Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography

doi:10.1177/1352458514567216

Review

. 2015 May;21(6):678-88.

doi: 10.1177/1352458514567216. Epub 2015 Feb 6.

Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography

J L Bennett¹, J de Seze², M Lana-Peixoto³, J Palace⁴, A Waldman⁵, S Schippling⁶, S Tenembaum⁷, B Banwell⁵, B Greenberg⁸, M Levy⁹, K Fujihara¹⁰, K H Chan¹¹, H J Kim¹², N Asgari¹³, D K Sato¹⁴, A Saiz¹⁵, J Wuerfel¹⁶, H Zimmermann¹⁷, A Green¹⁸, P Villoslada¹⁵, F Paul¹⁹; GJCF-ICC&BR

Affiliations

¹ Departments of Neurology and Ophthalmology, University of Colorado, Denver, Colorado, USA.
² Neurology Service, University Hospital of Strasbourg, France.
³ CIEM MS Research Center, University of Minas Gerais Medical School, Belo Horizonte Brazil.
⁴ Department of Neurology, Oxford University Hospitals National Health Service Trust, Oxford, UK.
⁵ Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, USA.
⁶ Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Switzerland.
⁷ Department of Neurology, National Pediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina.
⁸ Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Texas, USA.
⁹ Department of Neurology, Johns Hopkins University, Baltimore, Maryland USA.
¹⁰ Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹¹ University Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
¹² Research Institute and Hospital of National Cancer Center Goyang Republic of Korea.
¹³ Institute of Molecular Medicine, University of Southern Denmark, and Department of Neurology, Vejle Hospital, Odense, Denmark.
¹⁴ Department of Neurology, Tohoku University School of Medicine, Sendai, Japan.
¹⁵ Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain.
¹⁶ NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, and Institute of Interventional and Diagnostic Neuroradiology, University Medicine Göttingen, Germany.
¹⁷ NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany.
¹⁸ Multiple Sclerosis Center, UCSF Department of Neurology and Neuro-ophthalmology Service, UCSF Department of Ophthalmology, San Francisco, USA.
¹⁹ NeuroCure Clinical Research and Department of Neurology, Charité - Universitätsmedizin Berlin and Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine, Berlin, Germany friedemann.paul@charite.de.

PMID: 25662342
PMCID: PMC4425816
DOI: 10.1177/1352458514567216

Review

Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography

J L Bennett et al. Mult Scler. 2015 May.

. 2015 May;21(6):678-88.

doi: 10.1177/1352458514567216. Epub 2015 Feb 6.

Authors

Affiliations

¹ Departments of Neurology and Ophthalmology, University of Colorado, Denver, Colorado, USA.
² Neurology Service, University Hospital of Strasbourg, France.
³ CIEM MS Research Center, University of Minas Gerais Medical School, Belo Horizonte Brazil.
⁴ Department of Neurology, Oxford University Hospitals National Health Service Trust, Oxford, UK.
⁵ Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, USA.
⁶ Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Switzerland.
⁷ Department of Neurology, National Pediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina.
⁸ Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Texas, USA.
⁹ Department of Neurology, Johns Hopkins University, Baltimore, Maryland USA.
¹⁰ Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹¹ University Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
¹² Research Institute and Hospital of National Cancer Center Goyang Republic of Korea.
¹³ Institute of Molecular Medicine, University of Southern Denmark, and Department of Neurology, Vejle Hospital, Odense, Denmark.
¹⁴ Department of Neurology, Tohoku University School of Medicine, Sendai, Japan.
¹⁵ Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain.
¹⁶ NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, and Institute of Interventional and Diagnostic Neuroradiology, University Medicine Göttingen, Germany.
¹⁷ NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany.
¹⁸ Multiple Sclerosis Center, UCSF Department of Neurology and Neuro-ophthalmology Service, UCSF Department of Ophthalmology, San Francisco, USA.
¹⁹ NeuroCure Clinical Research and Department of Neurology, Charité - Universitätsmedizin Berlin and Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine, Berlin, Germany friedemann.paul@charite.de.

PMID: 25662342
PMCID: PMC4425816
DOI: 10.1177/1352458514567216

Abstract

Neuromyelitis optica (NMO) is an inflammatory autoimmune disease of the central nervous system that preferentially targets the optic nerves and spinal cord. The clinical presentation may suggest multiple sclerosis (MS), but a highly specific serum autoantibody against the astrocytic water channel aquaporin-4 present in up to 80% of NMO patients enables distinction from MS. Optic neuritis may occur in either condition resulting in neuro-anatomical retinal changes. Optical coherence tomography (OCT) has become a useful tool for analyzing retinal damage both in MS and NMO. Numerous studies showed that optic neuritis in NMO typically results in more severe retinal nerve fiber layer (RNFL) and ganglion cell layer thinning and more frequent development of microcystic macular edema than in MS. Furthermore, while patients' RNFL thinning also occurs in the absence of optic neuritis in MS, subclinical damage seems to be rare in NMO. Thus, OCT might be useful in differentiating NMO from MS and serve as an outcome parameter in clinical studies.

