المؤلفون: Levin, Netta¹ netta@hadassah.org.il, Devereux, Michael², Bick, Atira¹, Baker, Nick², Green, Ari^2,3

المصدر: Journal of Neurology. May2019, Vol. 266 Issue 5, p1160-1166. 7p. 3 Graphs.

مصطلحات موضوعية: *OPTIC neuritis, *COLOR vision, *OPTICAL coherence tomography, *NERVE fibers, *ATROPHY

مستخلص: Background: Emphasis is often placed on the good recovery of vision following optic neuritis (ON). However, patients continue to perceive difficulties in performing everyday visual tasks and have reduced visual quality of life. This is in addition to documented permanent loss of retinal volume. Methods: Seventy-five subjects following monocular ON (> 3 months prior to assessment), were evaluated by the Rabin cone contrast test (CCT). Red, green and blue cone contrast scores were extracted for the affected and fellow eyes. Retinal nerve fiber layer (RNFL) and macular volume (MV) were assessed using optical coherence tomography. Results: Fifty-seven patients had multiple sclerosis and 17 had clinically isolated syndrome. Median time from ON to evaluation was 47 months. Expanded Disability Status Scale (EDSS) ranged between 0 and 6.5 with average of 2 ± 1.3. Cone contrast scores for red, green and blue in the affected eyes were significantly lower than in the fellow eyes. RNFL thickness and MV were reduced in the affected compared to the fellow eyes. Positive correlations between CCT and RNFL were found in both eyes, but much stronger in the affected eyes (r = 0.72, 0.74, 0.5 and 0.53, 0.58, 0.46 for red green and blue in each eye, respectively). Positive correlations between CCT and MV were found in both eyes, but only modestly stronger in the affected eyes. Conclusions: Impaired chromatic discrimination thresholds quantitatively document persistent functional complaints after ON. There is evidence of dysfunction in both the affected eye and the fellow eye. [ABSTRACT FROM AUTHOR]

المؤلفون: Kahila, Shahar^1,2,3 (AUTHOR), Zveik, Omri^1,2 (AUTHOR), Levin, Netta^1,2 (AUTHOR), Brill, Livnat^1,2 (AUTHOR), Rechtman, Ariel^1,2 (AUTHOR), Haham, Nitzan^1,2 (AUTHOR), Imbar, Tal^1,4 (AUTHOR), Vaknin-Dembinsky, Adi^1,2 (AUTHOR) Adembinsky@gmail.com

المصدر: Neurological Sciences. Nov2023, Vol. 44 Issue 11, p3989-3996. 8p.

مصطلحات موضوعية: *MULTIPLE sclerosis, *MAGNETIC resonance imaging, *PREGNANCY, *CLINICAL deterioration

مستخلص: Background: Pregnancy has been observed to reduce the frequency of relapses in Multiple Sclerosis (MS) patients, but the relapse risk tends to increase during the early post-partum period. Increased pre- and post-partum disease activity may predict a poor long-term prognosis. This study aimed to evaluate the correlation between magnetic resonance imaging (MRI) activity during the year before pregnancy and long-term clinically meaningful worsening in Expanded Disability Status Scale (EDSS). Methods: This observational, retrospective, case–control study included 141 pregnancies in 99 females with MS. Statistical analyses were used to evaluate the correlation between MRI activity during the year pre-pregnancy and post-partum clinical worsening during a 5-year follow-up. Clustered logistic regression was used to investigate the predictors of 5-year clinically meaningful worsening in EDSS (lt-EDSS). Results: We found a significant correlation between an active MRI pre-pregnancy and lt-EDSS (p = 0.0006). EDSS pre-pregnancy and lt-EDSS were also significantly correlated (p = 0.043). Using a multivariate model, we predicted which females would not experience long-term clinical deterioration by a stable MRI pre-pregnancy (92.7% specificity; p = 0.004). Conclusions: An active MRI pre-conception is a strong predictor of lt-EDSS and a higher annual relapse rate during the follow-up period, regardless of whether the female had clinical evidence of disease activity prior to conception and delivery. Optimizing disease control and achieving imaging stability prior to conception may reduce the risk of long-term clinical deterioration. [ABSTRACT FROM AUTHOR]

المؤلفون: Raz, Noa¹, Levin, Netta¹ netta@hadassah.org.il

المصدر: Journal of Neurology. Jun2017, Vol. 264 Issue 6, p1051-1058. 8p. 1 Color Photograph, 2 Diagrams, 1 Graph.

