The Experts below are selected from a list of 258 Experts worldwide ranked by ideXlab platform
Roy W Beck - One of the best experts on this subject based on the ideXlab platform.
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treatment of acute optic Neuritis a summary of findings from the optic Neuritis treatment trial
Archives of Ophthalmology, 2008Co-Authors: Roy W BeckAbstract:inconclusive because of small sample size. In the 1980s, the Optic Neuritis Treatment Trial was developed to evaluate corticosteroid treatment for optic Neuritis. This multicenter randomized clinical trial, supported by the National Eye Institute, was designed to answer the following questions: (1) Does treatment with either oral prednisone or intravenous methylprednisolone followed by oral prednisone improve the visual outcome of acute optic Neuritis? (2) Does either treatment speed recovery of vision? and (3) Are the complications of treatment insignificant in relation to the magnitude of the treatment effect? Long-term follow-up of the cohort was performed to investigate the relationship between optic Neuritis and the development of multiple sclerosis (MS).
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Brain Magnetic Resonance Imaging in Acute Optic Neuritis: Experience of the Optic Neuritis Study Group
JAMA Neurology, 1993Co-Authors: Roy W Beck, John A. Arrington, F. Reed Murtagh, Patricia A. Cleary, David I. KaufmanAbstract:• Objective. —Changes in the brain on magnetic resonance images are common in patients with optic Neuritis even when there is no other clinical evidence of multiple sclerosis. The current study was designed to determine systematically the prevalence of brain abnormalities on magnetic resonance images in the patients entered into the Optic Neuritis Treatment Trial. Design. —Prospective multicenter clinical trial. Setting. —Referral centers. Patients and Methods. —Brain magnetic resonance images from 418 patients with acute optic Neuritis (77% women; mean age, 32.0 years) were evaluated at a central reading center with the use of a standardized classification system (ranging from 0 for normal to IV for most extensive changes). Results. —Of the scans, 40.9% were classified as grade 0, 10.8% as grade I, 9.1% as grade II, 6.7% as grade III, and 32.5% as grade IV. For patients with isolated (monosymptomatic) optic Neuritis, 26.7% had two or more lesions. Conclusions. —We found a lower prevalence of brain magnetic resonance imaging abnormalities in isolated optic Neuritis than previous studies have reported. This likely is due to our study having a higher degree of standardization of patient inclusion criteria, which limited patient selection bias.
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Brain magnetic resonance imaging in acute optic Neuritis : experience of the optic Neuritis study group
1993Co-Authors: Roy W Beck, John A. Arrington, F. Reed Murtagh, Patricia A. Cleary, David I. KaufmanAbstract:Objective.-Changes in the brain on magnetic resonance images are common in patients with optic Neuritis even when there is no other clinical evidence of multiple sclerosis. The current study was designed to determine systematically the prevalence of brain abnormalities on magnetic resonance images in the patients entered into the Optic Neuritis Treatment Trial. Design.-Prospective multicenter clinical trial. Setting.-Referral centers. Patients and Methods.-Brain magnetic resonance images from 418 patients with acute optic Neuritis (77% women; mean age, 32.0 years) were evaluated at a central reading center with the use of a standardized classification system (ranging from 0 for normal to IV for most extensive changes)
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baseline visual field profile of optic Neuritis the experience of the optic Neuritis treatment trial
Archives of Ophthalmology, 1993Co-Authors: John L Keltner, Chris A Johnson, John O Spurr, Roy W BeckAbstract:• The purpose of the present study was to determine the baseline visual field characteristics in 448 patients with acute optic Neuritis who were entered into the Optic Neuritis Treatment Trial. The severity and pattern of visual field loss in both the affected and fellow eyes were classified. For affected eyes, diffuse visual field loss was present in 48.2% of eyes, central or centrocecal scotoma was present in 8.3% of eyes, altitudinal or other nervefiber bundle-type defects were present in 20.1% of eyes, and a variety of other defects were present in 23.4% of eyes. Visual field involvement was present in the fellow eye at baseline in 308 (68.8%) of the 448 patients. Evidence of a chiasmal or retrochiasmal visual field defect was present in 2.9% of the patients. Since a wide variety of visual field defects can occur with an acute attack of optic Neuritis, the pattern of visual field loss is of limited utility in distinguishing optic Neuritis from ischemic optic neuropathy and other optic nerve disorders. Asymptomatic visual field defects in the fellow eye are common.
