Albrecht et al. Optical coherence tomography for the diagnosis and monitoring of idiopathic intracranial hypertension

J Neurol. 2017 Jul;264(7):1370-1380

by Albrecht P, Blasberg C, Ringelstein M, Müller AK, Finis D, Guthoff R, Kadas EM, Lagreze W, Aktas O, Hartung HP, Paul F, Brandt AU, Methner A

(in cooperation with Universitätsklinikum Düsseldorf AG Albrecht)

The objectives of the study were to investigate the value of optical coherence tomography in detecting papilledema in patients with idiopathic intracranial hypertension (IIH), a disease which is difficult to monitor and which can lead to permanent visual deficits; to analyze retinal changes over time. In this non-interventional case-control study, spectral-domain optical coherence tomography (SD-OCT) was used to analyze the retinal and optic nerve head (ONH) morphology of 21 patients with IIH and 27 age- and sex-matched healthy controls over time. We analyzed the ONH volume using a custom-made algorithm and employed semi-automated segmentation of macular volume scans to assess the macular retinal nerve fiber layer (RNFL) and ganglion cell layer and inner plexiform layer complex as well as the total macular volume. In IIH patients, the ONH volume was increased and correlated with cerebrospinal fluid (CSF) pressure. The ONH volume decreased after the initiation of treatment with acetazolamide. The macular RNFL volume decreased by 5% in 3.5 months, and a stepwise multivariate regression analysis identified CSF pressure as the main influence on macular RNFL volume at diagnosis. The only factor predicting macular RNFL volume loss over time was ONH volume. SD-OCT can non-invasively monitor changes in retinal and ONH morphology in patients with IIH. Increased ONH volume leads to retinal atrophy in the form of macular RNFL volume loss, presumably due to mechanic jamming of the optic nerve at the disc and subsequent axonal loss.

Schlemm et al. – Gadopentetate but not gadobutrol accumulates in the dentate nucleus of multiple sclerosis patients

Mult Scler. 2017 Jun;23(7):963-972

by Schlemm L, Chien C, Bellmann-Strobl J, Dörr J, Wuerfel J, Brandt AU, Paul F, Scheel M

BACKGROUND: Previous studies have postulated an association between dentate nucleus T1 hyperintensity and multiple sclerosis (MS)-related progressive neurodegeneration. Therefore, MS patients have been excluded from most studies investigating brain deposition of gadolinium-based contrast agents (GBCAs).
OBJECTIVE: To study the hypothesis that dentate nucleus T1 hyperintensity in MS patients is associated with GBCA administration.
METHODS: In a cohort of 97 MS patients, the dentate-to-pons signal intensity ratio (DPSIR) was calculated for 265 consecutive T1-weighted magnetic resonance (MR) scans (including sessions with and without the administration of GBCA). Patients exclusively received either gadopentetate dimeglumine (Gd-DTPA, linear) or gadobutrol (Gd-BT-DO3A, macrocyclic).
RESULTS: In patients receiving Gd-DTPA, DPSIR increased significantly between the first and the last scan (+0.009, p < 0.001), and following magnetic resonance imaging (MRI) with Gd-DTPA administration as compared to following an MRI without Gd-DTPA administration (+0.005 vs -0.001; p = 0.022). Additionally, there was a positive linear relationship between the number of Gd-DTPA administrations and the increase in DPSIR ( p = 0.017). No DPSIR increase was observed after Gd-BT-DO3A administration.
CONCLUSION: Dentate nucleus T1 hyperintensity in MS patients is associated with Gd-DTPA (but not Gd-BT-DO3A) administration, suggesting an alternative explanation for the association of T1 hyperintensity with disease duration and severity.

Neuroimmunological Colloquium, Michael Demetriou

Dear Colleagues,

 

The  next Neuroimmunological colloquium will take place on Monday, 29th May, 2017. In this  session we are privileged to have Prof. Michael Demetriou, MD-PhD , of the Institute for Immunology, University of California, Irvine, USA.

 

Topic:  The glycobiology of T cell dysfunction in  autoimmune diseases.

 

Venue: Campus Charité Mitte, Hufelandweg 6, Ferdinand Sauerbruch Hörsaal 4.

Time:  14:00  

We will have scientific discussions with him further after his talk and you are all invited to join in the discussions.

We provide continuing education credits by the Deutsche Ärztekammer and graduate student credits for Medical Neuroscience students.

Lunch and light drinks will be provided.

This year 2017 and for the rest of the Semester we have an exciting schedule of national and international presenters with expertise in diverse sub-areas of neuroimmunology.

Our hope is that this seminar will provide a platform to exchange ideas, create new collaborations, re-connect with colleagues and learn about the novel research at the forefront of our neuroimmunology community.

