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Optical coherence tomography and visual evoked potentials in pediatric MS.

Amy T Waldman1, Grant T Liu1, Amy M Lavery1

  • 1Division 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.

Neurology(R) Neuroimmunology & Neuroinflammation
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Summary

Optical coherence tomography (OCT) detects retinal changes in pediatric multiple sclerosis (MS) with optic neuritis (ON), while visual evoked potentials (pVEPs) identify broader visual pathway involvement, offering complementary diagnostic insights.

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Pediatric Neurology

Background:

  • Pediatric-onset multiple sclerosis (MS) can affect the visual pathway, leading to significant disability.
  • Accurate detection of visual pathway involvement is crucial for monitoring disease progression and treatment efficacy in pediatric MS.
  • Optical coherence tomography (OCT) and pattern-reversal visual evoked potentials (pVEPs) are non-invasive tools used to assess visual pathway integrity.

Purpose of the Study:

  • To compare the effectiveness of OCT and pVEPs in detecting visual pathway involvement in children with MS.
  • To understand the distinct contributions of OCT and pVEPs in the context of optic neuritis (ON) and disseminated lesions within the visual pathway.

Main Methods:

  • Participants included pediatric-onset MS patients and healthy controls (HCs).
  • Both groups underwent OCT (Cirrus HD-OCT) to measure retinal nerve fiber layer (RNFL) and ganglion cell layer to inner plexiform layer (GCL-IPL) thickness.
  • pVEPs were used to measure P100 latency, with statistical models adjusting for age and intereye correlations.

Main Results:

  • RNFL thinning was observed in 50% of eyes with a history of ON compared to 5% of non-ON eyes.
  • Prolonged pVEP latency was present in 58% of ON eyes and 55% of non-ON eyes.
  • A history of ON predicted RNFL and GCL-IPL thinning, whereas prolonged pVEP latency occurred independently of ON history in children with MS.

Conclusions:

  • OCT and pVEPs offer complementary information for evaluating the visual pathway in pediatric MS.
  • OCT is particularly sensitive to retinal changes associated with clinical ON.
  • pVEPs are valuable for detecting subclinical or disseminated lesions affecting the visual pathway in this population.