Abstract Details

Title Exploring the evolution of functional and structural damage along the visual pathway in multiple sclerosis related acute optic neuritis.

Topic Multiple Sclerosis

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 344

Objective

To describe functional and structural damage after acute optic neuritis (aON) in relapsing-remitting multiple sclerosis (RRMS) or clinically isolated syndrome (CIS).

Background full-field visual evoked potentials (ff-VEPs) and optical coherence tomography (OCT) are used to monitor aON, to assess demyelination and neurodegeneration. Multifocal VEPs (mf-VEPs) allow the topographic characterization of optic nerve damage.

Design/Methods prospective study enrolling 16 CIS and 24 RRMS patients with a first aON episode in the study eye, who underwent OCT, ff-VEPs and mf-VEPs at 4 weeks after onset, with follow-up at 3, 6 and 9 months. For 21 patients prebaseline assessment was available.

Results VEPs latency was initially delayed (mean: 135.5 ms for ff-VEP; 169.1 ms for mf-VEP) to progressively recover over months 1-9 (mean change: -9.94 ms, p<0.001 for ff-VEPs; -9.0 ms, p=0.001 for mf-VEPs), with a parallel peripapillary retinal nerve fiber layer (pRNFL) thinning (mean change: -9.8 µm, p<0.001). Ganglion cell-inner plexiform layer (GCIPL) atrophy was already detectable at 1 month. Pre-baseline ff-VEPs latency (Adj.R2=0.153, β - 0.445, p=0.049) and GCIPL thinning at 1 month (Adj.R2=0.647, β 0.815, p<0.001) predicted subsequent pRNFL loss. Initial ff-VEPs latency ≥140 ms was associated with pRNFL loss >5 µm (χ2 5.79, p=0.016); the same outcome was found in patients aged >33 years with ff-VEPs latency <140 ms (χ2 3.309, p=0.049). At 1 month ff-VEPs and mf-VEPs abnormality rates did not differ significantly (77% vs 85%, p=0.998), both performing better than OCT (42%, p<0.001); at 9 months mf-VEPs were more sensitive than ff-VEPs (65% vs 40%, p=0.035).

Conclusions significant retinal damage has occurred within 1 month after aON, with initial demyelination and age influencing consequent neurodegeneration; hyperacute recruitment is therefore crucial to prompt remyelinating and neuroprotective strategies. Considering their sensitivity over time, we suggest mf-VEPs inclusion among aON monitoring protocols

Authors/Disclosures
Simone Guerrieri, MD (San Raffaele Hospital - Vita-Salute San Raffaele University) PRESENTER	Dr. Guerrieri has nothing to disclose.
Marco Pisa, MD (Nuffield Department of Clinical Neurosciences, University of Oxford)	Dr. Pisa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.
Francesca Sangalli	No disclosure on file
Vittorio Martinelli (S. Raffaele Hospital)	Dr. Martinelli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis, Biogen, Sanofi Genzyme, TEVA and Merck. Dr. Martinelli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck .
Giancarlo Comi, MD (University Vita-Salute)	Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Janssen. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Aspen Healthcare. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Sanofi. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Rewind.
Letizia M. Leocani, MD (University Vita-Salute San Raffaele, INSPE)	Dr. Leocani has received personal compensation in the range of $0-$499 for serving as a Consultant for Roche . Dr. Leocani has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Leocani has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. Dr. Leocani has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Med-ex learning.

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