fMRI Unit, Neurology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
J Neuroophthalmol. 2018 Mar;38(1):85-90. doi: 10.1097/WNO.0000000000000634.
Multiple sclerosis (MS), a demyelinating disease of the central nervous system, is multifaceted. It manifests as acute episodes as well as an accumulative chronic disability; myelin involvement as well as axonal damage; local as well as global effects; and disease load elements as well as compensatory mechanisms. The visual system, with its clear structural organization and relatively direct reflection of damage, may serve as an appropriate model to study MS.
In recent years, we have witnessed a blossoming in the field of visual measures in MS. Because it is impossible to cover all different aspects of these measures, we chose to focus on several hot topics in MS literature and shed light on them through studies conducted in the visual system.
We argue that numerous methods can be used to study axonal and demyelinating aspects of the disease. Although optical coherence tomography and static visual functions better reflect the axonal aspects of the disease, conduction velocity as measured by visual-evoked potential latencies and dynamic visual function mirrors myelin levels. We also posit that the classic disease load parameters cannot be the only means by which we assess a patient's condition. Novel imaging methods such as diffusion tensor imaging and functional magnetic resonance imaging can be used to assess the global effects of local damage on neighboring white matter and compensatory abilities of the brain.
There have been great advances in therapeutic research in MS. However, the stratification of patients according to their prognosis and predictive outcomes in response to treatment is still in its infancy. The many facets of MS make it difficult to piece all the data together into one cohesive conclusion for the individual patient. The visual system, with our ability to assess both structure and function, offers a promising opportunity to study both pathophysiologic mechanisms and novel therapies.
多发性硬化症（MS）是一种中枢神经系统脱髓鞘疾病，具有多面性。它表现为急性发作和累积性慢性残疾；髓鞘受累和轴突损伤；局部和全局影响；疾病负荷元素和代偿机制。视觉系统具有明确的结构组织和相对直接的损伤反射，可能是研究 MS 的合适模型。
近年来，我们见证了 MS 视觉测量领域的蓬勃发展。由于不可能涵盖这些测量方法的所有不同方面，我们选择专注于 MS 文献中的几个热门话题，并通过在视觉系统中进行的研究来阐明它们。
我们认为，可以使用多种方法来研究疾病的轴突和脱髓鞘方面。虽然光学相干断层扫描和静态视觉功能更好地反映了疾病的轴突方面，但视觉诱发电位潜伏期和动态视觉功能测量的传导速度反映了髓鞘水平。我们还假设经典的疾病负荷参数不能成为评估患者病情的唯一手段。新型成像方法，如弥散张量成像和功能磁共振成像，可用于评估局部损伤对邻近白质的全局影响和大脑的代偿能力。
MS 的治疗研究取得了重大进展。然而，根据患者的预后和对治疗的预测结果对患者进行分层仍处于起步阶段。MS 的多面性使得将所有数据整合为个体患者的一个连贯结论变得困难。视觉系统，我们评估结构和功能的能力，为研究病理生理机制和新型治疗方法提供了一个有前途的机会。
