TY - JOUR
T1 - A model for interrogating the clinico-radiological paradox in multiple sclerosis
T2 - Internuclear ophthalmoplegia
AU - Nij Bijvank, Jenny A
AU - Sánchez Aliaga, Esther
AU - Balk, Lisanne J
AU - Coric, Danko
AU - Davagnanam, Indran
AU - Tan, H Stevie
AU - Uitdehaag, Bernard M J
AU - van Rijn, Laurentius J
AU - Petzold, Axel
N1 - Funding Information: This research was supported by Stichting MS Research. Funding Information: J.A. Nij Bijvank: receives research support from the Dutch MS Research Foundation, grant number 18‐1006. E. Sanchez, L.J. Balk, D. Coric, I. Davagnanam, H.S. Tan and L.J. van Rijn: report no conflicts of interest. B.M.J Uitdehaag: has received consultancy fees from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche and Teva. A. Petzold: reports personal fees from Novartis, Heidelberg Engineering, Zeiss, grants from Novartis, outside the submitted work; and is part of the steering committee of the OCTiMS study which is sponsored by Novartis and the Angio‐OCT steering committee which is sponsored by Zeiss. He does not receive compensation for these activities. Publisher Copyright: © 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/5
Y1 - 2021/5
N2 - Background and purpose: The clinico-radiological paradox in multiple sclerosis (MS) is well recognized, relevant and yet poorly understood. The suitability of an in vivo model for the clinico-radiological paradox was tested, using internuclear ophthalmoplegia (INO) and the medial longitudinal fasciculus (MLF). Methods: In this cross-sectional study lesions of the MLF were rated by an experienced MS neuroradiologist blinded to all other information. The presence of an INO was objectively determined by a validated infrared oculography protocol (DEMoNS). Clinical information, including the National Eye Institute Visual Function Questionnaire, was obtained. Results: This study included 202 patients with MS. The clinico-radiological paradox occurred in 50 patients (25%). This consisted of 45 patients having an INO without an MLF lesion and five patients with an MLF lesion but without an INO. The visual function overall score was related to the presence of an INO (p = 0.016), but not to MLF lesions seen on magnetic resonance imaging (MRI) (p = 0.207). A consensus list of potential causes for the clinico-radiological paradox was compiled and the MRI images were deposited in a repository. Conclusion: This study provides an objective and quantitative model to investigate the clinico-radiological paradox. Our data suggest that pathology of the MLF is more frequently detected and more clinically relevant by infrared oculography than by MLF lesion rating on MRI.
AB - Background and purpose: The clinico-radiological paradox in multiple sclerosis (MS) is well recognized, relevant and yet poorly understood. The suitability of an in vivo model for the clinico-radiological paradox was tested, using internuclear ophthalmoplegia (INO) and the medial longitudinal fasciculus (MLF). Methods: In this cross-sectional study lesions of the MLF were rated by an experienced MS neuroradiologist blinded to all other information. The presence of an INO was objectively determined by a validated infrared oculography protocol (DEMoNS). Clinical information, including the National Eye Institute Visual Function Questionnaire, was obtained. Results: This study included 202 patients with MS. The clinico-radiological paradox occurred in 50 patients (25%). This consisted of 45 patients having an INO without an MLF lesion and five patients with an MLF lesion but without an INO. The visual function overall score was related to the presence of an INO (p = 0.016), but not to MLF lesions seen on magnetic resonance imaging (MRI) (p = 0.207). A consensus list of potential causes for the clinico-radiological paradox was compiled and the MRI images were deposited in a repository. Conclusion: This study provides an objective and quantitative model to investigate the clinico-radiological paradox. Our data suggest that pathology of the MLF is more frequently detected and more clinically relevant by infrared oculography than by MLF lesion rating on MRI.
KW - Cross-Sectional Studies
KW - Humans
KW - Magnetic Resonance Imaging
KW - Multiple Sclerosis/complications
KW - Ocular Motility Disorders/diagnostic imaging
KW - Ophthalmoplegia
KW - Radiography
UR - http://www.scopus.com/inward/record.url?scp=85100751277&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/ene.14723
DO - https://doi.org/10.1111/ene.14723
M3 - Article
C2 - 33426786
SN - 1351-5101
VL - 28
SP - 1617
EP - 1626
JO - European journal of neurology
JF - European journal of neurology
IS - 5
ER -