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Abstract
Objective To investigate if patients with neuromyelitis optica spectrum disorder (NMOSD) develop subclinical visual pathway impairment independent of acute attacks.
Methods A total of 548 longitudinally assessed full-field visual evoked potentials (VEP) of 167 patients with NMOSD from 16 centers were retrospectively evaluated for changes of P100 latencies and P100-N140 amplitudes. Rates of change in latencies (RCL) and amplitudes (RCA) over time were analyzed for each individual eye using linear regression and compared using generalized estimating equation models.
Results The rates of change in the absence of optic neuritis (ON) for minimal VEP intervals of ≥3 months between baseline and last follow-up were +1.951 ms/y (n = 101 eyes; SD = 6.274; p = 0.012) for the P100 latencies and −2.149 µV/y (n = 64 eyes; SD = 5.013; p = 0.005) for the P100-N140 amplitudes. For minimal VEP intervals of ≥12 months, the RCL was +1.768 ms/y (n = 59 eyes; SD = 4.558; p = 0.024) and the RCA was −0.527 µV/y (n = 44 eyes; SD = 2.123; p = 0.111). The history of a previous ON >6 months before baseline VEP had no influence on RCL and RCA. ONs during the observational period led to mean RCL and RCA of +11.689 ms/y (n = 16 eyes; SD = 17.593; p = 0.003) and −1.238 µV/y (n = 11 eyes; SD = 3.708; p = 0.308), respectively.
Conclusion This first longitudinal VEP study of patients with NMOSD provides evidence of progressive VEP latency delay occurring independently of acute ON. Prospective longitudinal studies are needed to corroborate these findings and help to interpret the clinical relevance.
Glossary
- AQP4-Ab=
- antibodies against aquaporin-4;
- ffVEP=
- full-field visual evoked potentials;
- HON-eyes=
- eyes that had optic neuritis >6 months before baseline visual evoked potential;
- IQR=
- interquartile range;
- MOG=
- myelin oligodendrocyte glycoprotein;
- MS=
- multiple sclerosis;
- NEMOS=
- Neuromyelitis Optica Study Group;
- NMOSD=
- neuromyelitis optica spectrum disorders;
- no-HON-eyes=
- eyes that never had optic neuritis;
- ON=
- optic neuritis;
- OP=
- observational period;
- RCA=
- rate of change in amplitudes;
- RCL=
- rate of change in latencies;
- SD-OCT=
- spectral-domain optical coherence tomography;
- SR=
- stimulation response;
- VEP=
- visual evoked potential;
- VEP1=
- baseline visual evoked potential;
- vrQoL=
- vision-related quality of life
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
Coinvestigators are listed at links.lww.com/WNL/B22.
- Received February 11, 2019.
- Accepted in final form July 22, 2019.
- © 2019 American Academy of Neurology
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- Author response: Longitudinal optic neuritis-unrelated visual evoked potential changes in NMO spectrum disorders
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