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Optical Coherence Tomography as a Marker of Axonal Damage in Multiple Sclerosis

Shiv Saidha, MRCPI, Christopher Eckstein, MD, and John N Ratchford, MD

Multiple sclerosis (MS) is a complex immune-mediated disorder of the central nervous system (CNS) and is the most common non-traumatic cause of neurological disability in early to middle adulthood [1]. The precise etiology of MS remains elusive, although pathological hallmarks of MS lesions include breakdown of the blood–brain barrier, demyelination, gliosis, axonal degeneration, and neuronal loss [2]. While inflammatory relapses represent the most dramatic manifestation of MS, the majority of disability is thought to accumulate during the progressive phases of the illness. MS-related disability shows best correlation with axonal loss [3–5] and markers of axonal loss, including cerebral atrophy [6] and volume of T1 hypointensities on brain magnetic resonance imaging (MRI) [7]. Axonal damage has been observed to occur early in the disease process [4,8]. While immunomodulatory and immunosuppressive therapies are partially effective at reducing relapse frequency in relapsing–remitting MS (RRMS), they have not been shown to prevent disability progression in secondary progressive MS (SPMS) or primary progressive MS (PPMS). Thus, the currently available treatments for MS lack specific neuroprotective qualities that may help protect against axonal damage in progressive forms of this disease.

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