مصطلحات موضوعية: *MEDICAL rehabilitation, *BLINDSIGHT (Visual perception), *VISUAL cortex physiology, *HEMIANOPSIA, *PATIENTS, *THERAPEUTICS, TREATMENT of vision disorders

مستخلص: Despite the fact that almost one-third of patients suffer from visual deficits following brain damage; neuro-visual rehabilitation to compensate for visual field deficits is relatively neglected in the clinical setting. This is in contrast to physio and speech therapies, which are the bread and butter of rehabilitative programs. Likewise, programs that address coping with dementia usually concentrate on language, memory and cognitive skills, but often fail to address the deficits experienced by the subset of patients suffering from progressive cortico-visual dysfunction. Herein, we will review the different approaches to neuro-visual rehabilitation, mainly concentrating on restorative and compensatory treatments. While the first claims to restore vision in the blind visual field, the latter attempts to improve the use of the remaining intact field. These approaches differ in their premise regarding the ability of the adult human brain to adapt following damage, reflecting different attitudes toward the presumed treatment target organ. While restorative therapies claim to reactivate inactive neurons within or around the damaged cortices, compensatory approaches aim to improve voluntary eye movements to compensate the visual loss. We will also briefly discuss the use of optical devices for bypassing the visual deficit as well as the use of the blind-sight phenomena to convert non-conscious visual abilities in the blind visual field into awareness. The various therapeutic approaches will be discussed in the context of patients suffering from hemianopsia and in patients suffering from posterior cortical atrophy. We will argue that of all, the compensatory strategies have shown the most promising results. [ABSTRACT FROM AUTHOR]

المؤلفون: Levin, Netta¹ netta@hadassah.org.il, Dumoulin, Serge O.², Winawer, Jonathan¹, Dougherty, Robert F.¹, Wandell, Brian A.¹

المصدر: Neuron. Jan2010, Vol. 65 Issue 1, p21-31. 11p.

مصطلحات موضوعية: *EYE abnormalities, *BRAIN imaging, *VISUAL perception, *RETINAL (Visual pigment), *MONOCULAR vision, *IMAGE reconstruction

مستخلص: Summary: Abnormal visual input during development has dramatic effects on the visual system. How does the adult visual system respond when input is corrected? MM lost his left eye and became blind in the right due to corneal damage at the age of 3. At age 46, MM regained his retinal image, but his visual abilities, even seven years following the surgery, remain severely limited, and he does not rely on vision for daily life. Neuroimaging measurements reveal several differences among MM, sighted controls, sighted monocular, and early blind subjects. We speculate that these differences stem from damage during the critical period in development of retinal neurons with small, foveal receptive fields. In this case, restoration of functional vision requires more than improving retinal image contrast. In general, visual restoration will require accounting for the developmental trajectory of the individual and the consequences of the early deprivation on cortical circuitry. [Copyright &y& Elsevier]

المؤلفون: Levin, Netta^1,2 neta@lobster.ls.huji.ac.il, Orlov, Tanya¹, Dotan, Shlomo³, Zohary, Ehud¹

المصدر: NeuroImage. Dec2006, Vol. 33 Issue 4, p1161-1168. 8p.

مصطلحات موضوعية: *PERIPHERAL neuropathy, *VISUAL cortex, *PERIPHERAL nervous system, *NERVOUS system

مستخلص: Abstract: Recovery to normal or near normal visual acuity after an optic neuritis episode is common, despite frequent persistence of conduction abnormalities, evident in prolonged visual evoked potential (VEP) latencies. Improvement of visual function is commonly attributed to peripheral nerve recovery. However, central reorganization processes may also be involved. To assess this, we compared the patterns of fMRI activation, elicited by stimulation of the affected and the normal eye, along the visual cortical hierarchy. Activation was assessed in 8 subjects, which recovered clinically from an episode of optic neuritis but still had prolonged VEP latencies. In all patients, reduced fMRI activation was seen in V1 during stimulation of the affected eye, compared to the normal eye. The fMRI signal difference decreased in magnitude with progression along the visual hierarchy, and in some regions within the lateral occipital complex even showed the opposite preference (for the affected eye). These results may indicate a built-in robustness of the object-related areas to disruption of the visual input. Alternatively, it could reflect an adaptive functional reorganization of the cortical response to an abnormal input. [Copyright &y& Elsevier]

المؤلفون: Levin, Netta^1,2, Abramsky, Oded¹, Lossos, Alexander^1,2, Karussis, Dimitrios¹, Siegal, Tali², Argov, Zohar¹, Ben Hur, Tamir¹ tamir@hadassah.org.il

المصدر: Journal of the Neurological Sciences. Oct2005, Vol. 237 Issue 1/2, p39-43. 5p.