Keywords: Neuromyelitis optica; ganglion cell layer; multiple sclerosis; optic neuritis; optical coherence tomography; retinal nerve fiber layer.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

**Figure 1.**
Retinal parameters acquired by OCT. (a) Fundus image showing the acquisition of the peripapillary RNFL thickness. OCT records a ring scan of 3.4 mm diameter around the optic nerve head, which is divided into quadrants. (b) The total macular volume is derived from a volume scan and contains all retinal layers in a 6 mm diameter cylinder around the fovea centralis. (c) Intra-retinal layer segmentation in a spectral domain OCT image. (d) MME in a patient with optic neuritis. MME locations are marked by yellow arrows. OCT: optical coherence tomography; RNFL: retinal nerve fiber layer; S: superior; N: nasal; I: inferior; T: temporal; TMV: total macular volume; GCL; ganglion cell layer; IPL: inner plexiform layer; INL: inner nuclear layer; OPL: outer plexiform layer; ONL: outer nuclear layer; ELM: external limiting membrane; IS/OS: inner segments/outer segments of the photoreceptor layer; RPE: retinal pigment epithelium; MME: microcystic macular edema.

**Figure 2.**
Typical differences in retinal damage between NMO-ON and MS-ON. (a) RNFL thickness values for different locations of the peripapillary ring scans including comparison to a healthy reference group. (b) Thickness map of the retinal GCL, derived with help of a semiautomatic segmentation software. The NMO-ON patient shows more severe thinning both in the RNFL and GCL. MS: multiple sclerosis; ON: optic neuritis; NMO: neuromyelitis optica; RNFL: retinal nerve fiber layer; GCL: ganglion cell layer.

See this image and copyright information in PMC

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References

1. Wingerchuk DM, Hogancamp WF, O’Brien PC, et al. The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology 1999; 53: 1107–1114. - PubMed
1. Lennon VA, Kryzer TJ, Pittock SJ, et al. IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med 2005; 202: 473–477. - PMC - PubMed
1. Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica: Distinction from multiple sclerosis. Lancet 2004; 364: 2106–2112. - PubMed
1. Wingerchuk DM, Lennon VA, Lucchinetti CF, et al. The spectrum of neuromyelitis optica. Lancet Neurol 2007; 6: 805–815. - PubMed
1. Papadopoulos MC, Verkman A. Aquaporin 4 and neuromyelitis optica. Lancet Neurol 2012; 11: 535–544. - PMC - PubMed

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[1] Wingerchuk DM, Hogancamp WF, O’Brien PC, et al. The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology 1999; 53: 1107–1114. - PubMed

[2] Wingerchuk DM, Hogancamp WF, O’Brien PC, et al. The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology 1999; 53: 1107–1114. - PubMed

[3] Lennon VA, Kryzer TJ, Pittock SJ, et al. IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med 2005; 202: 473–477. - PMC - PubMed

[4] Lennon VA, Kryzer TJ, Pittock SJ, et al. IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med 2005; 202: 473–477. - PMC - PubMed

[5] Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica: Distinction from multiple sclerosis. Lancet 2004; 364: 2106–2112. - PubMed

[6] Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica: Distinction from multiple sclerosis. Lancet 2004; 364: 2106–2112. - PubMed

[7] Wingerchuk DM, Lennon VA, Lucchinetti CF, et al. The spectrum of neuromyelitis optica. Lancet Neurol 2007; 6: 805–815. - PubMed

[8] Wingerchuk DM, Lennon VA, Lucchinetti CF, et al. The spectrum of neuromyelitis optica. Lancet Neurol 2007; 6: 805–815. - PubMed

[9] Papadopoulos MC, Verkman A. Aquaporin 4 and neuromyelitis optica. Lancet Neurol 2012; 11: 535–544. - PMC - PubMed

[10] Papadopoulos MC, Verkman A. Aquaporin 4 and neuromyelitis optica. Lancet Neurol 2012; 11: 535–544. - PMC - PubMed

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Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography

Affiliations

Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography

Authors

Affiliations

Abstract

Conflict of interest statement

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Conflict of interest statement

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