RT Journal Article
SR Electronic
T1 Microstructural visual system changes in AQP4-antibody–seropositive NMOSD
JF Neurology - Neuroimmunology Neuroinflammation
JO Neurol Neuroimmunol Neuroinflamm
FD Lippincott Williams & Wilkins
SP e334
DO 10.1212/NXI.0000000000000334
VO 4
IS 3
A1 Oertel, Frederike C.
A1 Kuchling, Joseph
A1 Zimmermann, Hanna
A1 Chien, Claudia
A1 Schmidt, Felix
A1 Knier, Benjamin
A1 Bellmann-Strobl, Judith
A1 Korn, Thomas
A1 Scheel, Michael
A1 Klistorner, Alexander
A1 Ruprecht, Klemens
A1 Paul, Friedemann
A1 Brandt, Alexander U.
YR 2017
UL http://nn.neurology.org/content/4/3/e334.abstract
AB Objective: To trace microstructural changes in patients with aquaporin-4 antibody (AQP4-ab)-seropositive neuromyelitis optica spectrum disorders (NMOSDs) by investigating the afferent visual system in patients without clinically overt visual symptoms or visual pathway lesions.Methods: Of 51 screened patients with NMOSD from a longitudinal observational cohort study, we compared 6 AQP4-ab–seropositive NMOSD patients with longitudinally extensive transverse myelitis (LETM) but no history of optic neuritis (ON) or other bout (NMOSD-LETM) to 19 AQP4-ab–seropositive NMOSD patients with previous ON (NMOSD-ON) and 26 healthy controls (HCs). Foveal thickness (FT), peripapillary retinal nerve fiber layer (pRNFL) thickness, and ganglion cell and inner plexiform layer (GCIPL) thickness were measured with optical coherence tomography (OCT). Microstructural changes in the optic radiation (OR) were investigated using diffusion tensor imaging (DTI). Visual function was determined by high-contrast visual acuity (VA). OCT results were confirmed in a second independent cohort.Results: FT was reduced in both patients with NMOSD-LETM (p = 3.52e−14) and NMOSD-ON (p = 1.24e−16) in comparison with HC. Probabilistic tractography showed fractional anisotropy reduction in the OR in patients with NMOSD-LETM (p = 0.046) and NMOSD-ON (p = 1.50e−5) compared with HC. Only patients with NMOSD-ON but not NMOSD-LETM showed neuroaxonal damage in the form of pRNFL and GCIPL thinning. VA was normal in patients with NMOSD-LETM and was not associated with OCT or DTI parameters.Conclusions: Patients with AQP4-ab–seropositive NMOSD without a history of ON have microstructural changes in the afferent visual system. The localization of retinal changes around the Müller-cell rich fovea supports a retinal astrocytopathy.AD=axial diffusivity; ART=automatic real time; DTI=diffusion tensor imaging; FT=foveal thickness; GCIPL=ganglion cell and inner plexiform layer; GEE=general estimate equation; HC=healthy control; LETM=longitudinally extensive transverse myelitis; LGN=lateral geniculate nucleus; LPA=lesion prediction algorithm; LST=Lesion Segmentation Toolbox; MD=mean diffusivity; NMOSD=neuromyelitis optica spectrum disorder; OCT=optical coherence tomography; ON=optic neuritis; OR=optic radiation; pRNFL=peripapillary retinal nerve fiber layer; RD=radial diffusivity; ROI=region of interest; VA=visual acuity