John J. Chen - One of the best experts on this subject based on the ideXlab platform.
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Optic Neuritis in the era of biomarkers.
Survey of Ophthalmology, 2019Co-Authors: John J. Chen, Sean J. Pittock, Eoin P. Flanagan, Vanda A. Lennon, M. Tariq BhattiAbstract:Abstract The Optic Neuritis Treatment Trial, a landmark study completed in 1991, stratified the risk of multiple sclerosis in patients with optic Neuritis. Since that time, unique biomarkers for optic Neuritis have been found. The antibody against aquaporin-4 (AQP4)-immunoglobulin G (IgG) discovered in 2004 was found to be both the pathologic cause and a reliable biomarker for neuromyelitis optica spectrum disorders. This finding enabled an expanded definition of the phenotype of neuromyelitis optica spectrum disorder and improved treatment of the disease. Subsequently, myelin oligodendrocyte glycoprotein (MOG) IgG was recognized to be a marker for MOG-IgG-associated disorder, a central demyelinating disease characterized by recurrent optic Neuritis, prominent disk edema, and perineural optic nerve enhancement on magnetic resonance imaging. Most multiple sclerosis disease-modifying agents are ineffective for AQP4-IgG-positive neuromyelitis optica spectrum disorder and MOG-IgG-associated disorder. Because there are crucial differences in treatment and prognosis between multiple sclerosis, AQP4-IgG-positive neuromyelitis optica spectrum disorder, and MOG-IgG-associated disorder, ophthalmologists should be aware of these new biomarkers of optic Neuritis and incorporate their testing in all patients with atypical optic Neuritis.
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optical coherence tomography is highly sensitive in detecting prior optic Neuritis
Neurology, 2019Co-Authors: Sarah Chaoying Xu, Sean J. Pittock, Eoin P. Flanagan, Jacqueline A Leavitt, Randy H Kardon, John J. ChenAbstract:Objective To explore sensitivity of optical coherence tomography (OCT) in detecting prior unilateral optic Neuritis. Methods This is a retrospective, observational clinical study of all patients who presented from January 1, 2014, to January 6, 2017, with unilateral optic Neuritis and OCT available at least 3 months after the attack. We compared OCT retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thicknesses between affected and unaffected contralateral eyes. We excluded patients with concomitant glaucoma or other optic neuropathies. Based on analysis of normal controls, thinning was considered significant if RNFL was at least 9 µm or GCIPL was at least 6 µm less in the affected eye compared to the unaffected eye. Results Fifty-one patients (18 male and 33 female) were included in the study. RNFL and GCIPL thicknesses were significantly lower in eyes with optic Neuritis compared to unaffected eyes (p Conclusions OCT, especially with GCIPL analysis, is a highly sensitive modality in detecting prior optic Neuritis, which is made more robust by using intereye differences to approximate change. Classification of evidence This study provides Class III evidence that OCT accurately identifies patients with prior unilateral optic Neuritis.
