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Visual system involvement in patients with Friedreich's ataxia

神经纤维层 视神经病变 Leber遗传性视神经病 光辐射 视网膜 共济失调 视野 视神经 眼科 医学 视力 视皮层 听力学 磁共振弥散成像 神经科学 心理学 磁共振成像 放射科 精神科
作者
F. Fortuna,Piero Barboni,Rocco Liguori,Maria Lucia Valentino,Giacomo Savini,Cinzia Gellera,Caterina Mariotti,Giovanni Rizzo,Caterina Tonon,David Neil Manners,Raffaele Lodi,Alfredo A. Sadun,Valério Carelli
出处
期刊:Brain [Oxford University Press]
卷期号:132 (1): 116-123 被引量:156
标识
DOI:10.1093/brain/awn269
摘要

Optic neuropathy is common in mitochondrial disorders, but poorly characterized in Friedreich's ataxia (FRDA), a recessive condition caused by lack of the mitochondrial protein frataxin. We investigated 26 molecularly confirmed FRDA patients by studying both anterior and posterior sections of the visual pathway using a new, integrated approach. This included visual field testing and optical coherence tomography (OCT), pattern visual evoked potentials (P-VEPs) and diffusion-weighted imaging. The latter was used to study optic radiation by calculating water apparent diffusion coefficients (ADC). All patients suffered optic nerve involvement with their disorder. Different patterns of visual field defects were observed and a variably reduced retinal nerve fiber layer thickness was seen by OCT in all cases. P-VEPs were abnormal in approximately half of the patients. Decreased visual acuity and temporal optic disc pallor were present in advanced stages of the disease, but only five patients were symptomatic. Two of these patients suffered a sudden loss of central vision, mimicking Leber's hereditary optic neuropathy (LHON), and of the other three symptomatic patients two were noted to be compound heterozygotes. ADC values of optic radiations in patients were significantly higher than controls (P < 0.01). Retinal nerve fiber layer thickness at OCT and P-VEPs correlated with age at onset and ICARS total score. ADC values correlated with age at onset, disease duration, GAA triplet expansion size, ICARS total score and P-VEPs. Visual pathway involvement is found consistently in FRDA, being previously underestimated, and we here document that it also involves the optic radiations. Occasional LHON-like cases may occur. However, optic neuropathy in FRDA substantially differs from classic mitochondrial optic neuropathies implying a different pathophysiology of visual system degeneration in this mitochondrial disease.

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