Chronic Optic Neuropathy in Multiple Sclerosis Clinical Trial
Official title:
CHRONIC OPTIC NEUROPATHY IN MULTIPLE SCLEROSIS: DEMYELINATING AND/OR PRIMARY DEGENERATIVE PATHOPHYSIOLOGY?
Patients with multiple sclerosis (MS) may show chronic signs of optic neuropathy (CON) that
may follow acute optic neuritis (secondary form of CON, S-CON) or occur independently of any
acute demyelinating lesion of the optic nerve (primary form of CON, P-CON). In both S-CON and
P-CON, a long term progressive ganglion cell axonal loss occurs. This axonal damage could be
secondary to retrograde atrophy of axons within plaques of demyelination or a primary
progressive degeneration of ganglion cells, but the underlying physiopathology has not been
fully questioned in the different profile types of CON.
In this project, investigators aim at understanding the pathophysiology of S-CON and P-CON,
i.e. secondary to demyelination or primary degeneration, in patients complaining of
persistent visual complaints. In a first cross sectional study, 30 MS patients with mild to
moderate P-CPON or S-CON and 30 age-matched control subjects will perform an extensive
neuro-ophthalmological assessment including clinical examination, visual evoked potentials
(pattern and low contrast), electroretinogram (pattern and multifocal ERG), OCT
(peripapillary and macular volume scan segmentation protocols) and MRI of the optic nerve. In
these patients with mild to moderate CON, investigators aim at differentiating patients
showing predominant demyelination from those showing pure or predominant axonal degeneration.
Visual function assessment and degree of axonal degeneration will be compared and correlated
in the two types of underlying pathophysiology and in the group of control subject. In a
following longitudinal study, the patients will be re-assessed a year later in order to
evaluate the progression of CON in both profile types. Our hypothesis would be that visual
function and progression is worse in the degeneration group as compared to the demyelination
group. This study should help to find reliable measures of the pathophysiology of CON and
correlate it with the long-term visual prognostic of the disease.
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