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myelin oligodendrocyte glycoprotein antibody positive optic Neuritis clinical characteristics radiologic clues and outcome
American Journal of Ophthalmology, 2018Co-Authors: John J. Chen, Eoin P. Flanagan, Jiraporn Jitprapaikulsan, Alfonso Sebastian Lopezchiriboga, James P Fryer, Jacqueline A Leavitt, Brian G Weinshenker, Andrew Mckeon, Janmendelt Tillema, Vanda A. LennonAbstract:Purpose To characterize the clinical phenotype of myelin oligodendrocyte glycoprotein antibody (MOG-IgG) optic Neuritis. Design Observational case series. Methods Setting : Multicenter. Patient/Study Population : Subjects meeting inclusion criteria: (1) history of optic Neuritis; (2) seropositivity (MOG-IgG binding index > 2.5); 87 MOG-IgG-seropositive patients with optic Neuritis were included (Mayo Clinic, 76; other medical centers, 11). MOG-IgG was detected using full-length MOG-transfected live HEK293 cells in a clinically validated flow cytometry assay. Main Outcome Measures : Clinical and radiologic characteristics and visual outcomes. Results Fifty-seven percent were female and median age at onset was 31 (range 2–79) years. Median number of optic Neuritis attacks was 3 (range 1–8), median follow-up 2.9 years (range 0.5–24 years), and annualized relapse rate 0.8. Average visual acuity (VA) at nadir of worst attack was count fingers. Average final VA was 20/30; for 5 patients (6%) it was ≤20/200 in either eye. Optic disc edema and pain each occurred in 86% of patients. Magnetic resonance imaging showed perineural enhancement in 50% and longitudinally extensive involvement in 80%. Twenty-six patients (30%) had recurrent optic Neuritis without other neurologic symptoms, 10 (12%) had single optic Neuritis, 14 (16%) had chronic relapsing inflammatory optic neuropathy, and 36 (41%) had optic Neuritis with other neurologic symptoms (most neuromyelitis optica spectrum disorder–like phenotype or acute disseminated encephalomyelitis). Only 1 patient was diagnosed with MS (MOG-IgG-binding index 2.8; normal range ≤ 2.5). Persistent MOG-IgG seropositivity occurred in 61 of 62 (98%). A total of 61% received long-term immunosuppressant therapy. Conclusions Manifestations of MOG-IgG-positive optic Neuritis are diverse. Despite recurrent attacks with severe vision loss, the majority of patients have significant recovery and retain functional vision long-term.
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prevalence of myelin oligodendrocyte glycoprotein and aquaporin 4 igg in patients in the optic Neuritis treatment trial
JAMA Ophthalmology, 2018Co-Authors: John J. Chen, Eoin P. Flanagan, Jiraporn Jitprapaikulsan, James P Fryer, Jacqueline A Leavitt, Andrew Mckeon, Oliver W Tobin, Masoud Majed, Sean J. PittockAbstract:Importance Autoantibodies to aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) are recently established biomarkers of autoimmune optic Neuritis whose frequency and accompanying phenotype, especially for MOG-IgG, are still being characterized. The Optic Neuritis Treatment Trial (ONTT) was a well-known randomized clinical trial in optic Neuritis; therefore, knowledge of the serostatus and accompanying phenotype of these patients would be useful to determine the frequency of these antibodies in patients presenting with typical monocular optic Neuritis and their outcomes. Objectives To determine the AQP4-IgG and MOG-IgG serostatus of patients within the ONTT and describe the clinical features of seropositive patients. Design, Setting, and Participants In this follow-up study of the randomized clinical trial, ONTT, conducted between July 1, 1988, and June 30, 1991, analysis of serum for AQP4-IgG and MOG-IgG was performed from January 1 to April 30, 2017. A total of 177 patients from the ONTT with acute optic Neuritis and serum available for analysis were enrolled from 13 academic referral centers. Interventions Analysis of serum for AQP4-IgG and MOG-IgG was performed at Mayo Clinic Neuroimmunology Laboratory in 2017 with a flow cytometry, live cell, AQP4- and MOG-transfected cell-based assay. Main Outcomes and Measures Aquaporin-4–IgG and MOG-IgG serostatus. Results Of the 177 patients in the study (135 women and 42 men; mean [SD] age, 32.8 [6.9] years), 3 were positive for MOG-IgG (1.7%) and none were positive for AQP4-IgG. All 3 patients positive for MOG-IgG had disc edema at presentation. Two patients later had a single episode of recurrent optic Neuritis. All 3 patients had complete recovery of visual acuity, and none were corticosteroid dependent, although peripheral visual field loss persisted in 1 patient. None of the 3 patients positive for MOG-IgG had demyelinating lesions on magnetic resonance imaging scans, and none had developed multiple sclerosis at the 15-year follow-up. Conclusions and Relevance Frequency of MOG-IgG was rare in the ONTT, and AQP4-IgG was not found in patients in the ONTT. Characteristics of patients positive for MOG-IgG in the ONTT support the previously described phenotype of MOG-IgG optic Neuritis. Myelin oligodendrocyte glycoprotein–related disease appears to be a different entity than multiple sclerosis. Overall, AQP4-IgG and MOG-IgG may be less common in isolated optic Neuritis than previously reported.
