N.V. POLEKHINA^{1, 2}, Z.V. SURNINA², M.N. ZAKHAROVA¹

¹Scientific Center of Neurology, Moscow

²City Clinical Hospital № 24 of the Department of Healthcare of the city of Moscow

 Contact details:

Polekhina N.V. — Neurologist of the Interdistrict Department of Multiple Sclerosis, graduate student of the 6^th neurological department

Address: 80 Volokolamskoe highway, Moscow, Russian Federation, 125367, tel.: +7-916-934-20-36, e—mail: natalie.polekhina@gmail.com 

One of the biomarkers of damage to the central nervous system (CNS) is the degree of neurodegeneration, the evaluation method of which is, among others, optical coherence tomography (OCT), due to which non-invasive non-contact examination of thin tissue layers is possible.

The purpose — to study the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS), neuromyelitics optica (NO) and neuromyelitics optica spectrum disorder (NOSD) and to identify a relationship between these indicators, indicators of visual evoked potentials on a reverse checkerboard pattern (VEP on a RCP) and the clinical condition of patients to determine the prospects of using this method to assess neurodegeneration and as an additional diagnostic method.

Material and methods. The study included 133 people, divided into 4 groups: 16 patients with a diagnosis of NO or NOSD, 39 patients with MS without ON in past medical history, 35 patients with MS with ON in past medical history, and 43 healthy volunteers. The examination included a medical history, an assessment according to the EDSS (Expanded Disability Status Scale) and FSS (Functional System Score), VEP on a RCP and OCT. There was a decrease in the thickness of the RNFL in all patients compared with the control group.

Results. A selective lesion of paramacular temporal retinal sector in the macula region was revealed in patients with MS. A selective decrease in the thickness of RNFL in the region of the optic nerve disc (OND) was found in patients with NO/NOSD. A strong inverse relationship was found between changes in VEP parameters and changes in the thickness of RNFL in the paramacular temporal sector of the retina in the macula region. A correlation was found between a decrease in the thickness of RNFL and an increase in the score on the EDSS scale.

Conclusion. The obtained data allow us to conclude that it is possible to use the OCT method to assess neurodegeneration and conduct differential diagnostics.

Key words: optical coherence tomography, retinal nerve fiber layer, neuromyelitis optica, multiple sclerosis, neurodegeneration. 

(For citation: Polekhina N.V., Surnina Z.V., MD Zakharova M.N. Changes in the nerve fiber layer in case of neuromyelitis optica and multiple sclerosis: neurodegenerative and diagnostic markers. Practical Medicine. 2019. Vol. 17, № 7, P. 60-66)

