title: Recovery from optic neuritis is associated with a change in the distribution of cerebral response to visual stimulation: a functional magnetic resonance imaging study.
abstract: OBJECTIVE
  Recovery to normal or near normal visual acuity is usual after acute demyelinating optic neuritis, despite the frequent persistence of conduction abnormalities as evidenced by the visual evoked potential (VEP). This raises the possibility that cortical adaptation to a persistently abnormal input contributes to the recovery process. The objective of this study was to investigate the pattern of cerebral response to a simple visual stimulus in recovered patients in comparison to normal subjects.
  
  
  METHODS
  Functional magnetic resonance imaging (fMRI) was used to study the brain activation pattern induced by a periodic monocular 8Hz photic stimulus in seven patients who had recovered from a single episode of acute unilateral optic neuritis, and in seven normal controls. VEPs and structural optic nerve MRI were performed on patients.
  
  
  RESULTS
  Stimulation of either eye in controls activated only the occipital visual cortex. However, in patients, stimulation of the recovered eye also induced extensive activation in other areas including the insula-claustrum, lateral temporal and posterior parietal cortices, and thalamus; stimulation of the clinically unaffected eye activated visual cortex and right insula-claustrum only. The volume of extraoccipital activation in patients was strongly correlated with VEP latency (r = 0.71, p = 0.005).
  
  
  CONCLUSIONS
  The extraoccipital areas that were activated in patients all have extensive visual connections, and some have been proposed as sites of multimodal sensory integration. The results indicate a functional reorganisation of the cerebral response to simple visual stimuli after optic neuritis that may represent an adaptive response to a persistently abnormal input. Whether this is a necessary part of the recovery process remains to be determined.
authors.affiliation: NMR Research Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Werring
authors.forename: E T
authors.initials: ET
authors.lastname: Bullmore
authors.forename: A T
authors.initials: AT
authors.lastname: Toosy
authors.forename: D H
authors.initials: DH
authors.lastname: Miller
authors.forename: G J
authors.initials: GJ
authors.lastname: Barker
authors.forename: D G
authors.initials: DG
authors.lastname: MacManus
authors.forename: M J
authors.initials: MJ
authors.lastname: Brammer
authors.forename: V P
authors.initials: VP
authors.lastname: Giampietro
authors.forename: A
authors.initials: A
authors.lastname: Brusa
authors.forename: P A
authors.initials: PA
authors.lastname: Brex
authors.forename: I F
authors.initials: IF
authors.lastname: Moseley
authors.forename: G T
authors.initials: GT
authors.lastname: Plant
authors.forename: W I
authors.initials: WI
authors.lastname: McDonald
authors.forename: A J
authors.initials: AJ
authors.lastname: Thompson
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009902:Optic Neuritis / Q000473:pathology* / Q000503:physiopathology*; D010775:Photic Stimulation; D013997:Time Factors