Jacqueline A Leavitt - One of the best experts on this subject based on the ideXlab platform.
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optical coherence tomography is highly sensitive in detecting prior optic Neuritis
Neurology, 2019Co-Authors: Sarah Chaoying Xu, Sean J. Pittock, Eoin P. Flanagan, Jacqueline A Leavitt, Randy H Kardon, John J. ChenAbstract:Objective To explore sensitivity of optical coherence tomography (OCT) in detecting prior unilateral optic Neuritis. Methods This is a retrospective, observational clinical study of all patients who presented from January 1, 2014, to January 6, 2017, with unilateral optic Neuritis and OCT available at least 3 months after the attack. We compared OCT retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thicknesses between affected and unaffected contralateral eyes. We excluded patients with concomitant glaucoma or other optic neuropathies. Based on analysis of normal controls, thinning was considered significant if RNFL was at least 9 µm or GCIPL was at least 6 µm less in the affected eye compared to the unaffected eye. Results Fifty-one patients (18 male and 33 female) were included in the study. RNFL and GCIPL thicknesses were significantly lower in eyes with optic Neuritis compared to unaffected eyes (p Conclusions OCT, especially with GCIPL analysis, is a highly sensitive modality in detecting prior optic Neuritis, which is made more robust by using intereye differences to approximate change. Classification of evidence This study provides Class III evidence that OCT accurately identifies patients with prior unilateral optic Neuritis.
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myelin oligodendrocyte glycoprotein antibody positive optic Neuritis clinical characteristics radiologic clues and outcome
American Journal of Ophthalmology, 2018Co-Authors: John J. Chen, Eoin P. Flanagan, Jiraporn Jitprapaikulsan, Alfonso Sebastian Lopezchiriboga, James P Fryer, Jacqueline A Leavitt, Brian G Weinshenker, Andrew Mckeon, Janmendelt Tillema, Vanda A. LennonAbstract:Purpose To characterize the clinical phenotype of myelin oligodendrocyte glycoprotein antibody (MOG-IgG) optic Neuritis. Design Observational case series. Methods Setting : Multicenter. Patient/Study Population : Subjects meeting inclusion criteria: (1) history of optic Neuritis; (2) seropositivity (MOG-IgG binding index > 2.5); 87 MOG-IgG-seropositive patients with optic Neuritis were included (Mayo Clinic, 76; other medical centers, 11). MOG-IgG was detected using full-length MOG-transfected live HEK293 cells in a clinically validated flow cytometry assay. Main Outcome Measures : Clinical and radiologic characteristics and visual outcomes. Results Fifty-seven percent were female and median age at onset was 31 (range 2–79) years. Median number of optic Neuritis attacks was 3 (range 1–8), median follow-up 2.9 years (range 0.5–24 years), and annualized relapse rate 0.8. Average visual acuity (VA) at nadir of worst attack was count fingers. Average final VA was 20/30; for 5 patients (6%) it was ≤20/200 in either eye. Optic disc edema and pain each occurred in 86% of patients. Magnetic resonance imaging showed perineural enhancement in 50% and longitudinally extensive involvement in 80%. Twenty-six patients (30%) had recurrent optic Neuritis without other neurologic symptoms, 10 (12%) had single optic Neuritis, 14 (16%) had chronic relapsing inflammatory optic neuropathy, and 36 (41%) had optic Neuritis with other neurologic symptoms (most neuromyelitis optica spectrum disorder–like phenotype or acute disseminated encephalomyelitis). Only 1 patient was diagnosed with MS (MOG-IgG-binding index 2.8; normal range ≤ 2.5). Persistent MOG-IgG seropositivity occurred in 61 of 62 (98%). A total of 61% received long-term immunosuppressant therapy. Conclusions Manifestations of MOG-IgG-positive optic Neuritis are diverse. Despite recurrent attacks with severe vision loss, the majority of patients have significant recovery and retain functional vision long-term.