REFERENCES

1. Svirin A.V., Kiyko Yu.I., Obruch B.V., Bogomolov A.V. Spectral optical coherence tomography: principles and capabilities of the method. RMZh Klinicheskaya oftal’mologiya, 2009, no. 2, p. 50 (in Russ.).
2. Davydovskaya M.V., Tsysar’ M.A., Boyko A.N. et al. Damage to the complex of ganglion cells and the layer of nerve fibers of the retina in multiple sclerosis. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova, 2012, vol. 112, no. 2, pp. 47–51 (in Russ.).
3. Manogaran P., Hanson J., Olbert E. et al. Optical Coherence Tomography and Magnetic Resonance Imaging in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder. Int J Mol Sci, 2016, vol. 15, p. 11.
4. Smith K., McDonald W. The pathophysiology of multiple sclerosis: the mechanisms underlying the production of symptoms and the natural history of the disease. Philos Trans R Soc Lond B Biol Sci, 1999, vol. 354, pp.1649–1673.
5. Kolappan M., Henderson A., Jenkins T. et al. Assessing structure and function of the afferent visual pathway in multiple sclerosis and associated optic neuritis. J Neurol, 2009, vol. 256, pp. 305–319.
6. Syc S., Saidha S., Newsome S. et al. Optical coherence tomography segmentation reveals ganglion cell layer pathology after optic neuritis. Brain, 2012, vol. 135 (2), pp. 521–533.
7. Lange A., Sadjadi R., Zhu F. et al. Spectral-domain optical coherence tomography of retinal nerve fiber layer thickness in NMO patients. J Neuroophthalmol, 2013, vol. 33, pp. 213–219.
8. de Seze J., Blanc F., Jeanjean L. et al. Optical coherence tomography in neuromyelitis optica. Arch Neurol, 2008, vol. 65, pp. 920–923.
9. Merle H., Olindo S., Donnio A. et al. Retinal peripapillary nerve fiber layer thickness in neuromyelitis optica. Invest Ophthalmol Vis Sci, 2008, vol. 49, pp. 4412–4417.
10. Moura F., Fernandes D., Apostolos-Pereira S. et al. Optical coherence tomography evaluation of retinal nerve fiber layer in longitudinally extensive transverse myelitis. Arq Neuropsiquiatr, 2011, vol. 69, pp. 69–73.
11. Jeong I., Kim H., Kim N.-H. et al. Subclinical primary retinal pathology in neuromyelitis optica spectrum disorder. J Neurol, 2016, vol. 263, pp. 1343–1348.
12. Kasymova M. Anatomical features of the optic disc. RMZh Klinicheskaya oftal’mologiya, 2001, no. 3, 111 p. (in Russ.).
13. Levin M., Bennett J., Verkman A. Optic neuritis in neuromyelitis optica. Prog Retin Eye Res. Author manuscript, 2013, vol. 36, pp. 159–171.
14. Bennett J., de Seze J., Lana-Peixoto M. et al. Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography. Mult Scler, 2015, vol. 21, pp. 678–688.
15. Ratchford J., Quigg M., Conger A. et al. Optical coherence tomography helps differentiate neuromyelitis optica and MS optic neuropathies. Neurology, 2009, vol. 73, pp. 302–308.
16. Schneider E., Zimmermann H., Oberwahrenbrock T. et al. Optical coherence tomography reveals distinct patterns of retinal damage in neuromyelitis optica and multiple sclerosis. PloS One, 2013, vol. 8, e66151.
17. Green A., Cree B. Distinctive retinal nerve fibre layer and vascular changes in neuromyelitis optica following optic neuritis. J Neurol Neurosurg Psychiatry, 2009, vol. 80, pp. 1002–1005.
18. Weier K., Eshaghi A., Magon S. et al. The role of cerebellar abnormalities in neuromyelitis optica – a comparison with multiple sclerosis and healthy controls. Mult Scler, 2015, vol. 21, pp. 757–766.
19. Sun J., Zhang N., Wang Q. et al. Normal-Appearing Cerebellar Damage in Neuromyelitis Optica Spectrum Disorder. AJNR Am J Neuroradiol, 2019, vol. 40, pp. 1156–1161.
20. Trip S., Schlottmann P., Jones S. et al. Retinal nerve fiber layer axonal loss and visual dysfunction in optic neuritis. Annals of Neurology, 2005, vol. 58, pp. 383–391.
21. Costello F., Hodge W., Pan Y. et al. Using retinal architecture to help characterize multiple sclerosis patients. Canadian Journal of Ophthalmology, 2010, vol. 45, pp. 520–526.
22. Pagani E., Rocca M., Gallo A. et al. Regional Brain Atrophy Evolves Differently in Patients with Multiple Sclerosis According to Clinical Phenotype. AJNR Am J Neuroradiol, 2005, vol. 26, pp. 341–346.
23. Gilmore C., DeLuca G., Bö L. et al. Spinal cord atrophy in multiple sclerosis caused by white matter volume loss. Arch Neurol, 2005, vol. 62, pp. 1859–1862.
24. McDonald W., Barnes D. The ocular manifestations of multiple sclerosis. Abnormalities of the afferent visual system. J Neurol Neurosurg Psychiatry, 1992, vol. 55, pp.747–752.
25. Birkeldh U., Manouchehrinia A., Hietala M. et al. The Temporal Retinal Nerve Fiber Layer Thickness Is the Most Important Optical Coherence Tomography Estimate in Multiple Sclerosis. Front Neurol, 2017, vol. 8, 675 p.
26. Cao D., Zele A., Pokorny J. et al. Functional Loss in the Magnocellular and Parvocellular Pathways in Patients with Optic Neuritis. Invest Ophthalmol Vis Sci, 2011, vol. 52, pp. 8900–8907.
27. La Morgia C., Barboni P., Rizzo G. et al. Loss of temporal retinal nerve fibers in Parkinson disease: a mitochondrial pattern? Eur J Neurol, 2013, vol. 20, pp. 198–201.
28. Stricker S., Oberwahrenbrock T., Zimmermann H. et al. Temporal retinal nerve fiber loss in patients with spinocerebellar ataxia type 1. PLoS One, 2011, vol. 6, e23024.
29. Kwon J., Yang J., Han J., Kim D. Analysis of the Retinal Nerve Fiber Layer Thickness in Alzheimer Disease and Mild Cognitive Impairment. Korean J Ophthalmol, 2017, vol. 31, pp. 548–556.
30. Sinha P., Joshi D., Singh V. et al. Optical Coherence Tomography and Subclinical Optical Neuritis in Longitudinally Extensive Transverse Myelitis. Ann Indian Acad Neurol, 2017, vol. 20, pp. 358–362.
31. Andersen M., Roar M., Sejbaek T. et al. Long-term structural retinal changes in patients with optic neuritis related to multiple sclerosis. Clin Ophthalmol, 2017, vol. 11, pp. 1519–1525.
32. Di Maggio G., Santangelo R., Guerrieri S. et al. Optical coherence tomography and visual evoked potentials: which is more sensitive in multiple sclerosis. Mult Scler, 2014, vol. 20, pp. 1342–1347.
33. Waldman A., Liu G., Lavery A. et al. Optical coherence tomography and visual evoked potentials in pediatric MS. Neurol Neuroimmunol Neuroinflamm, 2017, vol. 4, e356.
34. Kim N., Kim H., Park C. et al. Optical Coherence Tomography versus Visual Evoked Potentials for Detecting Visual Pathway Abnormalities in Patients with Neuromyelitis Optica Spectrum Disorder. J Clin Neurol, 2018, vol. 14, pp. 200–205.