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MULES on the Sidelines: A Vision-Based Assessment Tool for Sports-Related Concussion [Meeting Abstract]
Fallon, Samuel; Hasanaj, Lisena; Liu, Darlina; Akhand, Omar; Martone, John; Giles, Julie; Webb, Nikki; Drattell, Julia; Serrano, Liliana; Rizzo, John-Ross; Rucker, Janet; Cardone, Dennis; Galetta, Steven; Balcer, Laura
ISI:000475965902130
ISSN: 0028-3878
CID: 4028962
A Chronic Progressive Optic Neuropathy in a Patient with Anti-Myelin-Oligodendrocyte Glycoprotein (MOG) Antibodies [Meeting Abstract]
Gold, Doria; Balcer, Laura; Galetta, Steven
ISI:000475965900390
ISSN: 0028-3878
CID: 4028812
One-Month Feasibility of Progressive Muscle Relaxation (PMR) via Smartphone Application for Post Traumatic Headache (PTH) Patients [Meeting Abstract]
Usmani, Saima; Aldana, Sandra India; Ortega, Emma; Kasianko, Christian; Weiss, Zoe; Balcer, Laura; Minen, Mia
ISI:000475965904411
ISSN: 0028-3878
CID: 4029262
Delayed Development of a Dural AV Fistula and PTEN Hamartoma Syndrome in Pseudo-Idiopathic Intracranial Hypertension [Meeting Abstract]
Gold, Doria; Galetta, Steven; Balcer, Laura; Rucker, Janet
ISI:000475965900386
ISSN: 0028-3878
CID: 4028802
Multiple Sclerosis and Headache: A Further Examination of these Comorbid Conditions in Patients Receiving Care in a Multiple Sclerosis Center: A Cross-Sectional Study [Meeting Abstract]
Schaubhut, Kathryn; Morio, Kaitlyn; Balcer, Laura; Charvet, Leigh; Lipton, Richard; Minen, Mia
ISI:000475965904008
ISSN: 0028-3878
CID: 4029212
Education Research: Simulation training for neurology residents on acquiring tPA consent: An educational initiative
Rostanski, Sara K; Kurzweil, Arielle M; Zabar, Sondra; Balcer, Laura J; Ishida, Koto; Galetta, Steven L; Lewis, Ariane
PMID: 30530564
ISSN: 1526-632x
CID: 3639942
Optimal Intereye Difference Thresholds in Retinal Nerve Fiber Layer Thickness for Predicting a Unilateral Optic Nerve Lesion in Multiple Sclerosis
Nolan, Rachel C; Galetta, Steven L; Frohman, Teresa C; Frohman, Elliot M; Calabresi, Peter A; Castrillo-Viguera, Carmen; Cadavid, Diego; Balcer, Laura J
BACKGROUND:The optic nerve is a frequent site for involvement in multiple sclerosis (MS). Optical coherence tomography (OCT) detects thinning of the retinal nerve fiber layer (RNFL) in eyes of patients with MS and in those meeting criteria for clinically or radiologically isolated demyelinating syndromes. Current international diagnostic criteria for MS do not include the optic nerve as an imaging lesion site despite the high prevalence of acute optic neuritis (ON), or occult optic neuropathy, among early MS and clinically isolated syndrome patients; as well as most MS patients over the course of the disease. We sought to determine optimal thresholds for intereye difference in peripapillary RNFL thickness that are most predictive of a unilateral optic nerve lesion. METHODS:We analyzed spectral domain OCT data of 31 healthy volunteers and 124 patients with MS at a single center as part of an ongoing collaborative investigation of visual outcomes. Intereye differences in peripapillary (360°) RNFL thickness were calculated as the absolute value of the difference. First, we determined the 95th percentile value of intereye difference for the healthy volunteers. This value was applied to the convenience sample group of MS patients as a validation cohort determining how well this threshold could distinguish patients with vs without a history of unilateral ON. The relation of intereye differences in peripapillary RNFL thickness to binocular low-contrast letter acuity scores was also examined. RESULTS:Among healthy volunteer participants (n = 31), the 95th percentile value for intereye difference (upper boundary of expected for normal controls) was 6.0 μm. This value was applied to the convenience sample group of MS patients (n = 124, validation cohort). Positive predictive value, negative predictive value, sensitivity, and specificity for identifying MS patients with a history of unilateral ON were calculated for the 6-μm threshold value in a 2 × 2 table analysis with the application of χ tests (P < 0.0001). The 6-μm threshold was predictive of worse binocular low-contrast acuity scores at 2.5% (P = 0.03) and 1.25% (P = 0.002 by linear regression analyses). A receiver operating characteristic curve analysis demonstrated an optimal intereye difference threshold of 5 μm for identifying unilateral ON in the MS cohort. CONCLUSIONS:An intereye difference of 5-6 μm in RNFL thickness is a robust structural threshold for identifying the presence of a unilateral optic nerve lesion in MS.
