Department of Neurology, Oregon Health & Science University, Mail code: L226, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA.
Department of Veterans Affairs Portland Health Care System, Portland, OR, 97239, USA.
Curr Neurol Neurosci Rep. 2018 Jun 19;18(8):49. doi: 10.1007/s11910-018-0858-y.
Clinical trials using agents directed at neuroprotection and remyelination in multiple sclerosis (MS) are needed. As optic neuritis (ON) is common in people with MS and the pathology of ON is similar to other MS lesions in the brain, measurements of the anterior visual system are frequently utilized in neuroprotection and remyelination trials. Understanding the strengths and weaknesses of the measurements is vital when interpreting the results of this research.
Techniques such as visual evoked potentials (VEP) and optical coherence tomography (OCT) are well established in MS and are thought to measure axonal integrity and myelination. Novel imaging techniques can also be used in conjunction with these measurements to provide better insight into optic nerve structure and function. Magnetization transfer imaging (MTR) together with optic nerve area and volume measures neurodegeneration; diffusion tensor imaging (DTI) measures myelination status and neurodegeneration. However, these techniques require various levels of experience to interpret, and all can be confounded by ocular motion and surrounding fat and bone. This article provides a review of established and novel techniques to measure the anterior visual system in multiple sclerosis with a focus on the evidence to support their use as outcome measures in clinical trials focused on neuroprotection and remyelination therapies.
目的综述：需要开展临床试验，以评估靶向多发性硬化（MS）神经保护和髓鞘修复的药物。由于视神经炎（ON）在 MS 患者中较为常见，且 ON 的病理学与脑内其他 MS 病变相似，因此在前瞻性视觉系统的测量在神经保护和髓鞘修复试验中经常被使用。在解读该研究结果时，了解这些测量方法的优缺点至关重要。
最新发现：在 MS 中，视觉诱发电位（VEP）和光学相干断层扫描（OCT）等技术已得到广泛应用，被认为可以测量轴突完整性和髓鞘形成。新型成像技术也可与这些测量方法结合使用，从而更深入地了解视神经的结构和功能。磁化传递成像（MTR）联合视神经面积和体积测量可用于评估神经退行性变；弥散张量成像（DTI）可用于评估髓鞘状态和神经退行性变。然而，这些技术的解释需要不同程度的经验，并且所有技术都可能受到眼球运动以及周围脂肪和骨骼的影响。本文重点介绍了评估 MS 患者前视系统的既定和新型技术，并对其作为神经保护和髓鞘修复治疗临床试验的结局指标的应用提供了相关证据。
