المؤلفون: Toosy, Ahmed T¹ (AUTHOR) a.toosy@ucl.ac.uk, Barkhof, Frederik^1,2,3 (AUTHOR)

المصدر: Multiple Sclerosis Journal. May2024, Vol. 30 Issue 6, p637-639. 3p.

مصطلحات موضوعية: *MULTIPLE sclerosis, *DIAGNOSIS, *CEREBRAL small vessel diseases

مستخلص: The article argues that the current diagnostic criteria for multiple sclerosis (MS) should be revised. The authors propose that the diagnosis of MS can be made solely based on the presence of dissemination in space (DIS) on magnetic resonance imaging (MRI), without the need for dissemination in time (DIT) or further clinical events. They argue that MRI can accurately distinguish MS lesions from non-MS lesions and that the requirement for DIT is unnecessary. The authors also suggest incorporating other factors, such as CSF-OCBs and additional MRI acquisitions, to improve the diagnostic criteria. They acknowledge that there are limitations to their proposal and that further research is needed. [Extracted from the article]

المؤلفون: Toosy, Ahmed T^1,2 a.toosy@ucl.ac.uk, Mason, Deborah F³, Miller, David H^1,4,5

المصدر: Lancet Neurology. Jan2014, Vol. 13 Issue 1, p83-99. 17p.

مصطلحات موضوعية: *CLINICAL trials, *OPTIC neuritis, *OPTIC nerve diseases, *DISEASES in young adults, *PATHOLOGICAL physiology, *MULTIPLE sclerosis, *DIFFERENTIAL diagnosis

مستخلص: Summary: Acute optic neuritis is the most common optic neuropathy affecting young adults. Exciting developments have occurred over the past decade in understanding of optic neuritis pathophysiology, and these developments have been translated into treatment trials. In its typical form, optic neuritis presents as an inflammatory demyelinating disorder of the optic nerve, which can be associated with multiple sclerosis. Atypical forms of optic neuritis can occur, either in association with other inflammatory disorders or in isolation. Differential diagnosis includes various optic nerve and retinal disorders. Diagnostic investigations include MRI, visual evoked potentials, and CSF examination. Optical coherence tomography can show retinal axonal loss, which correlates with measures of persistent visual dysfunction. Treatment of typical forms with high-dose corticosteroids shortens the period of acute visual dysfunction but does not affect the final visual outcome. Atypical forms can necessitate prolonged immunosuppressive regimens. Optical coherence tomography and visual evoked potential measures are suitable for detection of neuroaxonal loss and myelin repair after optic neuritis. Clinical trials are underway to identify potential neuroprotective or remyelinating treatments for acutely symptomatic inflammatory demyelinating CNS lesions. [Copyright &y& Elsevier]

المؤلفون: Thompson, Alan J¹, Toosy, Ahmed T¹, Ciccarelli, Olga¹ o.ciccarelli@ion.ucl.ac.uk

المصدر: Lancet Neurology. Dec2010, Vol. 9 Issue 12, p1182-1199. 18p.

مصطلحات موضوعية: *MULTIPLE sclerosis treatment, *SYMPTOMS, *PHARMACOLOGY, *DRUGS, *CLINICAL trials, *REHABILITATION

مستخلص: Summary: Management of symptoms in multiple sclerosis (MS) has received little attention compared with disease-modifying treatments. However, the effect of these symptoms on quality of life can be profound. Clinical trials of pharmacological drugs to treat symptoms of MS have often been underpowered and have used inappropriate measures of outcome. Many currently used symptomatic drugs were introduced decades ago, when study quality was considerably below current standards. Therefore, the evidence base on which to make clinical decisions is less than adequate. Interest in pharmacological treatment of symptoms in MS has increased in recent years, and several large randomised controlled trials have been reported. Pharmacological strategies are a core component of the treatment of these symptoms, but it is imperative to remember that a multidisciplinary rehabilitation approach is needed for effective management. [ABSTRACT FROM AUTHOR]

المؤلفون: Ciccarelli, Olga¹ o.ciccarelli@ion.ucl.ac.uk, Toosy, Ahmed T.¹, de Stefano, Nicola², Wheeler-Kingshott, Claudia A. M.³, Miller, David H.³, Thompson, Alan J.¹

المصدر: Journal of Neuroscience. 11/10/2010, Vol. 30 Issue 45, p15030-15033. 4p.

