Publications by authors named "Costello F"

Purpose Of Review: This article explores the role of optical coherence tomography (OCT) in neurology practice, particularly in diagnosing and monitoring conditions such as papilledema, optic neuritis, and retinal artery occlusion. OCT has been increasingly utilized as a noninvasive and effective tool for detecting and monitoring neuroaxonal damage in the visual pathway, which is important for early intervention and improved patient outcomes across a variety of neurologic conditions.

Recent Findings: OCT as an imaging modality continues to demonstrate its utility in quantifying optic nerve and retinal changes reflecting neuroaxonal injury, including, peripapillary retinal nerve fiber layer (pRNFL) thickness and macular ganglion cell layer thickness (or volume).

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Optic neuritis (ON) is an inflammatory condition that affects the optic nerve and may be associated with various central nervous system demyelinating conditions, infectious diseases, and systemic autoimmune syndromes. This manuscript sheds light on the epidemiologic patterns and diverse clinical features of ON, emphasizing the importance of early detection and prompt treatment. Various studies have revealed geographic and ethnic variations across ON subtypes, which are likely related to the incidence and prevalence of co-associated disorders.

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Article Synopsis
  • The study focused on developing a deep learning system (DLS) to differentiate between optic disc drusen (ODD) and papilledema in digital fundus photographs, which is important for understanding different ocular conditions.
  • The research involved a large dataset of over 4,500 images from multiple centers worldwide, allowing for robust training and validation of the DLS.
  • Results showed the DLS performed exceptionally well, achieving high accuracy in distinguishing between ODD and various severities of papilledema, indicating its potential for clinical use in neuro-ophthalmology.
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Background: Optic neuritis (ON) is a complex clinical syndrome that has diverse etiologies and treatments based on its subtypes. Notably, ON associated with multiple sclerosis (MS ON) has a good prognosis for recovery irrespective of treatment, whereas ON associated with other conditions including neuromyelitis optica spectrum disorders or myelin oligodendrocyte glycoprotein antibody-associated disease is often associated with less favorable outcomes. Delay in treatment of these non-MS ON subtypes can lead to irreversible vision loss.

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Article Synopsis
  • Optical coherence tomography (OCT) is a special imaging tool that helps doctors see the inside of your eye without any surgery.
  • It measures different parts of the retina to check for problems with the optic nerve and can help diagnose eye diseases.
  • New technologies like artificial intelligence are making OCT even better, so doctors can understand eye issues more easily and provide better care.
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  • The study aims to evaluate how age-adjusted scores from retinal optical coherence tomography (OCT) can predict future disease activity and disability worsening in people with multiple sclerosis (PwMS).
  • Researchers created age-adjusted reference values for specific retinal measurements using data from healthy eyes and transformed existing data from PwMS into these scores for comparison.
  • Results showed that lower scores (pRNFL-z) were linked to a greater risk of disability worsening, with significant findings from two different cohorts highlighting the importance of retinal imaging in assessing MS progression.
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Outbreaks of COVID-19 in meat processing plants (MPPs) were recorded globally throughout the pandemic. There was speculation these outbreaks resulted in dissemination of COVID-19 throughout the surrounding county leading to high incidence rates. We aimed to investigate the dynamics of spread between MPPs and their surrounding counties.

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Significant advances have been made in the diagnosis and treatment of multiple sclerosis in recent years yet challenges remain. The current classification of MS phenotypes according to disease activity and progression, for example, does not adequately reflect the underlying pathophysiological mechanisms that may be acting in an individual with MS at different time points. Thus, there is a need for clinicians to transition to a management approach based on the underlying pathophysiological mechanisms that drive disability in MS.

