Optic neuritis as an initial symptom in multiple sclerosis

Abstract

The present study is based on a multicenter documentation system which includes standardized information on a total of 1271 patients with multiple sclerosis (MS). In 441 (34.7 %) cases the optic nerve was involved at the first appearance of the disease, and in 212 (16.6 %) subjects optic neuritis (ON) was the sole initial sign. For all MS patients with ON at the onset of the disease the female to male ratio was 1.3, whereas it was 1.5 for the whole series. The mean age at onset was 2 years lower for patients with initial ON as compared with the whole series (29.0 and 31.1 years, respectively). Correlation of the disability o f the patients t o the duration of the disease revealed the best prognosis for patients with ON as the sole initial sign of MS. The frequency of brainstedcerebellar and pyramidal signs was lowest among these patients at the time of the present examination. The difference was more pronounced during the first years of the disease and disappeared after longer duration. The correlation curves of disability to the present age of the patients confirmed this pattern. Our findings do not support the idea of initial ON as being a favorable sign of the later course. As an initial bout of MS, it may reflect more precisely the mean age of onset of the disease than other signs.

Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability

“…In our cohort of 303 patients recruited consecutively from an MS clinic, 34.6% of them complained of permanent visual disturbances unrelated to a recent attack. The prevalence of neuro-ophthalmologic attacks at onset, 26.4% for ON and 12.2% for ocular motor manifestation, is in accordance with previous epidemiological studies reporting frequencies from 14% to 35% for ON 5,22,23 and 13% for diplopia. 22 Compared to patients without PVCs, patients with PVCs were more likely males with a progressive onset of the disease who experienced a higher number of previous neuro-ophthalmologic attacks and were more disabled.…”

Prognostic indicators in multiple sclerosis

“…In our earlier investigation when we analysed both disability and progression index, we found a more favorable prognosis for patients with initial optic nerve disturbance (15). In agreement with Sanders et al (14) a further study revealed that this difference disappeared after a disease duration of more than 10 years (16). This example shows that the parameter used in a particular study of prognosis and the length of follow-up influences the results.…”

Fingolimod after a first unilateral episode of acute optic neuritis (MOVING) – preliminary results from a randomized, rater-blind, active-controlled, phase 2 trial

“…Optic neuritis (ON) represents one of the most frequent phenotypes of MS relapse and occurs as the first demyelinating event in about one out of 3 MS patients [11,12]. ON offers an elegant opportunity for studies of remyelination and neuroprotection in MS [13].…”