مصطلحات موضوعية: *MYASTHENIA gravis, *NEUROMUSCULAR diseases, *TUMORS, *ONCOLOGY, *PATIENTS

مستخلص: Abstract: Introduction: Myasthenia gravis (MG) is considered a paraneoplastic phenomenon of thymomas in 15% of patients. Co-existence of MG with extrathymic malignancies, and an increased risk of second malignancy in patients with thymoma have been reported. Data on clinical characteristics of MG patients with extrathymic malignancies and the role of concomitant diseases and their treatment are lacking. Methods: The clinical records of 188 consecutive MG patients were studied retrospectively. We examined whether gender, age, generalized disease, seropositivity for acetyl-choline receptor antibodies, occurrence of thymoma, immunosuppressive therapy and occurrence of other autoimmune diseases determined an increased risk for development of extrathymic malignancy. Results: This group followed the typical epidemiological characteristics of MG. Thirty-three patients (17.6%) had a thymoma. Twenty-nine patients (15.4%) had 30 extrathymic malignant tumors of various origins. Only four patients with extrathymic tumors had an associated thymoma. Tumors were diagnosed between 20 years prior to and 35 years after the appearance of MG. Older age of MG onset was the only risk factor identified for development of malignancy in MG. Discussion: Extrathymic malignancies are common in MG patients, especially in the older age group. There are no specific clinical features of the subgroup of MG patients with cancer. Although MG is not a paraneoplastic phenomenon of extrathymic malignancy, the association between MG and malignancy may be due to a common background of immune dysregulation. [Copyright &y& Elsevier]

المؤلفون: Levin, Netta¹ imbar_l@netvision.net.il, Ben-Hur, Tamir¹, Biran, Iftah¹, Wertman, Eli²

المصدر: Neuropsychologia. Jul2005, Vol. 43 Issue 9, p1385-1390. 6p.

مصطلحات موضوعية: *PTYCHOBRANCHUS, *NECROSIS, *INFARCTION, *THALAMUS

مستخلص: Abstract: Category specific naming impairment was described mainly after cortical lesions. It is thought to result from a lesion in a specific network, reflecting the organization of our semantic knowledge. The deficit usually involves multiple semantic categories whose profile of naming deficit generally obeys the animate/inanimate dichotomy. Thalamic lesions cause general semantic naming deficit, and only rarely a category specific semantic deficit for very limited and highly specific categories. We performed a case-control study on a 56-year-old right-handed man who presented with language impairment following a left anterior thalamic infarction. His naming ability and semantic knowledge were evaluated in the visual, tactile and auditory modalities for stimuli from 11 different categories, and compared to that of five controls. In naming to visual stimuli the patient performed poorly (error rate>50%) in four categories: vegetables, toys, animals and body parts (average 70.31±15%). In each category there was a different dominating error type. He performed better in the other seven categories (tools, clothes, transportation, fruits, electric, furniture, kitchen utensils), averaging 14.28±9% errors. Further analysis revealed a dichotomy between naming in animate and inanimate categories in the visual and tactile modalities but not in response to auditory stimuli. Thus, a unique category specific profile of response and naming errors to visual and tactile, but not auditory stimuli was found after a left anterior thalamic infarction. This might reflect the role of the thalamus not only as a relay station but further as a central integrator of different stages of perceptual and semantic processing. [Copyright &y& Elsevier]

المؤلفون: Lehmann, Hillel¹ (AUTHOR), Zveik, Omri¹ (AUTHOR), Levin, Netta¹ (AUTHOR), Brill, Livnat¹ (AUTHOR), Imbar, Tal^1,2 (AUTHOR), Vaknin-Dembinsky, Adi¹ (AUTHOR) Adembinsky@gmail.com

المصدر: Multiple Sclerosis Journal. Dec2021, Vol. 27 Issue 14, p2232-2239. 8p.

مصطلحات موضوعية: *MAGNETIC resonance imaging, *DISEASE relapse, *PREGNANCY, *MEDICAL personnel

مستخلص: Background: There are fewer multiple sclerosis (MS) relapses during pregnancy, although relapse risk increases in the early post-partum period, as has been predicted by pre-pregnancy or pregnancy disease activity in some studies. Objective: The aim of this study was to evaluate the correlation between magnetic resonance imaging (MRI) changes in the year before pregnancy and the relapse rate in the year post-partum. Methods: An observational retrospective case–control study included 172 pregnancies in 118 females with MS. Statistical analyses were used to evaluate the correlation between MRI and post-partum relapses. Clustered logistic regression was used to investigate the predictors of early post-partum relapses. Results: We found a significant correlation for an active-MRI pre-pregnancy and relapses in the first 3 months post-partum (p < 0.001). Expanded Disability Status Scale (EDSS) pre-pregnancy and relapses in the first 3 months post-partum were also significantly correlated (p = 0.009). Using a multivariate model, we predicted which women will not experience post-partum relapse by EDSS and by an active-MRI pre-pregnancy (96.7% specificity; p < 0.001). Conclusion: An active-MRI pre-pregnancy is a strong and sensitive predictor of early post-partum relapse, regardless of whether the woman had clinical evidence of disease activity prior to conception and delivery. This finding could provide clinicians with a strategy to minimize post-partum relapse risk in women with MS planning pregnancy. [ABSTRACT FROM AUTHOR]

