Contributions
Abstract: P1100
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - Neurophysiology
Introduction: In Multiple Sclerosis (MS) Optical Coherence Tomography (OCT) is used to measure Retinal Nerve Fiber Layer (RNFL) thickness as marker of axonal loss, while Visual Evoked Potentials (VEPs) as indicator of demyelination. We explored whether a multimodal visual system evaluation could be useful to assess MS patients in clinical practice.
Methods: 200 MS patients (16 Clinically Isolated Syndromes-CIS, 126 Relapsing Remitting-RRMS, 38 Secondary Progressive-SPMS, 20 Primary Progressive-PPMS, mean age 40.3 years, mean disease duration 8.19 years, median EDSS 2.0) underwent neurophysiological evaluation with OCT, full-field (ff-VEPs) and multifocal (mf-VEPs) VEPs. OCT was evaluated considering normative data provided by manufacturer; ff-VEPs and mf-VEPs were interpreted according to our lab data; for mf-VEPs cluster analysis was also performed. Sensitivities were compared using McNemar test.
Results: In eyes without Optic Neuritis (nON, n=274), OCT, ff-VEPs and mf-VEPs combination was more sensitive than each single technique (75.2% vs 28.8%, 52.2% and 66.1% respectively, p< 0.001). The same advantage (91.1% vs 63.3%, 75.6% and 82.2% respectively, p< 0.001 for OCT and ff-VEP, p=0.008 for mf-VEP) was found considering eyes with previous ON (>3 months - cON, n=90). In eyes with recent ON (< 3 months - aON, n=36) the combination of the three techniques was only superior to OCT (94.4% vs 58.8%, p< 0.001); both ff-VEPs and mf-VEPs showed alone a good diagnostic power (83.3% and 86.1% respectively). When comparing single techniques, both ff-VEPs and mf-VEPs were superior to OCT in nON eyes (28.8% vs 52.2% and 66.1% respectively, p< 0.001), with mf-VEPs more sensitive than ff-VEPs (p< 0.001). In cON eyes no statistical difference was found between OCT and ff-VEPs (63.3% vs 75.5%, p=0.071), with mf-VEPs more sensitive than OCT (82.2% vs 63.3%, p=0.002) but not than ff-VEPs. In aON eyes both ff-VEPs and mf-VEPs were superior to OCT (52.8% vs 83.4%, p=0.003 and 86.1%, p=0.008 respectively), with no difference among them. Including cluster analysis mf-VEPs were found more sensitive than ff-VEPs also in cON eyes (87.8% vs 75.2%, p=0.013), but not in aON eyes, although reaching 94.4% sensitivity in this category.
Conclusions: These results support a routine multimodal approach to the visual system in MS, especially when examining nON and cON eyes. Among functional techniques, mf-VEPs show higher sensitivities than ff-VEPs if cluster analysis is performed.
Disclosure: Part of this work was supported by Merck Serono S.A., Geneva, Switzerland. Merck Serono is the biopharmaceutical division of Merck KGaA, Darmstadt, Germany.
S. Guerrieri: nothing to disclose.
G. Di Maggio: nothing to disclose.
M. Pisa: nothing to disclose.
F. Vitali: nothing to disclose.
R. Santangelo: nothing to disclose.
S. Medaglini: nothing to disclose.
L. Moiola: speaking honoraria by Biogen, Sanofi Aventis, Merck Serono.
U Del Carro: nothing to disclose.
V. Martinelli: travelling and speaking honoraria by Biogen, Sanofi, Merck-Serono, Bayer and Teva.
G. Comi: honoraria by Biogen, Sanofi-Genzyme, Merck-Serono, Bayer, Teva, Novartis, Actelion and Almirall.
L. Leocani: personal compensation and research funding by Biogen, Sanofi-Genzyme, Merck-Serono, Novartis, Abbvie and Almirall.
Abstract: P1100
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - Neurophysiology
Introduction: In Multiple Sclerosis (MS) Optical Coherence Tomography (OCT) is used to measure Retinal Nerve Fiber Layer (RNFL) thickness as marker of axonal loss, while Visual Evoked Potentials (VEPs) as indicator of demyelination. We explored whether a multimodal visual system evaluation could be useful to assess MS patients in clinical practice.
Methods: 200 MS patients (16 Clinically Isolated Syndromes-CIS, 126 Relapsing Remitting-RRMS, 38 Secondary Progressive-SPMS, 20 Primary Progressive-PPMS, mean age 40.3 years, mean disease duration 8.19 years, median EDSS 2.0) underwent neurophysiological evaluation with OCT, full-field (ff-VEPs) and multifocal (mf-VEPs) VEPs. OCT was evaluated considering normative data provided by manufacturer; ff-VEPs and mf-VEPs were interpreted according to our lab data; for mf-VEPs cluster analysis was also performed. Sensitivities were compared using McNemar test.
Results: In eyes without Optic Neuritis (nON, n=274), OCT, ff-VEPs and mf-VEPs combination was more sensitive than each single technique (75.2% vs 28.8%, 52.2% and 66.1% respectively, p< 0.001). The same advantage (91.1% vs 63.3%, 75.6% and 82.2% respectively, p< 0.001 for OCT and ff-VEP, p=0.008 for mf-VEP) was found considering eyes with previous ON (>3 months - cON, n=90). In eyes with recent ON (< 3 months - aON, n=36) the combination of the three techniques was only superior to OCT (94.4% vs 58.8%, p< 0.001); both ff-VEPs and mf-VEPs showed alone a good diagnostic power (83.3% and 86.1% respectively). When comparing single techniques, both ff-VEPs and mf-VEPs were superior to OCT in nON eyes (28.8% vs 52.2% and 66.1% respectively, p< 0.001), with mf-VEPs more sensitive than ff-VEPs (p< 0.001). In cON eyes no statistical difference was found between OCT and ff-VEPs (63.3% vs 75.5%, p=0.071), with mf-VEPs more sensitive than OCT (82.2% vs 63.3%, p=0.002) but not than ff-VEPs. In aON eyes both ff-VEPs and mf-VEPs were superior to OCT (52.8% vs 83.4%, p=0.003 and 86.1%, p=0.008 respectively), with no difference among them. Including cluster analysis mf-VEPs were found more sensitive than ff-VEPs also in cON eyes (87.8% vs 75.2%, p=0.013), but not in aON eyes, although reaching 94.4% sensitivity in this category.
Conclusions: These results support a routine multimodal approach to the visual system in MS, especially when examining nON and cON eyes. Among functional techniques, mf-VEPs show higher sensitivities than ff-VEPs if cluster analysis is performed.
Disclosure: Part of this work was supported by Merck Serono S.A., Geneva, Switzerland. Merck Serono is the biopharmaceutical division of Merck KGaA, Darmstadt, Germany.
S. Guerrieri: nothing to disclose.
G. Di Maggio: nothing to disclose.
M. Pisa: nothing to disclose.
F. Vitali: nothing to disclose.
R. Santangelo: nothing to disclose.
S. Medaglini: nothing to disclose.
L. Moiola: speaking honoraria by Biogen, Sanofi Aventis, Merck Serono.
U Del Carro: nothing to disclose.
V. Martinelli: travelling and speaking honoraria by Biogen, Sanofi, Merck-Serono, Bayer and Teva.
G. Comi: honoraria by Biogen, Sanofi-Genzyme, Merck-Serono, Bayer, Teva, Novartis, Actelion and Almirall.
L. Leocani: personal compensation and research funding by Biogen, Sanofi-Genzyme, Merck-Serono, Novartis, Abbvie and Almirall.