Monitoring of chronic degenerative diseases, such as multiple sclerosis (MS), in individual patients represents one of the most important challenges for clinicians. MS evolves over decades, but therapeutic decisions are based on short-term, risk-benefit analyses. In addition, in all areas of medicine, therapeutics often develop in conjunction with the means for measuring their efficacy. As an example, highly active antiretroviral therapies were able to be developed for the treatment of the human immunodeficiency virus because of the development of CD4 count and viral load as outcomes that could be targeted for treatment. Although T2 lesion load and new gadolinium-enhancing lesions are very useful metrics for measuring inflammatory activity in MS, they only have a modest correspondence with disability. For these reasons, developing biomarkers that reflect the degree of neurologic injury and predict the future course of the disease is a high priority for personalizing health care for people with MS.1 Internuclear ophthalmoplegia (INO) is commonly found in patients with MS due to plaques in the medial longitudinal fasciculus and imposes substantial disability.2,3 A previous study using MRI and the new technology of infrared oculography found a well-defined mapping between damage of the medial longitudinal fasciculus in the brainstem and INO.4

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