The evolution of internuclear ophthalmoparesis in multiple sclerosis: a one year follow-up study

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Introduction: Internuclear ophthalmoparesis (INO) affects about 25% of individuals with multiple sclerosis (MS) if assessed by infrared oculography. The assessment of INO by infrared oculography is more sensitive than bedside assessment. The evolution over time of an INO detected by infrared oculography is not known.
Objectives: We aimed to describe the evolution of INO over time as assessed by infrared oculography and to investigate the relation of the course of INO to clinical characteristics of MS.
Methods: In a prospective, longitudinal, cohort study from the MS Center Amsterdam, horizontal pro-saccades were measured and analysed using a validated standardized infrared oculography protocol (DeMonS) at baseline and one year follow-up. Presence of an INO was defined by previously published cut-off levels of the versional dysconjugacy index (VDI). All subjects were also assessed for clinical function, including Expanded Disability Status Scale (EDSS), Nine Hole Peg Test (NHPT), High and Low Contrast Visual Acuities (HCVA and LCVA).
Results: There were 80 individuals (74% female, age 47 ± 10 years) with eye-tracking data at baseline and after one year follow-up. The median disease duration was 11 years (IQR 11). The median EDSS was 3.5 (IQR 1.5). At baseline an INO was present in 21/80 (26%) participants, which was bilateral in 6/21 (29%). At one year follow-up the INO persisted in 14/21 (67%) participants and resolved in 7/21 (33%) participants. Among participants without an INO at baseline 3/59 (5%) developed a de novo INO. Overall INO wasmore prevalent among males (52%) than females (22%) (p=0.002). MS subtype or EDSS had no statistically significant relation with the course of INO. Compared to participants in which INO resolved after one year, participants with a persistent INO performed worse on the NHPT at both baseline (median 26 vs. 21 sec, p=0.012) and follow-up (median 24 vs. 20, p=0.031) and LCVA (median 13 vs. 24, p=0.040) at follow-up. Participants with a novel INO performed worse on LCVA at follow-up compared to individuals without INO (median 14 vs. 29, p=0.028).
Conclusions: Consistent with clinical experience spontaneous resolution of an INO was observed in a proportion of patients using infrared oculography.For the majority of subjects the INO persisted independent of the MS disease course. Both persistent and de novo INO were related, statistically, to loss of function on other clinical scales.
Original languageEnglish
Publication statusPublished - 12 Oct 2022
EventECTRIMS - Amsterdam, Netherlands
Duration: 26 Oct 202229 Oct 2022



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