To better understand the driving factors and other dynamics of neuroaxonal loss in epilepsy, a recent study explored progressive brain atrophy reflected as retinal neuroaxonal loss. The study employed OCT to monitor retinal changes in 44 patients with epilepsy compared to 56 healthy controls over an average of seven months to observe short-term neuroaxonal changes.

In an article published in Epilepsia, the researchers outlined their goals of evaluating the progression rate of retinal neuroaxonal loss in adult people with epilepsy (PwE) and assessing its association with clinical measures with a focus on the number of seizures the subject experienced. The study used OCT imaging to examine the peripapillary retinal nerve fiber layer (pRNFL) which is believed to be the primary site of the neuroaxonal loss. The researchers noted that it is still unknown if this loss occurs with or following cerebral atrophy.

They found that PwE showed significant thinning in the pRNFL and ganglion cell-inner plexiform layer, with annualized percentage changes of -0.98% and -1.24%, respectively, compared to healthy controls. Tonic-clonic seizures were associated with more pronounced retinal neuroaxonal loss, highlighting the impact of seizure frequency on retinal atrophy. Higher antiseizure medication usage was also associated with increased retinal thinning. PwE who experienced cognitive decline also showed accelerated retinal thinning, suggesting a link between neuroaxonal loss and broader neurodegenerative processes in epilepsy.

While further longitudinal studies are needed to fully understand the mechanisms of neuroaxonal loss dynamics, the findings suggest OCT could be a valuable, non-invasive tool for tracking disease progression and assessing the impact of treatment in epilepsy patients. While the dynamic of neuroaxonal loss is different, the same approach might be of use when tracking progression of other neurodegenerative conditions including multiple sclerosis, Parkinson’s, or Alzheimer’s disease, the researchers noted.

A full list of author disclosures can be found in the published research.