 

Please feel free to forward the invitation to your colleagues and friends.

 

Looking forward to seeing you there!

 

Best regards,

Priscilla Koduah

 

……………………………………………

Priscilla Koduah, PhD Candidate Neurodiagnostics Laboratory and Clinical Neuroimmunology Group NeuroCure Clinical Research Center Charité – Universitätsmedizin Berlin Charitéplatz 1 10117 Berlin, Germany Email: priscilla.koduah@charite.de

Papazoglou et al. – Single-subject independent component analysis-based intensity normalization in non-quantitative multi-modal structural MRI Authors

Hum Brain Mapp. 2017 Apr 22. doi: 10.1002/hbm.23615.

by Papazoglou S, Würfel J, Paul F, Brandt AU, Scheel M.

Non-quantitative MRI is prone to intersubject intensity variation rendering signal intensity level based analyses limited. Here, we propose a method that fuses non-quantitative routine T1-weighted (T1w), T2w, and T2w fluid-saturated inversion recovery sequences using independent component analysis and validate it on age and sex matched healthy controls. The proposed method leads to consistent and independent components with a significantly reduced coefficient-of-variation across subjects, suggesting potential to serve as automatic intensity normalization and thus to enhance the power of intensity based statistical analyses. To exemplify this, we show that voxelwise statistical testing on single-subject independent components reveals in particular a widespread sex difference in white matter, which was previously shown using, for example, diffusion tensor imaging but unobservable in the native MRI contrasts. In conclusion, our study shows that single-subject independent component analysis can be applied to routine sequences, thereby enhancing comparability in-between subjects. Unlike quantitative MRI, which requires specific sequences during acquisition, our method is applicable to existing MRI data.

Oertel & Zimmermann et al. – Contribution of blood vessels to retinal nerve fiber layer thickness in NMOSD

Neurol Neuroimmunol Neuroinflamm. 2017 Apr 18;4(3):e338

by Oertel FC & Zimmermann H, Mikolajczak J, Weinhold M, Kadas EM, Oberwahrenbrock T, Pache F, Bellmann-Strobl J, Ruprecht K, Paul F, Brandt AU.

Neuromyelitis optica spectrum disorders (NMOSDs) are relapsing inflammatory demyelinating disorders with optic neuritis (ON) as the hallmark. ON causes neuroaxonal damage to the optic nerve and retina, regularly leading to severely impaired visual acuity (VA).

Peripapillary retinal nerve fiber layer (pRNFL) thickness measured by optical coherence tomography (OCT) has been increasingly recognized as a marker for neuroaxonal damage and correlate of visual dysfunction. As such, pRNFL is implemented as an outcome in clinical trials of ON-associated disorders. Blood vessels (BVs) running within the pRNFL contribute approximately 13% to an average RNFL thickness2 and could present an important confounder when tracking small pRNFL changes or in diseases with severe thinning such as NMOSD. Against this background, the objective of this study was to investigate the influence of retinal BVs on pRNFL measurements in an NMOSD cohort.

Oertel & Kuchling et al. – Microstructural visual system changes in AQP4-antibody-seropositive NMOSD

Neurol Neuroimmunol Neuroinflamm. 2017 Feb 22;4(3):e334

by Oertel FC & Kuchling J, Zimmermann H, Chien C, Schmidt F, Knier B, Bellmann-Strobl J, Korn T, Scheel M, Klistorner A, Ruprecht K, Paul F, Brandt AU.

OBJECTIVE: To trace microstructural changes in patients with aquaporin-4 antibody (AQP4-ab)-seropositive neuromyelitis optica spectrum disorders (NMOSDs) by investigating the afferent visual system in patients without clinically overt visual symptoms or visual pathway lesions.

METHODS: Of 51 screened patients with NMOSD from a longitudinal observational cohort study, we compared 6 AQP4-ab-seropositive NMOSD patients with longitudinally extensive transverse myelitis (LETM) but no history of optic neuritis (ON) or other bout (NMOSD-LETM) to 19 AQP4-ab-seropositive NMOSD patients with previous ON (NMOSD-ON) and 26 healthy controls (HCs). Foveal thickness (FT), peripapillary retinal nerve fiber layer (pRNFL) thickness, and ganglion cell and inner plexiform layer (GCIPL) thickness were measured with optical coherence tomography (OCT). Microstructural changes in the optic radiation (OR) were investigated using diffusion tensor imaging (DTI). Visual function was determined by high-contrast visual acuity (VA). OCT results were confirmed in a second independent cohort.

