الفهرس 
Clinically isolated syndromeOnly 14 pages are availabe for public view
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Abstract
Clinically isolated syndrome (CIS) is defined as an acute or subacute episode of neurological symptoms due to inflammatory demyelinating lesion in the CNS, which lasts more than 24 hours and occurs in the absence of fever, infection or encephalopathy. CIS is typically the first MS episode and generally consists in optic neuritis, myelitis or brain stem syndrome. It corresponds to the presence of a demyelinating lesion in the CNS, usually consisting in asymptomatic T2 or FLAIR hyper intensity and T1 hypo intensity, sometimes enhanced after gadolinium injection, and generally accompanied by other asymptomatic preexisting lesions. VEP provide information about nerve conduction velocity (latency) that is useful in assessing the extent of demyelination. Recently, VEP amplitude has been shown to be a functional biomarker of axonal loss in MS. Optical coherence tomography (OCT) has shown specific retinal alterations in MS patients. The retinal nerve fiber layer thickness (RNFLT) is significantly reduced in the clinically affected eyes of patients with MS and optic neuritis (ON) and in their unaffected fellow eyes, as well as in the eyes of patients with CIS or MS without ON This work aim to evaluate visual pathway structure and function in patients with clinical isolated syndrome (CIS) by using optical coherence tomography (OCT) and visual-evoked potentials (VEP), predicting CIS conversion to clinically definite multiple sclerosis (CDMS). This study was conducted on patients who had clinically isolated syndrome and admitted at neuropsychological department from November 2011 to November 2012 and was done on 2 groups: group (I) 20 patients of clinically isolated syndrome according to 2010 McDonald MRI criteria for multiple sclerosis (dissemination in space and time) in patients with a clinically isolated syndrome. group (II) 10 healthy volunteers matched with age and sex with patient’s group and were subjected to: 1- Magnetic resonance imaging with contrast of the brain and/or spinal cord. 1- Optic coherence tomography. 2- Visual evoked potential. All patients were subjected to: (I) Full history taking that includes Family history (Parental consanguinity, number of siblings, relatives with MS and relatives with autoimmune disorders), Medical history (Diabetes, hypertension, Thyroid dysfunction, renal impairment, hepatic impairment, drug intake and operations) and Present history (Date of onset of first attack, age of onset of first attack and total number of relapse). (II) Neurologic Examination: Thorough neurological examination was done for all patients in order to detect the presence of any neurological abnormalities. (III) Investigations 1. Magnetic resonance imaging with contrast of the brain and/or spinal cord with GE – closed – 1.5 Tesla MRI imaging device in Tanta University 2. Optic coherence tomography with Ziess Cirrus 4000 spectral domain OCT. 3. Visual evoked potential with VEP electromyography usb transmission device (NCC MEDICAL CO.,LTD). In this study, patientsˈ age was 31.4 ± 7.8 years, and female was more than male and there was no significant statistical difference between two groups regarding age and sex. Most patients were presented with optic neuritis (unilateral decreased visual acuity and unilateral painful eye movement).on examining patients relative afferent pupillary defect, decreased visual acuity, optic disc swelling and impaired color perception were founded in optic neuritis patients. Examination of other cranial nerves and cerebellar system was normal in all patients except in one patient who had abnormal oculomotor nerve examination (diplopia). Transverse myelitis patients had hypotonia, hyporeflexia. Brain MRI revealed optic neuritis (unilateral swelling of retrobulbar intraorbital segment of optic nerve with contrast enhancement) with highly significant statistical difference between two groups (P value 0.001).Multiple asymptomatic white matter brain lesions were present in most patients. Spinal cord MRI (cervical) reveals lesions in two patients. OCT revealed decreased retinal nerve fiber layer thickness in 85% of patients while VEP revealed delayed latency in 95% of patients with highly significant statistical difference between two groups (P value 0.001). Relation between MRI, OCT and VEP findings in patients revealed that 15% of patients with decreased retinal nerve fiber layer thickness and delayed latency had no brain lesions in MRI. Relation between OCT and VEP revealed that 10% of patients with delayed latency had normal retinal nerve fiber layer thickness. Follow up MRI, OCT and VEP of studied patients after 1 year revealed that eight CIS patients (40%) were converted to CDMS. One CDMS patient had 4-8 brain lesions, seven had 8 - 9 brain lesions and two from ten had also spinal cord lesions revealing dissemination in space and time. OCT showed increased thinning of RNFLT and VEP revealed longer latency in eight patients who were converted to CDMS.