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Optikusneuropathie nach Retrobulbärneuritis bei Multipler Sklerose

Sind OCT und cMRT hilfreiche Verlaufsparameter?

Optic neuropathy after retrobulbar neuritis in multiple sclerosis

Are optical coherence tomography and magnetic resonance imaging useful and necessary follow-up parameters?

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Zusammenfassung

Hintergrund

In dieser Arbeit wird untersucht, ob es regelhaft eine progrediente Optikusneuropathie nach Retrobulbärneuritis (ON) gibt und ob die Optical-coherence-Tomographie (OCT) eine sinnvolle ergänzende Untersuchung bei der Verlaufskontrolle der Multiplen Sklerose (MS) ist.

Methoden

Die Observationsstudie schloss 86 immunmodulatorisch behandelte Patienten mit Optikusneuritis in der Anamnese ein, bei denen in 2010 und 2012 EDSS, Visus, VEP (visuell evozierte Potenziale), OCT und in 2012 MRT-Untersuchungen durchgeführt wurden. Dabei wurden einerseits Patienten nach unilateraler und bilateraler ON miteinander und andererseits Augen von Patienten nach ON mit Augen ohne vorheriger ON verglichen.

Resultate

In unsere Studie wurden 16 Männer und 70 Frauen mit einem mittleren Alter von 41,6 und 43,8 Jahren evaluiert. 28 Patienten hatten einen Zustand nach bilateraler und 58 Patienten einen Zustand nach unilateraler ON. Visus und VEP verbesserten sich im Untersuchungszeitraum oder blieben gleich. Dabei waren Visus, VEP, die Nervenfaserschichtdicke (NFSD) und das Makulavolumen sowohl in 2010 und 2012 signifikant schlechter in Augen nach ON als in Augen ohne vorherige ON. Die NFSD nahm sowohl in Augen mit (von 79,9 ± 13,3 µm auf 77,0 ± 12,9 µm) als auch ohne vorherige ON (von 89,5 ± 12,9 µm auf 86,0 ± 12,5 µm) signifikant in der Untersuchungsperiode ab (p < 0,0001). VEP und NFSD korrelierten signifikant sowohl in Augen nach als auch Augen ohne vorherige ON mit dem Visus. Bei Patienten nach unilateraler ON waren der EDSS und die Hirnatrophieparameter Corpus-callosum-Index (CCI) und Cella-media-Index (CMI) miteinander reziprok korreliert.

Zusammenfassung

Die oft mit einer ON beginnende MS-Erkrankung kann durch Immunmodulation durchaus stabilisiert werden und eine progrediente Optikusneuropathie nach Retrobulbärneuritis war in milder Form generell und im Ausnahmefall in deutlicher Weise nachweisbar. Die OCT-Messung zeigte in unserer Studie keine bessere Korrelation als die VEP, kann aber bei atypischer ON zur Sicherung der Diagnose eingesetzt werden. Bei der kranialen MRT-Untersuchung ist der CCI am besten mit dem Grad der Behinderung assoziiert, während, wie schon in der Literatur beschrieben, die T2-Läsionsanzahl aufgrund der Small-world-network-Funktion des Gehirns zum einen und der Lage von Läsionen in klinisch nicht symptomrelevanten Regionen zum anderen für die Klinik nicht so entscheidend ist.

Summary

Background

This study evaluated whether progressive optic neuropathy (ON) is commonly found after retrobulbar neuritis and whether optical coherence tomography (OCT) is a useful tool for follow-up of patients with multiple sclerosis (MS).

Methods

An observational study of 86 MS patients (currently treated with immunomodulation) with a past medical history of ON was carried out. Patients were assessed in 2010 and 2012 using the expanded disability status scale (EDSS), visual acuity, visual evoked potentials (VEP) and OCT but magnetic resonance imaging (MRI) was performed only in 2012.

Results

In this study 16 men and 70 women with a mean age of 41.6 and 43.8 years, respectively, were evaluated (28 patients post bilateral and 58 patients post unilateral ON including 114 eyes post-ON and 58 eyes without previous ON). Visual acuity and VEPs improved or remained the same over the study period. Visual acuity, VEPs, retinal nerve fiber layer (RNFL) thickness and macular volume were significantly worse in eyes post-ON compared to eyes without previous ON. The RNFL significantly decreased over the study period in eyes post-ON from an average of 79.9 ± 13.3 μm to 77.0 ± 12.9 μm (p < 0.0001) and eyes without previous ON from 89.5 ± 12.9 μm to 86.0 ± 12.5 μm (p < 0.0001). The number of VEPs and RNFL thickness were significantly correlated with visual acuity in all eyes. In patients after unilateral ON the brain atrophy parameters corpus callosum index (CCI) and cella media index (CMI) were negatively correlated with the EDSS.

Conclusion

Initially MS often begins with an episode of ON which can be stabilized by immunomodulation. A mild progressive ON was generally detectable in this study but severe progressive ON was rarely observed. The OCT measurements showed no better correlation than the VEPs with visual acuity; however, OCT can be applied for confirmation of atypical ON. The corpus callosum index seems to be best associated with the degree of disability while, as already described in the literature, the number of T2 lesions is not well correlated with disability, probably due to the small-world network function of the brain and the position of the lesions in areas with no clinical relevance.

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Abbreviations

CCI:

Corpus-callosum-Index

CMI:

Cella-media-Index

EDSS:

Expanded Disability Status Scale

MS:

Multiple Sklerose

MRT:

Magnetresonanztomographie

NFSD:

Nervenfaserschichtdicke

ON:

Optikusneuritis

OCT:

optical coherence tomography

VEP:

visuell evozierte Potenziale

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Danksagung

Die Arbeit wurde von der Firma Novartis unterstützt

Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Dachsel und S. Domke haben Honorare für Vorträge und Beratertätigkeiten und Reisekostenerstattung von den Firmen Bayer HealthCare, Biogen Idec, Novartis, Sanofi-Genzyme und Teva bekommen. R.M. Dachsel, T. Groß, O. Schubert, L. Kotrini, K. Ladegast, J. Vogel, T. Jordan und S. Zawade geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, Redhill, UK

    R.M. Dachsel

  2. MS-Schwerpunktpraxis, Chemnitz, Deutschland

    R. Dachsel, S. Domke & S. Zawade

  3. Ophthalmologische Praxis, Chemnitz, Deutschland

    T. Groß

  4. Ophthalmologische Praxis, Limbach/Oberfrohna, Deutschland

    O. Schubert

  5. Radiologische Gemeinschaftspraxis, Chemnitz, Deutschland

    L. Kotrini, K. Ladegast, J. Vogel & T. Jordan

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  1. R.M. Dachsel
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Dachsel, R., Dachsel, R., Domke, S. et al. Optikusneuropathie nach Retrobulbärneuritis bei Multipler Sklerose. Nervenarzt 86, 187–196 (2015). https://doi.org/10.1007/s00115-014-4241-1

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