مصطلحات موضوعية: *NEUROPLASTICITY, *MICRODIALYSIS, *MITOCHONDRIAL pathology, *MULTIPLE sclerosis, *ACAMPROSATE, *AXONAL transport

مستخلص: Mitochondrial dysfunction contributes to the pathogenesis of many neurological diseases, including multiple sclerosis (MS), but is not directly measurable in vivo. We modeled N-acetyl-aspartate (NAA), which reflects axonal structural integrity and mitochondrial metabolism, with imaging measures of axonal structural integrity (axial diffusivity and cord cross-sectional area) to extract its mitochondrial metabolic contribution. Lower residual variance in NAA, reflecting reduced mitochondrial metabolism, was associated with greater clinical disability in MS, independent of structural damage. [ABSTRACT FROM AUTHOR]

المؤلفون: Jenkins, Thomas M.¹, Toosy, Ahmed T.¹, Ciccarelli, Olga¹, Miszkiel, Katherine A.², Wheeler-Kingshott, Claudia A.³, Henderson, Andrew P.⁴, Kallis, Constantinos^3,5, Mancini, Laura², Plant, Gordon T.^6,7, Miller, David H.^4,6, Thompson, Alan J.^1,6

المصدر: Annals of Neurology. Jan2010, Vol. 67 Issue 1, p99-113. 15p.

مستخلص: Objectives To determine whether lateral occipital complex (LOC) activation with functional magnetic resonance imaging (fMRI) predicts visual outcome after clinically isolated optic neuritis (ON). To investigate the reasons behind good recovery following ON, despite residual optic nerve demyelination and neuroaxonal damage. Methods Patients with acute ON and healthy volunteers were studied longitudinally over 12 months. Structural MRI, visual evoked potentials (VEPs), and optical coherence tomography (OCT) were used to quantify acute inflammation, demyelination, conduction block, and later to estimate remyelination and neuroaxonal loss over the entire visual pathway. The role of neuroplasticity was investigated using fMRI. Multivariable linear regression analysis was used to study associations between vision, structure, and function. Results Greater baseline fMRI responses in the LOCs were associated with better visual outcome at 12 months. This was evident on stimulation of either eye ( p = 0.007 affected; p = 0.020 fellow eye), and was independent of measures of demyelination and neuroaxonal loss. A negative fMRI response in the LOCs at baseline was associated with a relatively worse visual outcome. No acute electrophysiological or structural measures, in the anterior or posterior visual pathways, were associated with visual outcome. Interpretation Early neuroplasticity in higher visual areas appears to be an important determinant of recovery from ON, independent of tissue damage in the anterior or posterior visual pathway, including neuroaxonal loss (as measured by MRI, VEP, and OCT) and demyelination (as measured by VEP). ANN NEUROL 2010;67:99-113 [ABSTRACT FROM AUTHOR]

المؤلفون: Ciccarelli, Olga¹, Toosy, Ahmed T.¹, Hickman, Simon J.², Parker, Geoff J.M.³, Wheeler-Kingshott, Claudia A.M.², Miller, David H.², Thompson, Alan J.¹

المصدر: Human Brain Mapping. Jul2005, Vol. 25 Issue 3, p308-316. 9p.

مستخلص: Postmortem data suggest that trans-synaptic degeneration occurs in the lateral geniculate nucleus after optic nerve injury. This study investigated in vivo the optic radiations in patients affected by optic neuritis using fast marching tractography (FMT), a diffusion magnetic resonance imaging (MRI) fiber tracking method, and group mapping techniques, which allow statistical comparisons between subjects. Seven patients, 1 year after isolated unilateral optic neuritis, and ten age and gender-matched controls underwent whole-brain diffusion tensor MR imaging. The FMT algorithm was used to generate voxel-scale connectivity (VSC) maps in the optic radiations in each subject in native space. Group maps of the left and right optic radiations were created in the patient and control group in a standardized reference frame using statistical parametric mapping (SPM99). The reconstructed optic radiations in the patient group were localized more laterally in the posterior part of the tracts and more inferiorly than in the control group. Patients showed reduced VSC values in both tracts compared with controls. These findings suggest that the group mapping techniques might be used to assess changes in the optic radiations in patients after an episode of optic neuritis. The changes we have observed may be secondary to the optic nerve damage. Hum Brain Mapp, 2005. © 2005 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

المؤلفون: Hickman, Simon J.^1,2, Toosy, Ahmed T.^1,2, Miszkiel, Katherine A.³, Jones, Stephen J.⁴, Altmann, Daniel R.^1,5, MacManus, David G.¹, Plant, Gordon T.², Thompson, Alan J.¹, Miller, David H.¹ d.miller@ion.ucl.ac.uk

المصدر: Journal of Neurology. Aug2004, Vol. 251 Issue 8, p996-1005. 10p.

