Acute optic neuritis and the prognosis for multiple sclerosis.

Hutchinson, W. M.

doi:10.1136/jnnp.39.3.283

Cited by 108 publications

(43 citation statements)

References 17 publications

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“…18 Several natural history studies have suggested that optic neuritis at CIS onset may signify a form of MS with a better prognosis compared with other syndromes. [24][25][26] However, among patients with abnormal cranial MRI studies and monosymptomatic presentation at CIS onset, syndrome type appears to have little effect on disease course. 17 Serial MRI activity also has been explored as a predictor of long-term disability.…”

Section: Results From Phase 3 Studies Of Ifnβ In Patients With a Cismentioning

confidence: 99%

The Efficacy of Interferon Beta in Delaying Conversion to Clinically Definite Multiple Sclerosis

Kremenchutzky¹,

Kinkel²

2010

International Journal of MS Care

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More than half of patients with a clinically isolated syndrome (CIS) develop clinically definite multiple sclerosis (CDMS). Patients at high risk for CDMS often present with asymptomatic lesions characteristic of CDMS on magnetic resonance imaging scans, although an absence of asymptomatic lesions is not atypical. Phase 3 studies of interferon beta in patients with a CIS suggest that this treatment can delay conversion to CDMS and reduce the risk of new asymptomatic white matter lesions. We reviewed phase 3 studies (CHAMPS, BENEFIT, and ETOMS) and post hoc analyses assessing the efficacy of interferon beta in delaying CDMS in patients with a CIS. The evidence supports early initiation of treatment. Int J MS Care. 2010;12:42-50. Multiple sclerosis (MS) is a chronic, demyelinating disorder of the central nervous system (CNS), with evidence of both inflammatory and neurodegenerative pathogenic features. A clinically isolated syndrome (CIS) such as acute monocular optic neuritis, partial transverse myelitis, or acute brainstem syndrome can be the first indication of MS, 1 and approximately 50% of patients who develop a CIS are eventually diagnosed with clinically definite MS (CDMS). 2Studies demonstrate that 80% of MS cases begin with a relapsing-remitting (RR) course 3 characterized by subacute development of neurologic symptoms and findings (relapses), followed by a recovery period of weeks to months. Despite significant recovery in the majority of cases, relapses appear to be the major cause of increases in sustained disability, with approximately 28% of patients with RRMS experiencing a 1-point or greater increase on the Expanded Disability Status Scale 4 (EDSS) following each relapse recovery. 5,6 The median time to reach a fixed EDSS score of 6.0-a disability milestone almost always associated with a secondary progressive (SP) phase of the disease-is 15 to 28 years. 3,7,8 In the course of MS, progression of disability is accompanied by accumulation of CNS abnormalities (including contrast-enhancing lesions, T2 lesions, T1 "black holes," and brain atrophy) and eventual loss of tissue caused by inflammation and axonal injury.9 It has been reported that inflammatory lesion activity in early relapsing MS, as detected by serial monthly magnetic resonance imaging (MRI) studies, may be ten times more frequent than clinical relapses and signals an ongoing pathologic process.9 Widespread inflammationindependent axonal damage has also been demonstrated in patients with a CIS.10 Although inflammatory demyelination is reversible, chronic demyelination and axonal degeneration are irreversible and result in progressive neurologic disability. 11This article reviews the rationale for early treatment of MS, assesses the available clinical evidence for the efficacy of interferon beta (IFNβ) therapy in slowing the development of MS in patients with a CIS, 12-15 and identifies the types of patients who may benefit the most from early treatment. Early Prognostic Factors of Disease Activity and DisabilityThe clinical course of MS v...

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Section: Results From Phase 3 Studies Of Ifnβ In Patients With a Cismentioning

confidence: 99%

The Efficacy of Interferon Beta in Delaying Conversion to Clinically Definite Multiple Sclerosis

Kremenchutzky¹,

Kinkel²

2010

International Journal of MS Care

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“…Comparison of the present series of ON with American [3,4,6], European [1,2,5,7,8], and Japanese studies [9] revealed no sub stantial differences in the clinical features of ON (maleifemale ratio, age at onset, later ality, fundus appearance, level of visual im pairment, final visual acuity, visual field de fect, and recurrences).…”

Section: Discussionmentioning

confidence: 98%

Progression of Optic Neuritis to Multiple Sclerosis: A Prospective Study in an Italian Population

Mapelli

Pavoni²,

Palma³

et al. 1991

Neuroepidemiology

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We prospectively studied 40 patients with uncomplicated optic neuritis (ON) to determine the risk of subsequent multiple sclerosis (MS). All patients were followed for at least 12 years. Ten patients (25%) developed MS. Seven of these 10 patients developed MS within 2 years. Both sexes were at high risk if ON occurred between the ages of 21 and 40. There was an overall increased risk of MS with recurrent ON. The course of MS appeared to be fairly benign during the period of observation.

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“…In one study, the 10-year risk of developing MS after an initial episode of ON was 56% if patients had one or more typical lesions on the baseline magnetic resonance imaging (MRI) scan of their brain, those with no lesions having a 22% risk [4]. Life-table analyses have shown that up to 78% of all ON patients progress to clinically definite MS within 15 years of follow-up [15]. Moreover, white matter abnormalities typical for MS are found on MRI in 48-62% of patients with monosymptomatic ON [3,12,18], and MS patients have shown lesions in the optic nerves in up to 94-99% of autopsy cases [16,26].…”

Section: Introductionmentioning

confidence: 99%