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Article Synopsis
  • Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a CNS demyelinating disease that has gained attention due to improved testing methods, but there's still confusion about interpreting antibody levels, especially in cerebrospinal fluid (CSF).
  • A study analyzed MOG antibody results from Alberta's MitogenDx lab over six years, focusing on patients with positive serum and CSF tests, examining demographics, antibody levels, clinical features, treatments, and diagnoses.
  • The findings revealed that CSF MOG antibodies were infrequent and mostly present in patients already seropositive for MOG, suggesting that routine CSF testing might not be necessary for most patients, warranting further research for clarification.
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  • Papilledema is optic disc swelling caused by high intracranial pressure and can lead to vision loss, making early diagnosis crucial for patient care.
  • The review emphasizes the advantages of optical coherence tomography (OCT) as a non-invasive imaging method to detect papilledema, especially when traditional ophthalmoscopy may not be reliable.
  • OCT can identify subtle changes like retinal nerve fiber layer thickening and assist in diagnosing related conditions, while also providing insights into treatment response and potential integration into advanced diagnostic models.
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  • This review emphasizes a clinical-anatomical method for identifying neuro-ophthalmic symptoms related to autoimmune disorders.
  • Recent developments in autoimmune research have revealed new autoantibodies, enhancing our understanding of neuro-ophthalmic signs linked to these conditions.
  • A detailed patient history and comprehensive examinations are crucial for diagnosing autoimmune disorders, helping to recognize key symptoms and avoid common mistakes in clinical practice.
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Background: For patients with idiopathic or multiple sclerosis (MS)-associated optic neuritis (ON), the largest multicenter clinical trial (Optic Neuritis Treatment Trial [ONTT]) showed excellent visual outcomes and baseline high-contrast visual acuity (HCVA) was the only predictor of HCVA at 1 year. We aimed to evaluate predictors of long-term HCVA in a modern, real-world population of patients with ON and compare with previously published ONTT models.

Methods: We performed a retrospective, longitudinal, observational study at the University of Michigan and the University of Calgary evaluating 135 episodes of idiopathic or MS-associated ON in 118 patients diagnosed by a neuro-ophthalmologist within 30 days of onset (January 2011-June 2021).

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New diagnostic criteria for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) have recently been proposed, distinguishing this syndrome from other inflammatory diseases of the central nervous system. Seropositivity status for MOG-IgG autoantibodies is important for diagnosing MOGAD, but only in the context of robust clinical characterization and cautious interpretation of neuroimaging. Over the last several years, access to cell-based assay (CBA) techniques has improved diagnostic accuracy, yet the positive predictive value of serum MOG-IgG values varies with the prevalence of MOGAD in any given patient population.

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One clear aspect of behaviour in the COVID-19 pandemic has been people's focus on, and response to, reported or observed infection numbers in their community. We describe a simple model of infectious disease spread in a pandemic situation where people's behaviour is influenced by the current risk of infection and where this behavioural response acts homeostatically to return infection risk to a certain preferred level. This homeostatic response is active until approximate herd immunity is reached: in this domain the model predicts that the reproduction rate R will be centred around a median of 1, that proportional change in infection numbers will follow the standard Cauchy distribution with location and scale parameters 0 and 1, and that high infection numbers will follow a power-law frequency distribution with exponent 2.

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Background: Post-stroke visual impairment (VI) is a common but under-recognized care challenge. Common manifestations of post-stroke VI include: diplopia, homonymous hemianopia, oscillopsia secondary to nystagmus, and visual inattention or neglect. In acute care settings, post-stroke VI recognition and treatment are often sub-optimal as emphasis is placed on survival.

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Purpose Of Review: The primary aim of this review is to describe the clinical course, salient imaging features, and relevant serological profiles of common optic neuritis (ON) subtypes. Key diagnostic challenges and treatment options will also be discussed.

Recent Findings: ON is a broad term that describes an inflammatory optic nerve injury arising from a variety of potential causes.

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Article Synopsis
  • - Optic neuritis (ON) encompasses various inflammatory optic neuropathies, commonly presenting as unilateral, painful vision loss, especially in young Caucasian women.
  • - The Optic Neuritis Treatment Trial (ONTT) has established important guidelines regarding the clinical aspects and visual outcomes of ON, also highlighting its association with a future multiple sclerosis (MS) diagnosis.
  • - Recent discoveries of immune-mediated conditions like neuromyelitis optica spectrum disorder (NMOSD) and MOGAD have complicated ON management, requiring clinicians to differentiate among ON subtypes due to their varying prognoses and treatment approaches.
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Background: The presence of subclinical optic nerve (ON) injury in youth living with pediatric-onset MS has not been fully elucidated. Magnetization transfer saturation (MTsat) is an advanced magnetic resonance imaging (MRI) parameter sensitive to myelin density and microstructural integrity, which can be applied to the study of the ON.

Objective: The objective of this study was to investigate the presence of subclinical ON abnormalities in pediatric-onset MS by means of magnetization transfer saturation and evaluate their association with other structural and functional parameters of visual pathway integrity.

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