RESULTS: FT was reduced in both patients with NMOSD-LETM (p = 3.52e-14) and NMOSD-ON (p = 1.24e-16) in comparison with HC. Probabilistic tractography showed fractional anisotropy reduction in the OR in patients with NMOSD-LETM (p = 0.046) and NMOSD-ON (p = 1.50e-5) compared with HC. Only patients with NMOSD-ON but not NMOSD-LETM showed neuroaxonal damage in the form of pRNFL and GCIPL thinning. VA was normal in patients with NMOSD-LETM and was not associated with OCT or DTI parameters.

CONCLUSIONS: Patients with AQP4-ab-seropositive NMOSD without a history of ON have microstructural changes in the afferent visual system. The localization of retinal changes around the Müller-cell rich fovea supports a retinal astrocytopathy.

Winter Semester 2017, NIC 2

Winter Semester 2017-NIC 2

 

 

 

 

 

 

January 23rd

 NEUROIMMUNOLOGICAL COLLOQUIUM @ AG Paul

Winter Semester 2017

Mondays at 14:00h

Charité Mitte Campus – Universitätsmedizin Berlin

Ferdinand Sauerbruch Hörsaal 4, Hufelandweg 6

 

 Volker Siffrin, MD

Max-Delbrück-Centrum for Molecular Medicine, Berlin

Introduction to Basic Science – Neuroimmunology

 

January  30th Michael Hoffmann, MD

University Eye Clinic, Otto von Guericke University, Madgeburg Germany

Electrophysiology of Visual Dysfunction

February  6th Marcus D’Souza, MD

Department of Neurology, University of Basel, Switzerland

Capturing disability in MS with kinect

February 13th Mir-Farzin Mashreghi, PhD

German Rheumatism Research Center, DRFZ, Berlin

The role of Regulatory RNA in Proinflammatory T-helper cells

February  20th

 

Véronique Blanchard, PhD

Institut für Labormedizin, Klinische Chemie und Pathobiochemie, Charité

The Glycome in Health and Disease

 

 

 

 

Neuroimmunological Colloquium @ AG Paul and NeuroCure/Charité Mitte

Dear Colleagues,

The next Neuroimmunological colloquium will take place on Monday, 30th January, 2017. This session will feature a talk by, Prof Dr. Michael Hoffmann from the University Eye Clinic, Otto von Guericke University, Magdeburg, Germany.

Topic: Electrophysiology of Visual Dysfunction

 

Venue: Campus Charité Mitte, Hufelandweg 6, Ferdinand Sauerbruch Hörsaal 4.

Time:  14:00

 

We provide continuing education credits by the Deutsche Ärztekammer and graduate student credits for Medical Neuroscience students.

Lunch and light drinks will be provided.

This year 2017 and for the rest of the Semester we have an exciting schedule of national and international presenters with expertise in diverse sub-areas of neuroimmunology.

Our hope is that this seminar will provide a platform to exchange ideas, create new collaborations, re-connect with colleagues and learn about the

novel research at the forefront of our neuroimmunology community.

 

Please feel free to forward the attached flyer to your colleagues and friends.

 

Looking forward to seeing you there!

 

Best regards,

Priscilla Koduah

 

……………………………………………

Priscilla Koduah, PhD Candidate Neurodiagnostics Laboratory and Clinical Neuroimmunology Group NeuroCure Clinical Research Center Charité – Universitätsmedizin Berlin Charitéplatz 1 10117 Berlin, Germany Email: priscilla.koduah@charite.de

Bremer et al. – Longitudinal Intravital Imaging of the Retina Reveals Long-term Dynamics of Immune Infiltration and Its Effects on the Glial Network in Experimental Autoimmune Uveoretinitis, without Evident Signs of Neuronal Dysfunction in the Ganglion Cell Layer

Front Immunol. 2016 Dec 23;7:642

by Bremer D, Pache F, Günther R, Hornow J, Andresen V, Leben R, Mothes R, Zimmermann H, Brandt AU, Paul F, Hauser AE, Radbruch H, Niesner R

(in cooperation with DRFZ AG Niesner)