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prevalence of myelin oligodendrocyte glycoprotein and aquaporin 4 igg in patients in the optic Neuritis treatment trial
JAMA Ophthalmology, 2018Co-Authors: John J. Chen, Eoin P. Flanagan, Jiraporn Jitprapaikulsan, James P Fryer, Jacqueline A Leavitt, Andrew Mckeon, Oliver W Tobin, Masoud Majed, Sean J. PittockAbstract:Importance Autoantibodies to aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) are recently established biomarkers of autoimmune optic Neuritis whose frequency and accompanying phenotype, especially for MOG-IgG, are still being characterized. The Optic Neuritis Treatment Trial (ONTT) was a well-known randomized clinical trial in optic Neuritis; therefore, knowledge of the serostatus and accompanying phenotype of these patients would be useful to determine the frequency of these antibodies in patients presenting with typical monocular optic Neuritis and their outcomes. Objectives To determine the AQP4-IgG and MOG-IgG serostatus of patients within the ONTT and describe the clinical features of seropositive patients. Design, Setting, and Participants In this follow-up study of the randomized clinical trial, ONTT, conducted between July 1, 1988, and June 30, 1991, analysis of serum for AQP4-IgG and MOG-IgG was performed from January 1 to April 30, 2017. A total of 177 patients from the ONTT with acute optic Neuritis and serum available for analysis were enrolled from 13 academic referral centers. Interventions Analysis of serum for AQP4-IgG and MOG-IgG was performed at Mayo Clinic Neuroimmunology Laboratory in 2017 with a flow cytometry, live cell, AQP4- and MOG-transfected cell-based assay. Main Outcomes and Measures Aquaporin-4–IgG and MOG-IgG serostatus. Results Of the 177 patients in the study (135 women and 42 men; mean [SD] age, 32.8 [6.9] years), 3 were positive for MOG-IgG (1.7%) and none were positive for AQP4-IgG. All 3 patients positive for MOG-IgG had disc edema at presentation. Two patients later had a single episode of recurrent optic Neuritis. All 3 patients had complete recovery of visual acuity, and none were corticosteroid dependent, although peripheral visual field loss persisted in 1 patient. None of the 3 patients positive for MOG-IgG had demyelinating lesions on magnetic resonance imaging scans, and none had developed multiple sclerosis at the 15-year follow-up. Conclusions and Relevance Frequency of MOG-IgG was rare in the ONTT, and AQP4-IgG was not found in patients in the ONTT. Characteristics of patients positive for MOG-IgG in the ONTT support the previously described phenotype of MOG-IgG optic Neuritis. Myelin oligodendrocyte glycoprotein–related disease appears to be a different entity than multiple sclerosis. Overall, AQP4-IgG and MOG-IgG may be less common in isolated optic Neuritis than previously reported.
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the investigation of acute optic Neuritis a review and proposed protocol
Nature Reviews Neurology, 2014Co-Authors: Axel Petzold, Jacqueline A Leavitt, Fiona Costello, Mike P Wattjes, Jose Floresrivera, Clare L Fraser, Kazuo Fujihara, Romain Marignier, Friedemann Paul, Sven SchipplingAbstract:Optic Neuritis is an inflammatory optic neuropathy that affects many patients with multiple sclerosis (MS) at some point during their disease course. Differentiation of acute episodes of MS-associated optic Neuritis from other autoimmune and inflammatory optic neuropathies is vital for treatment choice and further patient management, but is not always straightforward. Over the past decade, a number of new imaging, laboratory and electrophysiological techniques have entered the clinical arena. To date, however, no consensus guidelines have been devised to specify how and when these techniques can be most rationally applied for the diagnostic work-up of patients with acute optic Neuritis. In this article, we review the literature and attempt to formulate a consensus for the investigation of patients with acute optic Neuritis, both in standard care and in research with relevance to clinical treatment trials.
Elliot M Frohman - One of the best experts on this subject based on the ideXlab platform.
