Klistorner Alexander, Graham Stuart, Fraser Clare, Garrick Raymond, Nguyen Tan, Paine Michael, O'Day Justin, Grigg John, Arvind Hemamalini, Billson Frank A
Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, Australia.
Invest Ophthalmol Vis Sci. 2007 Oct;48(10):4549-56. doi: 10.1167/iovs.07-0381.
To examine the natural history of multifocal visual evoked potentials (mfVEPs) within 12 months of the first episode of optic neuritis (ON) in patients with possible multiple sclerosis (MS).
Twenty-seven patients with a first episode of ON, no previous demyelinating events, and MRI lesions consistent with demyelination were examined with mfVEP. Changes in amplitude and latency of mfVEP were analyzed at 1, 3, 6, and 12 months after an acute attack.
Five of 27 patients had persistent loss of amplitude after 12 months of follow-up. This loss was most marked centrally. Amplitude recovered in the remaining 22 patients at 1 month, but delayed latency, which was also most marked centrally, persisted. Of these, two distinct subgroups were identified: six patients with no improvement in latency and 16 patients with significant latency recovery over the 12 months of follow-up, suggesting remyelination. Conversion to MS was highest in the group with severe amplitude loss, followed by the group with no latency recovery. The conversion rate was lowest in the group of patients with latency improvement.
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.
研究疑似多发性硬化症（MS）患者视神经炎（ON）首次发作后12个月内多焦视觉诱发电位（mfVEP）的自然病程。
对27例首次发作ON、既往无脱髓鞘事件且MRI病变符合脱髓鞘表现的患者进行mfVEP检查。在急性发作后1、3、6和12个月分析mfVEP的振幅和潜伏期变化。
27例患者中有5例在随访12个月后振幅持续丧失。这种丧失在中央部位最为明显。其余22例患者的振幅在1个月时恢复，但潜伏期延迟（同样在中央部位最为明显）仍持续存在。其中，可分为两个不同的亚组：6例患者潜伏期无改善，16例患者在随访的12个月内潜伏期显著恢复，提示有髓鞘再生。振幅严重丧失组向MS的转化率最高，其次是潜伏期无恢复组。潜伏期改善组的转化率最低。
利用mfVEP在首次发作视神经炎且有MS高风险的患者中识别出了不同的疾病演变模式，支持MS早期病变异质性的概念。
