Waldman Amy T, Liu Grant T, Lavery Amy M, Liu Geraldine, Gaetz William, Aleman Tomas S, Banwell Brenda L
Division of Neurology (A.T.W., A.M.L., G.L., B.L.B.), Neuro-ophthalmology Service (G.T.L.), Division of Ophthalmology, and Division of Radiology (W.G.), Children's Hospital of Philadelphia, PA; and Departments of Neurology (A.T.W., B.L.B., G.T.L.), Pediatrics (A.T.W., B.L.B.), and Ophthalmology (G.T.L., T.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Neurol Neuroimmunol Neuroinflamm. 2017 Jun 5;4(4):e356. doi: 10.1212/NXI.0000000000000356. eCollection 2017 Jul.
To determine the relative ability of optical coherence tomography (OCT) and pattern-reversal visual evoked potentials (pVEPs) to detect visual pathway involvement in pediatric-onset MS.
Pediatric-onset MS participants (onset <18 years) and healthy controls (HCs) underwent OCT (Cirrus HD-OCT) and pVEPs. Retinal nerve fiber layer (RNFL), ganglion cell layer to inner plexiform layer (GCL-IPL), and P100 pVEP latency were measured. Generalized estimating equation models were used to compare the groups, adjusting for age and intereye correlations.
Twenty-four pediatric MS participants, 14 with a history of remote (>6 months) optic neuritis (ON) in one eye (8 participants) or both the eyes (6 participants), and 24 HCs were enrolled. RNFL thinning (<83 μm, 2 SDs below HC eyes) occurred in 50% of ON eyes vs 5% of non-ON eyes. Prolonged VEP latency (>109 msec) occurred in 58% of ON eyes and 55% of non-ON eyes. A clinical history of ON predicted RNFL ( < 0.001) and GCL-IPL thinning ( = 0.011), whereas prolonged pVEP latency in children with MS occurred independent of ON history.
OCT and pVEPs provide complementary but distinct insights. OCT is sensitive to retinal changes in the context of clinical ON, whereas pVEPs are useful to detect disseminated lesions of the visual pathway in children with MS.
确定光学相干断层扫描（OCT）和图形翻转视觉诱发电位（pVEP）检测儿童期多发性硬化症（MS）视觉通路受累的相对能力。
儿童期MS患者（发病年龄<18岁）和健康对照者（HC）接受了OCT（Cirrus HD-OCT）和pVEP检查。测量视网膜神经纤维层（RNFL）、神经节细胞层至内网状层（GCL-IPL）以及P100 pVEP潜伏期。采用广义估计方程模型对两组进行比较，并对年龄和双眼相关性进行校正。
纳入了24例儿童MS患者，其中14例有一只眼（8例患者）或双眼（6例患者）既往（>6个月）视神经炎（ON）病史，以及24例HC。50%的ON眼出现RNFL变薄（<83μm，低于HC眼2个标准差），而非ON眼为5%。58%的ON眼和55%的非ON眼出现VEP潜伏期延长（>109毫秒）。ON的临床病史可预测RNFL变薄（<0.001）和GCL-IPL变薄（=0.011），而MS患儿pVEP潜伏期延长与ON病史无关。
OCT和pVEP提供了互补但不同的见解。OCT对临床ON情况下的视网膜变化敏感，而pVEP有助于检测MS患儿视觉通路的播散性病变。