المؤلفون: Petrou, Panayiota¹ (AUTHOR), Kassis, Ibrahim¹ (AUTHOR), Levin, Netta² (AUTHOR), Paul, Friedemann^3,4,5 (AUTHOR), Backner, Yael² (AUTHOR), Benoliel, Tal² (AUTHOR), Oertel, Frederike Cosima^3,4 (AUTHOR), Scheel, Michael^3,4,6 (AUTHOR), Hallimi, Michelle¹ (AUTHOR), Yaghmour, Nour¹ (AUTHOR), Hur, Tamir Ben² (AUTHOR), Ginzberg, Ariel¹ (AUTHOR), Levy, Yarden¹ (AUTHOR), Abramsky, Oded² (AUTHOR), Karussis, Dimitrios¹ (AUTHOR) dimitrios@hadassah.org.il

المصدر: Brain: A Journal of Neurology. Dec2020, Vol. 143 Issue 12, p3574-3588. 15p.

مصطلحات موضوعية: *MESENCHYMAL stem cells, *STEM cell transplantation, *MULTIPLE sclerosis, *OPTICAL coherence tomography, *FUNCTIONAL magnetic resonance imaging, *MENTAL health, *MULTIPLE sclerosis treatment, *BRAIN, *DISEASE progression, *RESEARCH, *SPINAL injections, *RESEARCH methodology, *MAGNETIC resonance imaging, *MEDICAL cooperation, *EVALUATION research, *NEUROPSYCHOLOGICAL tests, *TREATMENT effectiveness, *DISEASE relapse, *COMPARATIVE studies, *RANDOMIZED controlled trials, *BLIND experiment, *WALKING, *BIOLOGICAL assay, *INTRAVENOUS injections, *STATISTICAL sampling, *LONGITUDINAL method

مستخلص: In this study (trial registration: NCT02166021), we aimed to evaluate the optimal way of administration, the safety and the clinical efficacy of mesenchymal stem cell (MSC) transplantation in patients with active and progressive multiple sclerosis. Forty-eight patients (28 males and 20 females) with progressive multiple sclerosis (Expanded Disability Status Scale: 3.0-6.5, mean : 5.6 ± 0.8, mean age: 47.5 ± 12.3) and evidence of either clinical worsening or activity during the previous year, were enrolled (between 2015 and 2018). Patients were randomized into three groups and treated intrathecally (IT) or intravenously (IV) with autologous MSCs (1 × 106/kg) or sham injections. After 6 months, half of the patients from the MSC-IT and MSC-IV groups were retreated with MSCs, and the other half with sham injections. Patients initially assigned to sham treatment were divided into two subgroups and treated with either MSC-IT or MSC-IV. The study duration was 14 months. No serious treatment-related safety issues were detected. Significantly fewer patients experienced treatment failure in the MSC-IT and MSC-IV groups compared with those in the sham-treated group (6.7%, 9.7%, and 41.9%, respectively, P = 0.0003 and P = 0.0008). During the 1-year follow-up, 58.6% and 40.6% of patients treated with MSC-IT and MSC-IV, respectively, exhibited no evidence of disease activity compared with 9.7% in the sham-treated group (P < 0.0001 and P < 0.0048, respectively). MSC-IT transplantation induced additional benefits on the relapse rate, on the monthly changes of the T2 lesion load on MRI, and on the timed 25-foot walking test, 9-hole peg test, optical coherence tomography, functional MRI and cognitive tests. Treatment with MSCs was well-tolerated in progressive multiple sclerosis and induced short-term beneficial effects regarding the primary end points, especially in the patients with active disease. The intrathecal administration was more efficacious than the intravenous in several parameters of the disease. A phase III trial is warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

المؤلفون: Levin, Netta¹ imbar_l@netvision.net.il, Karussis, Dimitrios¹, Abramsky, Oded¹

المصدر: Journal of Neurology. Jun2003, Vol. 250 Issue 6, p766-767. 2p.

مصطلحات موضوعية: *MYASTHENIA gravis, *LETTERS to the editor

مستخلص: Presents a letter to the editor discussing the association of myasthenia gravis with Parkinson's disease.