The natural history of recurrent optic neuritis
ABSTRACT Optic neuritis (ON) may occur in isolation or may herald multiple sclerosis (MS) or neuromyelitis optica (NMO). Occasionally, ON may recur many times without intervening evidence of dissemination in space.
To define the clinical course and prognosis of patients with recurrent ON.
Retrospective medical record review and telephone follow-up survey.
Clinic-based practice in a large tertiary referral institution.
Survival analysis of conversion to MS and NMO and final visual impairment. We studied the association of clinical and demographic factors, the presence of brain lesions on magnetic resonance images, and the use of corticosteroid treatment at the time of the first ON occurrence with conversion to MS and NMO.
We identified 1274 patients with ON between 1994 and 2000 and selected 72 (5.7%) with recurrent ON without intervening symptoms of a disseminated demyelinating condition for further analysis. The 5-year conversion rate to NMO was 12.5% and to MS, 14.4%. Among 5 patients with 2 or more lesions consistent with MS on brain magnetic resonance images, 2 (40.0%) converted to MS and none to NMO, while among 11 patients without such lesions, none converted to MS and 2 (18.2%) converted to NMO (P =.16). Conversion to MS occurred in 7 (19.4%) of 36 individuals treated for their first ON episode with corticosteroids vs 4 (44.4%) of 9 untreated individuals (P =.19). There was no difference in the conversion rate to MS between those treated with intravenous steroids (4 [16.7%] of 24) vs oral steroids (3 [25.0%] of 12) (P =.33). Conversion to NMO occurred earlier than conversion to MS (2.3 +/- 1.6 vs 5.3 +/- 4.3 years, respectively; P =.01). Women tended to convert to NMO more frequently than men (female-male ratio for NMO converters, 7:1; MS converters, 2:1; nonconverters, 2:1; P =.56), as did those with a higher annual frequency of ON episodes (NMO converters, 2.0 +/- 1.3; MS converters, 1.0 +/- 1.0; nonconverters, 0.6 +/- 0.5; P =.04). The number of ON events in the first 2 years following the first ON episode was higher in the NMO group (NMO converters, 2.4 +/- 0.9; MS converters, 1.9 +/- 1.1; nonconverters, 1.7 +/- 0.7; P =.04). The final visual impairment was greatest in the NMO group (P =.02).
Patients with rapid succession of severe ON events are more likely to develop a generalized demyelinating disease. Patients with NMO had a worse visual outcome.
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ABSTRACT: Background: Approximately 30–50% of idiopathic optic neuritis (ION) patients experience one or multiple episodes of recurrence. The aim of this study was to search for risk factors for ION recurrence. Methods: Clinical data on hospitalized patients diagnosed with ION between January 2003 and January 2011 at the First Affiliated Hospital of Guangxi Medical University were retrospectively collected. Univariate and multivariate analyses were performed on factors that might cause ION recurrence. In total, 115 ION cases (32 recurrent and 83 non-recurrent cases) with complete data were analyzed. The length of the follow-up period ranged from 12 to 108 months (median: 42 months). Results: The univariate analysis showed that the recurrence rate for unilateral ION was higher than that for bilateral ION (40% vs. 12%, p = 0.001). Underlying diseases had a significant impact on recurrence (p,0.001): the recurrence rates due to neuromyelitis optica (NMO), multiple sclerosis (MS), demyelinating lesions alone of the central nervous system, and unknown causes were 89%, 70%, 41%, and 8.7%, respectively. The multivariate analysis showed that the factors causing relatively high recurrence rates included NMO (odds ratio [OR], 73.5; 95% confidence interval [CI], 7.3 to 740.9), MS (OR, 33.9; 95% CI, 5.2 to 222.2), and demyelinating lesions alone (OR, 8.9; 95% CI, 2.3 to 34.4), unilateral involvement (OR, 5.7; 95% CI, 1.5 to 21.3), relatively low initial glucocorticoid dosage (equivalent to #100 mg prednisone/day) (OR, 4.3; 95% CI, 1.0 to 17.9). Conclusion: Underlying diseases, laterality (unilateral or bilateral), and initial glucocorticoid dosage are important risk factors of ION recurrence. Clinical physicians are advised to treat ION patients with a sufficient dose of glucocorticoid in the initial treatment stage to reduce the recurrence risk.PLoS ONE 09/2014; 9(9). DOI:10.1371/journal.pone.0108580 · 3.53 Impact Factor
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ABSTRACT: Im Jahr 2001 wurden durch ein internationales Gremium neue diagnostische Kriterien für die Multiple Sklerose (MS) vorgeschlagen, die sich durch die Integration klinischer, bildgebender (MRT) und paraklinischer Befunde für die Erleichterung der Diagnosestellung auszeichnen. Diese so genannten ,,McDonald-Kriterien“ haben seither große Akzeptanz und Verbreitung gefunden. Zwischenzeitlich haben sich eine Reihe von Publikationen mit der Sensitivität und Spezifität für die Diagnosestellung sowie der Umsetzung dieser neuen MS-Kriterien in der klinischen Praxis befasst. Basierend auf diesen Erfahrungswerten unter Einbeziehung neuerer Daten zur MS hat eine internationale Expertengruppe kürzlich eine Revision der Kriterien verfasst. Wesentliche Änderungen betreffen (1.) die MRT-Kriterien für die Disseminierung von Läsionen über die Zeit, (2.) die Rolle von Rückenmarksläsionen in der MRT und (3.) die Diagnosestellung einer primär progredienten MS. Die Erfahrungen der letzten Jahre mit den McDonald-Kriterien sowie die revidierten Kriterien werden hier dargestellt.Der Nervenarzt 10/2006; 77(10). DOI:10.1007/s00115-006-2127-6 · 0.86 Impact Factor
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ABSTRACT: Demyelinating optic neuritis (DON) is an acute inflammatory demyelinating disorder affecting the optic nerve. The risk of having a subsequent clinical episode elsewhere in the central nervous system leading to a diagnosis of clinically definite multiple sclerosis (CDMS) varies in different parts of the world. In countries with a high prevalence of MS, most patients with DON will eventually develop CDMS. The presence of oligoclonal bands in cerebrospinal fluid and asymptomatic lesions on magnetic resonance imaging (MRI) of the brain at presentation are strong predictors of progression to CDMS. The Optic Neuritis Treatment Trial reported that DON patients treated with intravenous methylprednisolone had a delay in progression to CDMS, but only up to two years. Interferon-β and glatiramer actetate have now been shown to reduce the risk of developing CDMS after two to three years when compared with placebo. The BENEFIT study has demonstrated that delaying interferon-β1b therapy in patients presenting with a clinically isolated syndrome (CIS) such as optic neuritis leads to a slightly higher risk for sustained disability progression compared with patients who started interferon-β1b after a CIS. Controversy remains if these small benefits of reducing conversion to CDMS from CIS and slowing disability with interferon-β treatment outweigh the adverse effects of the medication and its costs as the overall disability progression off treatment is mild, at least in the short-term, and particularly in patients in whom optic neuritis is the initial event.Neuro-Ophthalmology 07/2009; 33(1-2). DOI:10.1080/01658100802638602 · 0.18 Impact Factor