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optical coherence tomography segmentation reveals ganglion cell layer pathology after optic Neuritis
Brain, 2012Co-Authors: Shiv Saidha, Scott D Newsome, John N Ratchford, Michael J Levy, Etona Ford, Ciprian M Crainiceanu, Mary K Durbin, Jonathan D Oakley, Scott A Meyer, Elliot M FrohmanAbstract:Post-mortem ganglion cell dropout has been observed in multiple sclerosis; however, longitudinal in vivo assessment of retinal neuronal layers following acute optic Neuritis remains largely unexplored. Peripapillary retinal nerve fibre layer thickness, measured by optical coherence tomography, has been proposed as an outcome measure in studies of neuroprotective agents in multiple sclerosis, yet potential swelling during the acute stages of optic Neuritis may confound baseline measurements. The objective of this study was to ascertain whether patients with multiple sclerosis or neuromyelitis optica develop retinal neuronal layer pathology following acute optic Neuritis, and to systematically characterize such changes in vivo over time. Spectral domain optical coherence tomography imaging, including automated retinal layer segmentation, was performed serially in 20 participants during the acute phase of optic Neuritis, and again 3 and 6 months later. Imaging was performed cross-sectionally in 98 multiple sclerosis participants, 22 neuromyelitis optica participants and 72 healthy controls. Neuronal thinning was observed in the ganglion cell layer of eyes affected by acute optic Neuritis 3 and 6 months after onset ( P < 0.001). Baseline ganglion cell layer thicknesses did not demonstrate swelling when compared with contralateral unaffected eyes, whereas peripapillary retinal nerve fibre layer oedema was observed in affected eyes ( P = 0.008) and subsequently thinned over the course of this study. Ganglion cell layer thickness was lower in both participants with multiple sclerosis and participants with neuromyelitis optica, with and without a history of optic Neuritis, when compared with healthy controls ( P < 0.001) and correlated with visual function. Of all patient groups investigated, those with neuromyelitis optica and a history of optic Neuritis exhibited the greatest reduction in ganglion cell layer thickness. Results from our in vivo longitudinal study demonstrate retinal neuronal layer thinning following acute optic Neuritis, corroborating the hypothesis that axonal injury may cause neuronal pathology in multiple sclerosis. Further, these data provide evidence of subclinical disease activity, in both participants with multiple sclerosis and with neuromyelitis optica without a history of optic Neuritis, a disease in which subclinical disease activity has not been widely appreciated. No pathology was seen in the inner or outer nuclear layers of eyes with optic Neuritis, suggesting that retrograde degeneration after optic Neuritis may not extend into the deeper retinal layers. The subsequent thinning of the ganglion cell layer following acute optic Neuritis, in the absence of evidence of baseline swelling, suggests the potential utility of quantitative optical coherence tomography retinal layer segmentation to monitor neuroprotective effects of novel agents in therapeutic trials.
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Optic Neuritis: A mechanistic view
Pathophysiology, 2010Co-Authors: Erik V. Burton, Benjamin Greenberg, Elliot M FrohmanAbstract:Abstract Acute demyelinating optic Neuritis is a condition of the optic nerves characterized by inflammation, demyelination, and neurodegeneration. Optic Neuritis is a relatively common demyelinating event, strongly associated with multiple sclerosis. A number of clinical, radiographic, retinal imaging, and electrophysiologic techniques have provided significant insight into the pathologic and pathophysiologic mechanisms of optic Neuritis and its related disorder multiple sclerosis. The development of validated biomarkers within the anterior visual system has paved the way for novel investigations aimed at characterizing the processes of axonal loss and neurodegeneration, neuroprotection, and perhaps even neurorestoration strategies.
Gena Heidary - One of the best experts on this subject based on the ideXlab platform.
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update on pediatric optic Neuritis
Current Neurology and Neuroscience Reports, 2020Co-Authors: Ryan Gise, Gena HeidaryAbstract:The purpose of this review is to provide an update on advances in the understanding of pediatric demyelinating optic Neuritis. In the past decade, the disease phenotypes for demyelinating syndromes in children have been more clearly defined. Pediatric optic Neuritis may present as a clinically isolated syndrome or in the setting of underlying neurologic disease. In addition to optic Neuritis associated with multiple sclerosis or neuromyelitis optica, recent work has identified antibodies to the myelin oligodendrocyte glycoprotein (MOG IgG) as a unique demyelinating cause with distinct features regarding treatment and prognosis. The disease phenotypes for demyelinating pediatric optic Neuritis have expanded. Treatment strategies vary and are not universally effective for each cause of demyelinating disease. Accurately distinguishing among these unique clinical syndromes is therefore critical for initiation of appropriate treatment to prevent disability, to maximize visual outcomes, and to provide insight into long-term prognosis.