Electrophysiological Evidence for Heterogeneity of Lesions in Optic Neuritis

Klistorner, Alexander; Graham, Stuart L.; Fraser, Clare L.; Garrick, R.; Nguyen, Tracy; Paine, M.; O’Day, Justin; Grigg, John; Arvind, Hemamalini; Billson, Frank A.

doi:10.1167/iovs.07-0381

Cited by 50 publications

(35 citation statements)

References 54 publications

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“…This is again in accordance with recent OCT, clinical, pathological and electrophysiological studies indicating particular susceptibility of papillomacular bundle fibres (or small-size neurons) to damage in ON and MS [17,18,35,47,58,59]. We also found considerable reduction of the mfVEP amplitude in ON eyes in all three areas of the studied visual field.…”

Section: Discussionsupporting

confidence: 93%

“…It can, therefore, identify focal defects such as from glaucomatous losses with high sensitivity and specificity [30,31]. Multifocal VEP has been demonstrated to be superior to conventional VEP in assessing small independent regions of the visual field in ON patients [32][33][34] and monitoring the recovery of the optic nerve function [35,36].…”

Section: Introductionmentioning

confidence: 99%

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Multifocal VEP and OCT in optic neuritis: a topographical study of the structure–function relationship

et al. 2008

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Multifocal VEP and OCT in optic neuritis: a topographical study of the structure–function relationship

et al. 2008

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“…This hypothesis has been supported by recent animal studies [21]. Subsequent shortening of latency over the following weeks or months is thought to represent remyelination of the lesion [9,22]. The finding of persistent delayed latency at 1 year has been reported to be associated with increased risk of conversion to MS [23,24].…”

Section: Discussionmentioning

confidence: 82%

Reproducibility of multifocal VEP latency using different stimulus presentations

et al. 2012

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The aims of the article were to study the reproducibility of latency of multifocal visual evoked potential (mfVEP) recorded using different stimulus presentations and to identify the peak with least variability. Ten normal subjects, aged between 22 and 52 years (mean age 32 ± 8.37 years), participated in the study. All subjects underwent mfVEP testing with pattern reversal and pattern pulse stimulus presentations. The stimulus subtends 26° from fixation and includes 24 segments. Only the vertical channel was recorded on all subjects. Testing was repeated after 1-2 weeks. Only the right eye of all subjects was analysed. Segments with low signal-to-noise ratios (SNR < 1.5) were excluded from analysis. The latencies were analysed to confirm values from the same peak for the two tests. The latency values were then analysed for the start of the response, the first peak and the second peak. The waveforms were reproducible throughout the field. Reproducibility of latency at the "start of the response" was significantly lesser than the first and the second peaks studied, while the reproducibility of latency at the first peak was not statistically different from the second peak for either pattern reversal or pattern pulse stimulation. The latency values were not different between the first and the second sessions for either pattern reversal or pattern pulse stimulation for any of the peaks. The pattern reversal stimulus presentation produced less variability in latency. The first peak is the most reproducible among the three measures in both the stimulus presentation.

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“…7,9 Alternately, our pilot investigation was cross-sectional in nature, and aimed at characterizing the effects that low contrast visual stimulation exerts on visual system cortical responses. The results reported herein are similar to the outcomes observed with low contrast visual acuity testing in MS cohorts.…”

Section: Resultsmentioning

confidence: 99%

Multifocal visual evoked potentials are influenced by variable contrast stimulation in MS

et al. 2012

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Objective: To test the hypothesis that patients with multiple sclerosis (MS) with intereye asymmetry on low contrast letter acuity, and thickness of the retinal nerve fiber layer (RNFL), would exhibit corresponding changes in cortical timing and amplitude responses on pattern reversal multifocal visual evoked potentials (mfVEP), contingent upon variable stimulus contrast. Methods:In a cross-sectional study, we investigated a cohort of 11 normal subjects and 40 patients with MS, 21 of whom had a history of acute optic neuritis (MS-AON) with an intereye asymmetry with respect to RNFL thickness, and on low contrast letter acuity performance. Pattern reversal mfVEP was performed at high (100%), low (33.3%), and very low (14.2%) Michelson-contrast levels.Results: Compared to baseline measures at 100% contrast, the mean amplitude of the mfVEP was reduced in MS-AON eyes, upon pattern-reversal stimulation at the 2 lower contrast levels (p Ͻ 0.0001). With respect to changes in timing responses, the intereye asymmetry was increased in the MS-AON patients upon lower contrast pattern-reversal stimulation (p Ͻ 0.0001 for 33.3% compared to 100%, and p Ͻ 0.001 for 14.2% compared to 100%). The fellow eye in 12 (57%; p Ͻ 0.001) of the patients with an abnormal eye, and a history of AON, revealed abnormal amplitude and timing responses upon low contrast stimulation (signifying unmasking of occult damage). Conventional visual evoked potential (VEP) studies can reveal the cardinal features of inflammatory demyelination within the anterior visual system, such as prolongation in the P-100 latency. Conclusions: 1This finding represents the pathophysiologic signature of conduction slowing, and represents one of the earliest demonstrable and objective features of acute optic neuritis (AON). 2-4The recent assessment of conventional VEP measures, with the application of a low contrast pattern-reversal method, represents a potentially practical refinement in the sensitivity and specificity of detecting demyelinating optic neuropathy.5 Nonetheless, conventional VEP testing yields a single summed potential from the entire visual field of stimulation, rendering this *These authors contributed equally to this work.From the

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Electrophysiological Evidence for Heterogeneity of Lesions in Optic Neuritis

Abstract: Distinct patterns of disease evolution were identified using mfVEP in patients with first episode of optic neuritis and at high risk for MS, supporting the concept of heterogeneity of early lesions in MS.

Cited by 50 publications

References 54 publications

Multifocal VEP and OCT in optic neuritis: a topographical study of the structure–function relationship

Multifocal VEP and OCT in optic neuritis: a topographical study of the structure–function relationship

Reproducibility of multifocal VEP latency using different stimulus presentations

Multifocal visual evoked potentials are influenced by variable contrast stimulation in MS

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