Optic Nerve Topography in Multiple Sclerosis Diagnosis: The Utility of Visual Evoked Potentials

To assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria. From the Barcelona clinically isolated syndrome (CIS) cohort, patients with complete information to assess dissemination in space (DIS), the optic nerve region, and diss...

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Published in:Neurology Vol. 96; no. 4; p. e482
Main Authors: Vidal-Jordana, Angela, Rovira, Alex, Arrambide, Georgina, Otero-Romero, Susana, Río, Jordi, Comabella, Manuel, Nos, Carlos, Castilló, Joaquin, Galan, Ingrid, Cabello, Sergio, Moncho, Dulce, Rahnama, Kimia, Thonon, Vanessa, Rodríguez-Acevedo, Breogan, Zabalza, Ana, Midaglia, Luciana, Auger, Cristina, Sastre-Garriga, Jaume, Montalban, Xavier, Tintoré, Mar
Format: Journal Article
Language:English
Published: United States 26.01.2021
Subjects:
Adult
Cohort Studies
Evoked Potentials, Visual - physiology
Female
Follow-Up Studies
Humans
Male
Multiple Sclerosis - diagnostic imaging
Multiple Sclerosis - physiopathology
Neurologic Examination - methods
Optic Nerve - diagnostic imaging
Optic Nerve - physiopathology
Optic Neuritis - diagnostic imaging
Optic Neuritis - physiopathology
Retrospective Studies
Young Adult
ISSN:1526-632X, 1526-632X
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Abstract To assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria. From the Barcelona clinically isolated syndrome (CIS) cohort, patients with complete information to assess dissemination in space (DIS), the optic nerve region, and dissemination in time at baseline (n = 388) were selected. Modified DIS (modDIS) criteria were constructed by adding the optic nerve to the current DIS regions. The DIS and modDIS criteria were evaluated with univariable Cox proportional hazard regression analyses with the time to the second attack as the outcome. A subset of these patients who had at least 10 years of follow-up or a second attack occurring within 10 years (n = 151) were selected to assess the diagnostic performance. The analyses were also performed according to CIS topography (optic neuritis vs non-optic neuritis). The addition of the optic nerve as a fifth region improved the diagnostic performance by slightly increasing the accuracy (2017 DIS 75.5%, modDIS 78.1%) and the sensitivity (2017 DIS 79.2%, modDIS 82.3%) without lowering the specificity (2017 DIS 52.4%, modDIS 52.4%). When the analysis was conducted according to CIS topography, the modDIS criteria performed similarly in both optic neuritis and non-optic neuritis CIS. The addition of the optic nerve, assessed by VEP, as a fifth region in the current DIS criteria slightly improves the diagnostic performance because it increases sensitivity without losing specificity.
AbstractList To assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria. From the Barcelona clinically isolated syndrome (CIS) cohort, patients with complete information to assess dissemination in space (DIS), the optic nerve region, and dissemination in time at baseline (n = 388) were selected. Modified DIS (modDIS) criteria were constructed by adding the optic nerve to the current DIS regions. The DIS and modDIS criteria were evaluated with univariable Cox proportional hazard regression analyses with the time to the second attack as the outcome. A subset of these patients who had at least 10 years of follow-up or a second attack occurring within 10 years (n = 151) were selected to assess the diagnostic performance. The analyses were also performed according to CIS topography (optic neuritis vs non-optic neuritis). The addition of the optic nerve as a fifth region improved the diagnostic performance by slightly increasing the accuracy (2017 DIS 75.5%, modDIS 78.1%) and the sensitivity (2017 DIS 79.2%, modDIS 82.3%) without lowering the specificity (2017 DIS 52.4%, modDIS 52.4%). When the analysis was conducted according to CIS topography, the modDIS criteria performed similarly in both optic neuritis and non-optic neuritis CIS. The addition of the optic nerve, assessed by VEP, as a fifth region in the current DIS criteria slightly improves the diagnostic performance because it increases sensitivity without losing specificity.
To assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria.OBJECTIVETo assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria.From the Barcelona clinically isolated syndrome (CIS) cohort, patients with complete information to assess dissemination in space (DIS), the optic nerve region, and dissemination in time at baseline (n = 388) were selected. Modified DIS (modDIS) criteria were constructed by adding the optic nerve to the current DIS regions. The DIS and modDIS criteria were evaluated with univariable Cox proportional hazard regression analyses with the time to the second attack as the outcome. A subset of these patients who had at least 10 years of follow-up or a second attack occurring within 10 years (n = 151) were selected to assess the diagnostic performance. The analyses were also performed according to CIS topography (optic neuritis vs non-optic neuritis).METHODSFrom the Barcelona clinically isolated syndrome (CIS) cohort, patients with complete information to assess dissemination in space (DIS), the optic nerve region, and dissemination in time at baseline (n = 388) were selected. Modified DIS (modDIS) criteria were constructed by adding the optic nerve to the current DIS regions. The DIS and modDIS criteria were evaluated with univariable Cox proportional hazard regression analyses with the time to the second attack as the outcome. A subset of these patients who had at least 10 years of follow-up or a second attack occurring within 10 years (n = 151) were selected to assess the diagnostic performance. The analyses were also performed according to CIS topography (optic neuritis vs non-optic neuritis).The addition of the optic nerve as a fifth region improved the diagnostic performance by slightly increasing the accuracy (2017 DIS 75.5%, modDIS 78.1%) and the sensitivity (2017 DIS 79.2%, modDIS 82.3%) without lowering the specificity (2017 DIS 52.4%, modDIS 52.4%). When the analysis was conducted according to CIS topography, the modDIS criteria performed similarly in both optic neuritis and non-optic neuritis CIS.RESULTSThe addition of the optic nerve as a fifth region improved the diagnostic performance by slightly increasing the accuracy (2017 DIS 75.5%, modDIS 78.1%) and the sensitivity (2017 DIS 79.2%, modDIS 82.3%) without lowering the specificity (2017 DIS 52.4%, modDIS 52.4%). When the analysis was conducted according to CIS topography, the modDIS criteria performed similarly in both optic neuritis and non-optic neuritis CIS.The addition of the optic nerve, assessed by VEP, as a fifth region in the current DIS criteria slightly improves the diagnostic performance because it increases sensitivity without losing specificity.CONCLUSIONThe addition of the optic nerve, assessed by VEP, as a fifth region in the current DIS criteria slightly improves the diagnostic performance because it increases sensitivity without losing specificity.
Author Nos, Carlos
Vidal-Jordana, Angela
Thonon, Vanessa
Rovira, Alex
Moncho, Dulce
Auger, Cristina
Montalban, Xavier
Comabella, Manuel
Sastre-Garriga, Jaume
Zabalza, Ana
Arrambide, Georgina
Cabello, Sergio
Galan, Ingrid
Rodríguez-Acevedo, Breogan
Midaglia, Luciana
Tintoré, Mar
Rahnama, Kimia
Río, Jordi
Otero-Romero, Susana
Castilló, Joaquin
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  organization: From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
– sequence: 19
  givenname: Xavier
  surname: Montalban
  fullname: Montalban, Xavier
  organization: From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
– sequence: 20
  givenname: Mar
  surname: Tintoré
  fullname: Tintoré, Mar
  organization: From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
BackLink https://www.ncbi.nlm.nih.gov/pubmed/33328323$$D View this record in MEDLINE/PubMed
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References 33328321 - Neurology. 2021 Jan 26;96(4):139-140
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Snippet To assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria. From the Barcelona...
To assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria.OBJECTIVETo assess the added...
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SubjectTerms Adult
Cohort Studies
Evoked Potentials, Visual - physiology
Female
Follow-Up Studies
Humans
Male
Multiple Sclerosis - diagnostic imaging
Multiple Sclerosis - physiopathology
Neurologic Examination - methods
Optic Nerve - diagnostic imaging
Optic Nerve - physiopathology
Optic Neuritis - diagnostic imaging
Optic Neuritis - physiopathology
Retrospective Studies
Young Adult
Title Optic Nerve Topography in Multiple Sclerosis Diagnosis: The Utility of Visual Evoked Potentials
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