PMID: 29384802
ISSN: 1536-5166
CID: 2933802
The International Multiple Sclerosis Visual System Consortium: Advancing Visual System Research in Multiple Sclerosis
Balcer, Laura J; Balk, Lisanne J; Brandt, Alexander U; Calabresi, Peter A; Martinez-Lapiscina, Elena H; Nolan, Rachel C; Paul, Friedemann; Petzold, Axel; Saidha, Shiv
BACKGROUND:The International Multiple Sclerosis Visual System Consortium (IMSVISUAL) was formed in November 2014 with the primary goal of improving research, care, and education regarding the role of the visual system in multiple sclerosis (MS) and related disorders. METHODS:In this review, we describe the formation, goals, activities, and structure of IMSVISUAL, as well as the relationship of IMSVISUAL with the Americas Committee for Treatment and Research in MS (ACTRIMS). Finally, we provide an overview of the work IMSVISUAL has completed to date, as well as an outline of research projects ongoing under the auspices of IMSVISUAL. RESULTS:IMSVISUAL has 140 members worldwide and continues to grow. Through IMSVISUAL-related research, optical coherence tomography (OCT)-derived peripapillary retinal nerve fiber layer (pRNFL) thinning has been established as a predictor of future disability in MS. IMSVISUAL has also developed guidelines for reporting OCT studies in MS. Moreover, a systematic review performed by IMSVISUAL found that not only are pRNFL and ganglion cell + inner plexiform layer (GCIPL) thicknesses reduced in patients with MS (particularly in eyes with prior optic neuritis [ON]), but that inner nuclear layer measures may be higher among MS ON eyes, relative to healthy control eyes. Currently, there are several ongoing IMSVISUAL projects that will establish a role for visual outcomes in diagnosing MS and quantifying the effects of emerging therapies in clinical trials. CONCLUSIONS:The development of IMSVISUAL represents a major collaborative commitment to defining the role of visual outcomes in high-quality, large-scale studies that generate definitive and instructive findings in the field of MS. As a consortium, IMSVISUAL has completed several international collaborative projects, is actively engaged in numerous ongoing research studies, and is committed to expanding the role of vision research in MS and related disorders.
PMID: 30418332
ISSN: 1536-5166
CID: 3458382
Mobile Universal Lexicon Evaluation System (MULES) in MS: Evaluation of a new visual test of rapid picture naming
Seay, Meagan; Akhand, Omar; Galetta, Matthew S; Cobbs, Lucy; Hasanaj, Lisena; Amorapanth, Prin; Rizzo, John-Ross; Nolan, Rachel; Serrano, Liliana; Rucker, Janet C; Galetta, Steven L; Balcer, Laura J
OBJECTIVE:The Mobile Universal Lexicon Evaluation System (MULES) is a test of rapid picture naming that is under investigation for concussion. MULES captures an extensive visual network, including pathways for eye movements, color perception, memory and object recognition. The purpose of this study was to introduce the MULES to visual assessment of patients with MS, and to examine associations with other tests of afferent and efferent visual function. METHODS:We administered the MULES in addition to binocular measures of low-contrast letter acuity (LCLA), high-contrast visual acuity (VA) and the King-Devick (K-D) test of rapid number naming in an MS cohort and in a group of disease-free controls. RESULTS:Among 24 patients with MS (median age 36 years, range 20-72, 64% female) and 22 disease-free controls (median age 34 years, range 19-59, 57% female), MULES test times were greater (worse) among the patients (60.0 vs. 40.0 s). Accounting for age, MS vs. control status was a predictor of MULES test times (P = .01, logistic regression). Faster testing times were noted among patients with MS who had greater (better) performance on binocular LCLA at 2.5% contrast (P < .001, linear regression, accounting for age), binocular high-contrast VA (P < .001), and K-D testing (P < .001). Both groups demonstrated approximately 10-s improvements in MULES test times between trials 1 and 2 (P < .0001, paired t-tests). CONCLUSION/CONCLUSIONS:The MULES test, a complex task of rapid picture naming involves an extensive visual network that captures eye movements, color perception and the characterization of objects. Color recognition, a key component of this novel assessment, is early in object processing and requires area V4 and the inferior temporal projections. MULES scores reflect performance of LCLA, a widely-used measure of visual function in MS clinical trials. These results provide evidence that the MULES test can add efficient visual screening to the assessment of patients with MS.
