PMID- 21149159
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20121002
LR  - 20140730
IS  - 0065-955X (Print)
IS  - 0065-955X (Linking)
VI  - 57
DP  - 2007
TI  - The multiple facets of multiple sclerosis.
PG  - 69-78
LID - 10.3368/aoj.57.1.69 [doi]
AB  - INTRODUCTION: Multiple sclerosis (MS) is an inflammatory and degenerative entity 
      that may involve the brain, optic nerve, and/or the spinal cord. We reviewed 137 
      patients, aged 4-54 years old at the time of the diagnosis and will report on the 
      vision, different motility disorders found, visual fields, optic neuritis and 
      RAPD, return of vision following the neuritis, visual evoked potential, nerve 
      fiber layer analysis, and systemic problems such as Uhthoff phenomenon, 
      L'Hermitte sign, urinary urgency, and constipation. METHODS: One hundred 
      thirty-seven patients were given full ophthalmologic and orthoptic evaluations. 
      Particular attention was given to subtle relative afferent pupillary defects 
      (RAPD), oscillopsia, pain with eye movement, and other specialty testing 
      including visual evoked potentials and nerve fiber layer assessment. The 
      immunology, pediatric MS, clinical courses, and treatment are also discussed. 
      Treatment included medication, orthoptic modalities, strabismus procedures, and 
      cooling devices. RESULTS: Motiltiy disorders included exophoria, unilateral 
      Internuclear Ophthalmoplegia (INO), esophoria, and various types of nystagmus. 
      The majority of nonmotility ophthalmic entities included optic neuritis, RAPD, 
      and abnormal nerve fiber layer studies. Most patients were diagnosed based on 
      white matter lesions on the MRI and oligoclonal bands in the spinal fluid after 
      lumbar puncture. The majority of systemic signs were numbness, Uhthoff sign, and 
      balance difficulties. Thirty-four percent of the patients were helped with either 
      convergence therapy, prisms for all kinds of diplopia, and field manipulation. 
      CONCLUSIONS: MS is a multi-factorial entity. It is important to emphasize how 
      important a few extra history questions are, including: any pain with eye 
      movement, any bouncing of the images, and is vision or balance any worse in the 
      heat? The Visual Evoked Potential (VEP) and nerve fiber layer studies are 
      important in the diagnosis of MS. Seventy percent of patients with had eye 
      complaints as their initial symptom. Finally, one-third of all patients were 
      helped with some form of orthoptic therapy.
FAU - Jenkins, Patricia Fagan
AU  - Jenkins PF
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Orthopt J
JT  - The American orthoptic journal
JID - 0370520
EDAT- 2007/01/01 00:00
MHDA- 2007/01/01 00:01
CRDT- 2010/12/15 06:00
PHST- 2010/12/15 06:00 [entrez]
PHST- 2007/01/01 00:00 [pubmed]
PHST- 2007/01/01 00:01 [medline]
AID - 57/1/69 [pii]
AID - 10.3368/aoj.57.1.69 [doi]
PST - ppublish
SO  - Am Orthopt J. 2007;57:69-78. doi: 10.3368/aoj.57.1.69.