Optical coherence tomography and visual evoked potential and its relationship with neurological disability in patients with relapsing-remitting multiple sclerosis.

INTRODUCTION: To evaluate the relationship between retinal nerve fiber layer involvement and visual evoked potential with the neurological disability scale in relapsing remitting multiple sclerosis. METHODS: Fifty-two patients diagnosed with relapsing-remitting multiple sclerosis were evaluated for the study. Optical coherence tomography (retinal nerve fiber layer or RNFL and macular volume or MV), pattern visual evoked potential or VEP (latency and P100 wave amplitude), and neurological disability scale (EDSS) were performed. A baseline evaluation was carried out and it was repeated after one year and two years. RESULTS: The baseline values ​​in the retinal nerve fiber layer were 82.5 (75-93.5), the latency and amplitude of the VEP of 116 (108-125.5) and 9 (7-11), respectively, while the EDSS was 2 (1.5-3). A correlation was found between higher EDSS with prolonged latency and decreased amplitude of the P100 wave. There was an association between a higher EDSS with the prolongation of the latency of the P100 wave and a longer time of evolution of MS. No relationship was found between EDSS and macular volume. A higher EDSS was associated with a significant decrease in RNFL. When the discriminative performance of disability was evaluated, the latency of the VEP presented an area under the curve of 0.79 (CI95% 0.67- 0.92), the amplitude of the VEP an area under the curve of 0.71 (CI95% 0.56 - 0.87) and RNFL a area under the curve of 0.76 (95% CI 0.62 - 0.90. When comparing RNFL, MV and PEV in eyes without and with previous optic neuritis with RNFL values ​​of 88 (81-97) and 76 (71-81) (p 0.0007), MV of 246 (232-261) and 241 (229-251) (p 0.2541), PEV latency of 109 (105-117) and 125 (118-129) (p 0.0001), VEP amplitude of 9 (7-10) and 9 (7-11) (p 0.9391), respectively, which shows a statistically significant correlation between decrease in RNFL and prolongation of VEP latency in eyes with previous optic neuritis. In the 2-year follow-up there were no significant differences between the values ​​of RNFL, VEP and EDSS. DISCUSSION: In our study, a relationship was evidenced between retinal nerve fiber thickness, PEV and the degree of disability measured by EDSS in patients with relapsing MS - remissions in their baseline values. A lower RNFL thickness was correlated with prolonged latency and decreased amplitude in the PEV and was associated with a higher EDSS. This relationship was more significant in eyes with previous optic neuritis in terms of decreased RNFL thickness and prolongation of PEV latency. No significant differences were found in the 2-year follow-up in the measurements made.

[Argentinean consensus guidelines on the identification and clinical care of secondary progressive multiple sclerosis]. / Consenso sobre la identificación y seguimiento de la esclerosis múltiple secundaria progresiva en Argentina.

INTRODUCTION: The identification, diagnosis, follow-up, and treatment of patients with secondary progressive multiple sclerosis (SPMS) show significant differences between health care professionals in Argentina. AIM: To provide consensus recommendations on the management of patients with SPMS in Argentina to optimize patient care. DEVELOPMENT: A panel of expert neurologists from Argentina dedicated to the diagnosis and care of multiple sclerosis patients gathered during 2019 and 2020 to carry out a consensus recommendation on the diagnosis and treatment of SPMS patients in Argentina. To achieve consensus, the methodology of 'formal consensus-RAND/UCLA method' was used. Recommendations were established based on published evidence and the expert opinion. Recommendations focused on how to define SPMS and how to follow SPMS patients. CONCLUSION: The recommendations of this consensus guidelines attempt to optimize the care of SPMS patients in Argentina.

TITLE: Consenso sobre la identificación y seguimiento de la esclerosis múltiple secundaria progresiva en Argentina.Introducción. Existen diferencias significativas en el diagnóstico, la identificación y el seguimiento de pacientes con esclerosis múltiple secundaria progresiva (EMSP) entre los profesionales de la salud a cargo de su tratamiento. Objetivo. Proveer recomendaciones sobre el tratamiento de los pacientes con EMSP en Argentina con el fin de optimizar su cuidado. Desarrollo. Un grupo de neurólogos expertos en esclerosis múltiple de Argentina elaboró un consenso para el tratamiento de pacientes con EMSP en la región mediante metodología de ronda de encuestas a distancia y reuniones presenciales. Se establecieron 33 recomendaciones basadas en la evidencia publicada y en el criterio de los expertos que participaron. Las recomendaciones se enfocaron en el diagnóstico y el seguimiento de los pacientes con EMSP. Conclusión. Las recomendaciones establecidas en el presente consenso permitirían optimizar el cuidado y el seguimiento de los pacientes con EMSP en Argentina.

Desencadenantes migrañosos y habituación del potencial evocado visual. Definiendo subgrupos de pacientes / Migraine triggers and habituation of visual evoked potentials. Defining subset of patient

Identificar subgrupos específicos de pacientes dentro del espectro clínico de la migraña podría ayudar a personalizar el tratamiento de la misma. Definir perfiles de pacientes según su relación entre las características clínicas y los biomarcadores neurofisiológicos sería de suma importancia y es en gran medida un ámbito inexplorado. Los ataques de migraña pueden ser desencadenados por distintos factores, entre los cuales el estrés, los cambios hormonales, el ayuno y la falta de sueño son los mayormente asociados. Los desencadenantes de la migraña no forman parte de los criterios diagnósticos, pero pueden caracterizar subgrupos de pacientes. La deficiente habituación a los estímulos visuales repetidos es una característica neurofisiológica comúnmente encontrada en las cohortes de migraña, sin embargo, no se puede demostrar en todos los pacientes y no se ha reproducido en todos los estudios. Se puede suponer que los pacientes con diferentes perfiles de habituación pueden diferir por rasgos fenotípicos, como los desencadenantes de las crisis. Por ello nos propusimos estudiar qué asociación existe entre los desencadenantes del ataque de migraña y la habituación de los potenciales evocados visuales (PEV). (AU)

Identifying specific subsets of patients within the widespread clinical spectrum of migraine could help in developing a beneficial migraine treatment approach. The possibility of such categorization combining clinical features with accessible para-clinical tests remains quasi unexplored. Migraine attacks can be triggered by different factors, among which stress, hormonal changes, fasting, and lack of sleep are the most frequently referenced.1 Migraine triggers are not part of the diagnostic criteria for migraine, but they may characterize subgroups of patients. Also, deficient habituation to repeated stimulations is a neurophysiological feature commonly found in migraine cohorts, however it cannot be demonstrated in all patients and has not been reproduced in all studies. One may thus assume that patients with different habituation profiles might differ by phenotypic features, such as attack triggers. Therefore, we analyzed the visual evoked potentials habituation (VEP)4 profile in relation to the report of migraine triggers during a head-to-head, semi-structured interview, which preceded the neurophysiological recordings. (AU)