مصطلحات موضوعية: *NEURITIS, *NONARTICULAR rheumatism, *MAGNETIC resonance imaging, *DIAGNOSTIC imaging, *VISUAL pathways, *MEDICAL imaging systems

مستخلص: 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 T1–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 < 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 > –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 µV 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. [ABSTRACT FROM AUTHOR]

المؤلفون: Toosy, Ahmed T.¹, Ciccarelli, Olga¹, Parker, Geoff J.M.², Wheeler-Kingshott, Claudia A.M.¹, Miller, David H.¹, Thompson, Alan J.¹ a.thompson@ion.ucl.ac.uk

المصدر: NeuroImage. Apr2004, Vol. 21 Issue 4, p1452. 12p.

مصطلحات موضوعية: *MAGNETIC resonance imaging, *EYE, *RADIATION, *DIAGNOSTIC imaging

مستخلص: A key objective in neuroscience is to improve our understanding of the relationship between brain function and structure. We investigated this in the posterior visual pathways of healthy volunteers by applying functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) with tractography. The optic radiations were segmented using the Probabilistic Index of Connectivity (PICo) tractography algorithm and extracted at several thresholds of connection confidence. The mean fractional anisotropy (FA) of the estimated tracts was found to correlate significantly with fMRI measures of visual cortex activity (induced by a photic stimulation paradigm). The results support the hypothesis that the visual cortical fMRI response is constrained by the external anatomical connections of the subserving optic radiations. [Copyright &y& Elsevier]

المؤلفون: Jenkins, Thomas M, Toosy, Ahmed T

المصدر: Multiple Sclerosis Journal. Sep2014, Vol. 20 Issue 10, p1299-1301. 3p.

مصطلحات موضوعية: *OPTICAL coherence tomography, *MULTIPLE sclerosis diagnosis, *MEDICAL radiography, *GLAUCOMA, *CLINICAL medicine, *EQUIPMENT & supplies

مستخلص: The article offers the author's view on why the optical coherence tomography (OCT) should not be used for the routine monitoring of multiple sclerosis (MS). The author states that OCT would not contribute to the effective management of clinical evaluation. The author notes that the OCT measurements are affected by non-MS ocular conditions such as retinal problems, optic disc drusen, and glaucoma. The author mentions that the use of OCT is difficult to advocate.

المؤلفون: Foster, Michael A¹ (AUTHOR) m.a.foster@ucl.ac.uk, Prados, Ferran^1,2,3 (AUTHOR), Collorone, Sara¹ (AUTHOR), Kanber, Baris^1,2 (AUTHOR), Cawley, Niamh¹ (AUTHOR), Davagnanam, Indran⁴ (AUTHOR), Yiannakas, Marios C¹ (AUTHOR), Ogunbowale, Lola⁵ (AUTHOR), Burke, Ailbhe⁵ (AUTHOR), Barkhof, Frederik^1,2,6,7 (AUTHOR), Wheeler-Kingshott, Claudia AM Gandini^1,8 (AUTHOR), Ciccarelli, Olga^1,7 (AUTHOR), Brownlee, Wallace^1,7 (AUTHOR), Toosy, Ahmed T¹ (AUTHOR)

المصدر: Multiple Sclerosis Journal. Jun2024, Vol. 30 Issue 7, p800-811. 12p.

مصطلحات موضوعية: *DIFFUSION magnetic resonance imaging, *MAGNETIC resonance imaging, *PEOPLE with disabilities, *DIAGNOSTIC imaging

مستخلص: Background: Conventional magnetic resonance imaging (MRI) does not account for all disability in multiple sclerosis. Objective: The objective was to assess the ability of graph metrics from diffusion-based structural connectomes to explain motor function beyond conventional MRI in early demyelinating clinically isolated syndrome (CIS). Methods: A total of 73 people with CIS underwent conventional MRI, diffusion-weighted imaging and clinical assessment within 3 months from onset. A total of 28 healthy controls underwent MRI. Structural connectomes were produced. Differences between patients and controls were explored; clinical associations were assessed in patients. Linear regression models were compared to establish relevance of graph metrics over conventional MRI. Results: Local efficiency (p = 0.045), clustering (p = 0.034) and transitivity (p = 0.036) were reduced in patients. Higher assortativity was associated with higher Expanded Disability Status Scale (EDSS) (β = 74.9, p = 0.026) scores. Faster timed 25-foot walk (T25FW) was associated with higher assortativity (β = 5.39, p = 0.026), local efficiency (β = 27.1, p = 0.041) and clustering (β = 36.1, p = 0.032) and lower small-worldness (β = −3.27, p = 0.015). Adding graph metrics to conventional MRI improved EDSS (p = 0.045, Δ R 2 = 4) and T25FW (p < 0.001, Δ R 2 = 13.6) prediction. Conclusion: Graph metrics are relevant early in demyelination. They show differences between patients and controls and have relationships with clinical outcomes. Segregation (local efficiency, clustering, transitivity) was particularly relevant. Combining graph metrics with conventional MRI better explained disability. [ABSTRACT FROM AUTHOR]