New, diagnostic flicker test for optic neuritis shows specific stages following disease onset

Gorm Pihl-Jensen; Susanne Trauzettel-Klosinski; Benedikte Wanscher; Jette Frederiksen

doi:10.1016/j.msard.2022.104254

New, diagnostic flicker test for optic neuritis shows specific stages following disease onset

Mult Scler Relat Disord. 2022 Dec:68:104254. doi: 10.1016/j.msard.2022.104254. Epub 2022 Oct 28.

Authors

Gorm Pihl-Jensen¹, Susanne Trauzettel-Klosinski², Benedikte Wanscher³, Jette Frederiksen⁴

Affiliations

¹ Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark. Electronic address: gorm.pihl-jensen@regionh.dk.
² Vision Rehabilitation Research Unit, Centre for Ophthalmology, University Eye Hospital, Eberhard-Karls University of Tübingen, Tübingen, Germany.
³ Department of Clinical Neurophysiology, Rigshospitalet - Glostrup, Glostrup, Denmark and Department of Neurology, Slagelse Hospital, Slagelse, Denmark.
⁴ Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark.

PMID: 36544316
DOI: 10.1016/j.msard.2022.104254

Abstract

Background: Previously, results of the digital flicker test (DFT) have shown distinct patterns in acute optic neuritis (ON) and healthy eyes. We aimed to examine the diagnostic potential of the DFT in acute ON and to investigate the temporal development of the DFT response following ON while comparing with visual evoked potentials (VEP).

Methods: The DFT examines the subjective brightness of a flickering field, varied in 11 different frequencies from 0 to 60 Hz, compared to a steady field. Previous studies have indicated a pronounced darkness enhancement at medial frequencies in acute ON eyes. Darkness enhancement at medial frequencies was expressed as a quantitative covariate (DFT_DE). Results were compared with healthy controls and follow-up measurements were compared with VEP.

Results: 112 patients were examined <31 days of onset (median 14.0 days (IQR:12.25)). 104 of 112 patients showed an abnormal flicker test (sensitivity 93%). DFT was abnormal in 2 of 55 healthy controls. The DFT showed normalization in 34% at 3 months, 36.4% at 6 months and 71.4% at >8 months from ON onset compared to 13.3%, 22.4% and 28.6% for VEP. Changes to the pattern of the DFT results were shown at specific stages during and following ON.

Conclusions: The DFT is an easy-to-use and sensitive diagnostic test for acute ON. The flicker test shows a more pronounced temporal evolution following ON than VEP and may be of use monitoring the course of ON.

MeSH terms

Evoked Potentials, Visual*
Eye
Health Status
Humans
Neurologic Examination
Optic Neuritis* / diagnosis