A hallmark of autoimmune retinal inflammation is the infiltration of the retina with cells of the innate and adaptive immune system, leading to detachment of the retinal layers and even to complete loss of the retinal photoreceptor layer. As the only optical system in the organism, the eye enables non-invasive longitudinal imaging studies of these local autoimmune processes and of their effects on the target tissue. Moreover, as a window to the central nervous system (CNS), the eye also reflects general neuroinflammatory processes taking place at various sites within the CNS. Histological studies in murine neuroinflammatory models, such as experimental autoimmune uveoretinitis (EAU) and experimental autoimmune encephalomyelitis, indicate that immune infiltration is initialized by effector CD4+ T cells, with the innate compartment (neutrophils, macrophages, and monocytes) contributing crucially to tissue degeneration that occurs at later phases of the disease. However, how the immune attack is orchestrated by various immune cell subsets in the retina and how the latter interact with the target tissue under in vivo conditions is still poorly understood. Our study addresses this gap with a novel approach for intravital two-photon microscopy, which enabled us to repeatedly track CD4+ T cells and LysM phagocytes during the entire course of EAU and to identify a specific radial infiltration pattern of these cells within the inflamed retina, starting from the optic nerve head. In contrast, highly motile CX3CR+1 cells display an opposite radial motility pattern, toward the optic nerve head. These inflammatory processes induce modifications of the microglial network toward an activated morphology, especially around the optic nerve head and main retinal blood vessels, but do not affect the neurons within the ganglion cell layer. Thanks to the new technology, non-invasive correlation of clinical scores of CNS-related pathologies with immune infiltrate behavior and subsequent tissue dysfunction is now possible. Hence, the new approach paves the way for deeper insights into the pathology of neuroinflammatory processes on a cellular basis, over the entire disease course.

Pache & Zimmermann et al. – Afferent visual system damage after optic neuritis in MOG-IgG-seropositive versus AQP4-IgG-seropositive patients

Pache & Zimmermann et al. from our lab just published a study investigating afferent visual system damage after optic neuritis in MOG-IgG-seropositive versus AQP4-IgG-seropositive patients. MOG-antibodies have recently been identified in a subgroup of patients with neuromyelitis optica and in patients with recurrent optic neuritis.

The paper has been published in Journal of Neuroinflammation 2016 13:282.

BACKGROUND: Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been reported in patients with aquaporin-4 antibody (AQP4-IgG)-negative neuromyelitis optica spectrum disorders (NMOSD). The objective of this study was to describe optic neuritis (ON)-induced neuro-axonal damage in the retina of MOG-IgG-positive patients in comparison with AQP4-IgG-positive NMOSD patients.
METHODS: Afferent visual system damage following ON was bilaterally assessed in 16 MOG-IgG-positive patients with a history of ON and compared with that in 16 AQP4-IgG-positive NMOSD patients. In addition, 16 healthy controls matched for age, sex, and disease duration were analyzed. Study data included ON history, retinal optical coherence tomography, visual acuity, and visual evoked potentials.
RESULTS: Eight MOG-IgG-positive patients had a previous diagnosis of AQP4-IgG-negative NMOSD with ON and myelitis, and eight of (mainly recurrent) ON. Twenty-nine of the 32 eyes of the MOG-IgG-positive patients had been affected by at least one episode of ON. Peripapillary retinal nerve fiber layer thickness (pRNFL) and ganglion cell and inner plexiform layer volume (GCIP) were significantly reduced in ON eyes of MOG-IgG-positive patients (pRNFL = 59 ± 23 μm; GCIP = 1.50 ± 0.34 mm3) compared with healthy controls (pRNFL = 99 ± 6 μm, p < 0.001; GCIP = 1.97 ± 0.11 mm3, p < 0.001). Visual acuity  was impaired in eyes after ON in MOG-IgG-positive patients (0.35 ± 0.88 logMAR). There were no significant differences in any structural or functional visual parameters between MOG-IgG-positive and AQP4-IgG-positive patients (pRNFL: 59 ± 21 μm; GCIP: 1.41 ± 0.27 mm3; Visual acuity = 0.72 ± 1.09 logMAR). Importantly, MOG-IgG-positive patients had a significantly higher annual ON relapse rate than AQP4-IgG-positive patients (median 0.69 vs. 0.29 attacks/year,  p = 0.004), meaning that on average a single ON episode caused less damage in MOG-IgG-positive than in AQP4-IgG-positive patients. pRNFL and GCIP loss correlated with the number of ON episodes in MOG-IgG-positive patients (p < 0.001), but not in AQP4-IgG-positive patients.
CONCLUSIONS: Retinal neuro-axonal damage and visual impairment after ON in MOG-IgG-positive patients are as severe as in AQP4-IgG-positive NMOSD patients. In MOG-IgG-positive patients, damage accrual may be driven by higher relapse rates, whereas AQP4-IgG-positive patients showed fewer but more severe episodes of ON. Given the marked damage in some of our MOG-IgG-positive patients, early diagnosis and timely initiation and close monitoring of immunosuppressive therapy are important.

The study is part of a series of 4 papers describing different aspects of MOG-IgG in NMO and related disorders.

Part 1: Frequency, syndrome specificity, influence of disease activity, long-term course, association with AQP4-IgG, and origin
Part 2: Epidemiology, clinical presentation, radiological and laboratory features, treatment responses, and long-term outcome
Part 3: Brainstem involvement – frequency, presentation and outcome
Part 4: Afferent visual system damage after optic neuritis in MOG-IgG-seropositive versus AQP4-IgG-seropositive patients