PMID: 30193154
ISSN: 1878-5883
CID: 3271592
Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis: a longitudinal study
Caldito, Natalia Gonzalez; Saidha, Shiv; Sotirchos, Elias S; Dewey, Blake E; Cowley, Norah J; Glaister, Jeffrey; Fitzgerald, Kathryn C; Al-Louzi, Omar; Nguyen, James; Rothman, Alissa; Ogbuokiri, Esther; Fioravante, Nicholas; Feldman, Sydney; Kwakyi, Ohemaa; Risher, Hunter; Kimbrough, Dorlan; Frohman, Teresa C; Frohman, Elliot; Balcer, Laura; Crainiceanu, Ciprian; Van Zijl, Peter C M; Mowry, Ellen M; Reich, Daniel S; Oh, Jiwon; Pham, Dzung L; Prince, Jerry; Calabresi, Peter A
On average, African Americans with multiple sclerosis demonstrate higher inflammatory disease activity, faster disability accumulation, greater visual dysfunction, more pronounced brain tissue damage and higher lesion volume loads compared to Caucasian Americans with multiple sclerosis. Neurodegeneration is an important component of multiple sclerosis, which in part accounts for the clinical heterogeneity of the disease. Brain atrophy appears to be widespread, although it is becoming increasingly recognized that regional substructure atrophy may be of greater clinical relevance. Patient race (within the limitations of self-identified ancestry) is regarded as an important contributing factor. However, there is a paucity of studies examining differences in neurodegeneration and brain substructure volumes over time in African Americans relative to Caucasian American patients. Optical coherence tomography is a non-invasive and reliable tool for measuring structural retinal changes. Recent studies support its utility for tracking neurodegeneration and disease progression in vivo in multiple sclerosis. Relative to Caucasian Americans, African American patients have been found to have greater retinal structural injury in the inner retinal layers. Increased thickness of the inner nuclear layer and the presence of microcystoid macular pathology at baseline predict clinical and radiological inflammatory activity, although whether race plays a role in these changes has not been investigated. Similarly, assessment of outer retinal changes according to race in multiple sclerosis remains incompletely characterized. Twenty-two African Americans and 60 matched Caucasian Americans with multiple sclerosis were evaluated with brain MRI, and 116 African Americans and 116 matched Caucasian Americans with multiple sclerosis were monitored with optical coherence tomography over a mean duration of 4.5 years. Mixed-effects linear regression models were used in statistical analyses. Grey matter (-0.9%/year versus -0.5%: P =0.02), white matter (-0.7%/year versus -0.3%: P =0.04) and nuclear thalamic (-1.5%/year versus -0.7%/year: P =0.02) atrophy rates were approximately twice as fast in African Americans. African Americans also exhibited higher proportions of microcystoid macular pathology (12.1% versus 0.9%, P =0.001). Retinal nerve fibre layer (-1.1% versus -0.8%: P =0.02) and ganglion cell+ inner plexiform layer (-0.7%/year versus -0.4%/year: P =0.01) atrophy rates were faster in African versus Caucasian Americans. African Americans on average exhibited more rapid neurodegeneration than Caucasian Americans and had significantly faster brain and retinal tissue loss. These results corroborate the more rapid clinical progression reported to occur, in general, in African Americans with multiple sclerosis and support the need for future studies involving African Americans in order to identify individual differences in treatment responses in multiple sclerosis.
PMID: 30312381
ISSN: 1460-2156
CID: 3335132