Optic neuritis

Abstract

We investigated the paraclinical profile of monosymptomatic optic neuritis (ON) and its prognosis for multiple sclerosis (MS). The correct identification of patients with very early MS carrying a high risk for conversion to clinically definite MS is important when new treatments are emerging that hopefully will prevent or at least delay future MS. We conducted a prospective single observer and population-based study of 147 consecutive patients (118 women, 80%) with acute monosymptomatic ON referred from a catchment area of 1.6 million inhabitants between January 1, 1990 and December 31, 1995. Of 116 patients examined with brain MRI, 64 (55%) had three or more high signal lesions, 11 (9%) had one to two high signal lesions, and 41 (35%) had a normal brain MRI. Among 143 patients examined, oligoclonal IgG (OB) bands in CSF only were demonstrated in 103 patients (72%). Of 146 patients analyzed, 68 (47%) carried the DR15,DQ6,Dw2 haplotype. During the study period, 53 patients (36%) developed clinically definite MS. The presence of three or more MS-like MRI lesions as well as the presence of OB were strongly associated with the development of MS (p < 0.001). Also, Dw2 phenotype was related to the development of MS (p = 0.046). MRI and CSF studies in patients with ON give clinically important information regarding the risk for future MS.

Subgroups of the BENEFIT study: Risk of developing MS and treatment effect of interferon beta-1b

“…Accordingly, relapse frequency has previously been recognised to be higher in younger patients [8,13]. Also, the observation that patients who had positive CSF findings convert more frequently has been reported previously [18,19]. The finding that patients in whom the presenting episode was treated with intravenous steroids had a higher conversion rate appears to be somewhat surprising in the light of previous observations, mainly from the Optic Neuritis Treatment Trial, which indicated that steroids might have some protective effects [4].…”

Risk of multiple sclerosis after optic neuritis in patients with normal baseline brain MRI

“…Determining which patients have a higher risk of conversion to MS is important, as studies suggest that there may be a benefit from early immunomodulatory treatment in patients with clinically isolated syndrome (CIS), including ON [4][5][6][7][8][9][10]. Although the presence of one or more lesions on baseline brain MRI has been identified as the strongest predictor of MS conversion [3,[11][12][13][14][15][16], there are patients with normal baseline MRI who also develop MS and predictors of conversion are still to be determined in this subgroup of patients.…”

An MHC anchor‐substituted analog of myelin oligodendrocyte glycoprotein 35–55 induces IFN‐γ and autoantibodies in the absence of experimental autoimmune encephalomyelitis and optic neuritis

“…Optic neuritis is a very common early symptom in MS patients, with approximately 30-60% of patients experiencing visual problems associated with inflammation and demyelination in the optic nerve [6,7]. Optic nerve lesions have also been reported in EAE [8][9][10], and may represent an early event in the progression of anti-myelin immune responses [11].…”