Association of visual impairment in neuromyelitis optica spectrum disorder with visual network reorganization

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Item Type:	Article
Title:	Association of visual impairment in neuromyelitis optica spectrum disorder with visual network reorganization
Creators Name:	Finke, C., Zimmermann, H., Pache, F., Oertel, F.C., Chavarro, V.S., Kramarenko, Y., Bellmann-Strobl, J., Ruprecht, K., Brandt, A.U. and Paul, F.
Abstract:	Importance: Severe visual impairment is one of the major symptoms in neuromyelitis optica spectrum disorder (NMOSD), but functional network reorganization induced by the diminished sensory input has not been investigated thus far. Objective: To examine adaptive visual network connectivity changes in NMOSD. Design, Setting, and Participants: In this cross-sectional study, data were collected from May 1, 2013, through February 31, 2016, from 31 patients with aquaporin-4 antibody-positive NMOSD and 31 age- and sex-matched healthy control individuals at the Department of Neurology and NeuroCure Clinical Research Center at Charite-Universitaetsmedizin Berlin, Berlin, Germany. Main Outcomes and Measures: Visual function (high-contrast visual acuity and contrast sensitivity), optical coherence tomography (peripapillary retinal nerve fiber layer and ganglion cell layer thickness), and resting-state functional magnetic resonance imaging (functional connectivity of large-scale brain networks). Results: Thirty-one patients with NMOSD (mean [SD] age, 48.2 [13.9] years; 28 women and 3 men) and 31 healthy controls (mean [SD] age, 47.2 [15.3] years; 28 women and 3 men) participated in the study. Patients had a selective and pronounced increase of functional connectivity in the primary and secondary visual networks. Increased primary visual network connectivity correlated with reduced high-contrast visual acuity (r = -0.39, P = .006), reduced low-contrast sensitivity (r = -0.33, P = .03), and more severe retinal damage measured by optical coherence tomography (r = -0.4, P = .01). Furthermore, visual functional connectivity was significantly higher in patients with a history of optic neuritis compared with patients without optic neuritis (mean [SD] regression coefficients, 50.0 [4.3] vs 34.6 [5.6]; P = .04). Conclusions and Relevance: Impaired visual function and retinal damage are associated with selective reorganization of the visual network in NMOSD. These findings advance the understanding of visual system dysfunction in NMOSD and, more generally, provide insight into pathophysiologic responses of the visual system to impaired visual input.
Keywords:	Anti-Inflammatory Agents, Antibodies, Aquaporin 4, Case-Control Studies, Contrast Sensitivity, Cross-Sectional Studies, Magnetic Resonance Imaging, Neuromyelitis Optica, Optical Coherence Tomography, Retrospective Studies, Vision Disorders, Visual Pathways
Source:	JAMA Neurology
ISSN:	2168-6149
Publisher:	American Medical Association
Volume:	75
Number:	3
Page Range:	296-303
Date:	March 2018
Official Publication:	https://doi.org/10.1001/jamaneurol.2017.3890
External Fulltext:	View full text on PubMed Central
PubMed:	View item in PubMed

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