.
MS patients had significant higher mean FSS scores (p=0.001) and mean MFIS scores (p=0.003) than our control group.
Mean BDI scores were significant higher (p=0.001) in the MS group, but were in the lowest score range (0-10 points) in both groups.
Surprisingly, we found a statistically significant inverse correlation between PUI values and either FSS scores (p=0.001; r=-0.521) or MFIS scores (p=0.002; r=-0.423) in the MS group, but not in healthy participants.
We therefore conclude that Autonomic instability, as measured by Pupillary unrest is not associated with MS Fatigue severity.
Autonomic Dysfunction In Multiple Sclerosis: Correlation With Disease-Related Parameters
Gunal DI, Afsar N, Tanridag T, Aktan S
Eur Neurol 2002;48(1):1-5
Marmara University Hospital, Department of Neurology, Istanbul, Turkey
CardioVascular Autonomic functions were investigated in a prospective, controlled study of 22 consecutive Relapsing/Remitting Multiple Sclerosis (MS) patients and 22 healthy subjects using 5 simple noninvasive tests and Sympathetic Skin Response Testing.
Tests included the Heart Rate response to deep breathing, Valsalva maneuver and standing, blood pressure response to standing and sustained hand grip, and were graded according to the Ewing and Clark classification as early, definite or severe impairment.
The relationship between Autonomic Dysfunction and disease-related parameters such as the Expanded Disability Status Scale (EDSS) and disease duration was studied.
Ninety percent of the patients had symptoms related with Autonomic Dysfunction, and 45.5 % had abnormal results in CardioVascular Autonomic Function testing with 4 patients also having abnormal Sympathetic Skin Responses.
Statistical analysis indicated that patients with a long disease duration rather than high EDSS carried a risk of Autonomic involvement in MS.
Both ParaSympathetic and Sympathetic functions were impaired and this could have been easily overlooked by a standard EDSS follow-up.
In this regard, Autonomic function testing seems necessary in order to detect subclinical changes in MS patients and should be considered in outcome measures.
Copyright 2002 S. Karger AG, Basel
Irreversible Disability And Tissue Loss In Multiple Sclerosis: A Conventional And Magnetization Transfer Magnetic Resonance Imaging Study Of The Optic Nerves
Inglese M, Ghezzi A, Bianchi S, Gerevini S, Sormani MP, Martinelli V, Comi G, Filippi M
Arch Neurol 2002 Feb;59(2):250-5
NeuroImaging Research Unit, Department of NeuroScience, Scientific Institute and University Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
To assess, by magnetic resonance imaging, the volumes and Magnetization Transfer Ratio (MTR) values of Optic Nerves (ONs) from patients with Multiple Sclerosis (MS) who had incomplete or no visual recovery after Optic Neuritis.
And, to compare these quantities with those derived from ONs from patients with MS who showed a marked clinical recovery after Optic Neuritis, ONs from healthy volunteers, and ONs from patients with Leber Hereditary Optic Neuropathy (LHON).
Conventional and Magnetization Transfer Magnetic Resonance Images of the ONs were obtained from 30 patients with MS, 18 healthy volunteers, and 10 patients with LHON.
The ON from patients with MS were classified as:
- Clinically unaffected (n = 18);
- Clinically affected with recovery (n = 20; Visual Acuity > or =20/25 at least 6 months after Optic Neuritis); and
- Clinically affected with incomplete or no recovery (n = 22; Visual Acuity < 20/25 at least 6 months after Optic Neuritis).
- The ON volumes and MTR values were measured.
Volumes (P =.002) and MTR values (P < .001) of the ONs from patients with MS and incomplete or no recovery were both lower than those of the ONs from patients with MS and recovery, but not different from those of the ONs from patients with LHON.
Volumes and MTR values of the affected ONs from patients with MS and recovery did not differ from those of clinically unaffected ONs, which were similar to those of healthy volunteers.
These findings suggest that, in patients with MS, NeuroDegeneration is associated with persistent functional deficits secondary to incomplete recovery from relapses.