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Byline: S. J. Hickman (1,2), A. T. Toosy (1,2), K. A. Miszkiel (3), S. J. Jones (4), D. R. Altmann (1,5), D. G. MacManus (1), G. T. Plant (2), A. J. Thompson (1), D. H. Miller (1) Keywords: optic neuritis; multiple sclerosis; magnetic resonance imaging; gadolinium; visual evoked potentials Abstract: Abstract. This study reports the prospective follow--up of a cohort of patients with acute optic neuritis examined with serial visual tests, visual evoked potentials (VEPs), conventional and triple--dose gadolinium (Gd)--enhanced magnetic resonance imaging (MRI) to examine which factors are important in visual recovery. Thirty--three patients were recruited with acute unilateral optic neuritis. A clinical and VEP assessment was performed on each. Optic nerve MRI was performed using fast spin echo (FSE) (on all) and triple-dose Gdenhanced T.sub.1--weighted sequences (n = 28). Optic nerve lesion lengths were measured. Serial assessments were performed on 22 of the patients up to one--year. Serial Gd--enhanced optic nerve imaging was performed on 15 of the patients until enhancement ceased. The final 30--2 Humphrey visual field mean deviation (MD) was 2.55 dB higher in patients in the lowest quartile of initial Gd--enhanced lesion length compared with the other quartiles (p &lt 0.01) but recovery was not related to the duration of enhancement. The initial recovery of Humphrey MD was 4.60 dB units per day in patients with good eventual recoveries (MD &gt --6.0 dB) and 0.99 dB per day in poor-recovery patients (p = 0.02).Good--recovery patients had mean central field VEP amplitudes 2.29 AuV higher during recovery than poor-recovery patients (p = 0.047). The results suggest that factors which are associated with a better prognosis are: having a short acute lesion on triple--dose gadolinium enhanced imaging, higher VEP amplitudes during recovery and a steep gradient of the initial improvement in vision. Author Affiliation: (1) NMR Research Unit, Dept. of Neuroinflammation Institute of Neurology University College London, Queen Square, London, WC1N 3BG, UK (2) Dept. of Neuro-Ophthalmology, Moorfields Eye Hospital, London, UK (3) Lysholm Dept. of Neuroradiology, The National Hospital for Neurology &amp Neurosurgery, London, UK (4) Dept. of Clinical Neurophysiology, The National Hospital for Neurology &amp Neurosurgery, London, UK (5) Medical Statistics Unit, London School of Hygiene &amp Tropical Medicine, London, UK Article History: Registration Date: 01/01/2004 Received Date: 15/12/2003 Accepted Date: 15/03/2004

J Neurol Neurosurg Psychiatry 2003;74: 1551-1554 Background: Studies have suggested that T2 lesion activity is prominent in early relapsing-remitting multiple sclerosis, whereas brain atrophy, while seen early, appears more evident [...]

Background Regional atrophy measures may offer useful information about the causes of specific clinical deficits in multiple sclerosis (MS). Objective To determine the magnitude of cerebellar gray and white matter (GM and WM) atrophy in patients with clinically isolated syndromes (CIS) and MS, and their role in clinical manifestations of cerebellar damage. Methods T1-weighted volumetric magnetic resonance imaging (MRI) of 73 patients [29 CIS, 33 relapsing-remitting MS (RRMS), 11 secondary progressive MS (SPMS)] was compared with 25 controls. GM and WM regions were generated using SPM5 and cerebellar regions delineated. Linear regression was used to investigate differences in tissue-specific cerebellar volumes between groups and the association with clinical measures. Results Mean cerebellar GM volume (CGMV) was 100.1 cm3 in controls, 96.4 cm3 in CIS patients, 91.8 cm3 in RRMS patients, and 88.8 cm3 in SPMS patients. Mean cerebellar WM volumes (CWMV) were 21.3 cm3, 20.4 cm3, 19.9 cm3, and 18.8 cm3, respectively. CGMV was reduced by 4.8 cm3 (P = 0.054) in RRMS patients, and 8.5 cm3 (P = 0.012) in SPMS patients, relative to controls. Only patients with SPMS showed a borderline significant reduction in CWMV compared with controls (mean 2.1 cm3, P = 0.053). CGMV was significantly smaller in patients assessed as having cerebellar dysfunction compared with patients who had normal cerebellar function. Significant associations of CGMV and CWMV with performance on the nine-hole peg test were also observed. Conclusion Clinically relevant GM atrophy occurs in the cerebellum of MS patients and is more prominent than WM atrophy. As such, it may provide complementary data to other regional atrophy and intrinsic tissue measures. [ABSTRACT FROM AUTHOR]

The objectives of this study were (1) to determine how cerebrospinal fluid (CSF) neurofilament heavy chain (NfHSMI34 and NfHSMI35) levels relate to clinical outcome in optic neuritis (ON) and multiple sclerosis (MS) relapse patients treated with high dose oral methylprednisolone; and (2) to correlate neurofilament and myelin basic protein (MBP) concentrations, particularly as the latter was previously associated with clinical disability. Fifty subjects participated in two double-blind, randomized, placebo-controlled clinical trials. Eight/18 patients in the ON trial and 15/32 subjects in the MS attack trial were treated with oral methylprednisolone. In the MS attack trial group, CSF NfHSMI34 and NfHSMI35 measured at week 3 and ΔCSF NfHSMI34 levels from baseline to week 3 were predictive of clinical outcome at week 8 and 52. In the ON group, no such association was seen. When both groups were combined, baseline CSF NfHSMI34 and NfHSMI35 correlated positively with baseline enhancing lesion volume (ELV) (rs=0.50, P <0.01 and rs=0.53, P <0.01, respectively). Levels of NfHSMI35 at baseline and week 3 also strongly correlated with the MBP concentration. This study supports the view that acute inflammation in ON and MS results in axonal pathology and that the latter has a role in determining functional impairment. [ABSTRACT FROM AUTHOR]

Two relatively new techniques purport to give measures of the myelin content of brain tissue. These measures are the myelin water fraction from multicompartmental T2 analysis, and the semisolid proton fraction from analysis of magnetization transfer (MT). The myelin water fraction is the fraction of signal with a T2 of less than 50 ms measured from a 32-echo sequence. It is believed to originate from water trapped between the myelin bilayers. The semisolid proton fraction is thought to include protons within phospholipid bilayers and macromolecular protons, and may also be a measure of myelin content. Multicompartmental T2 and MT imaging were carried out on controls and patients with multiple sclerosis (MS), and estimates of the semisolid proton and myelin water fractions were obtained from white matter (WM), gray matter (GM), and MS lesions. These were then correlated for each tissue and subject group. Positive correlations were seen for MS lesions (r ≈ 0.2) and in WM in patients (r = 0.6). A negative correlation (r ≈ −0.3) was seen for GM. These results indicate that the two techniques measure, to some extent, the same thing (most likely myelin content), but that other factors, such as inflammation, mean they may provide complementary information. Magn Reson Med 53:1415-1422, 2005. © 2005 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Focuses on several studies related to use of magnetic resonance (MR) imaging in ophthalmology. Examination of white matter fibers in eye using diffusion tractography; Investigation of 'filling-in' into artificial central scotoma using MR imaging; Imaging of optic nerve in patient with different stages of papilledema.