Simultaneous bilateral optic neuritis in China: clinical, serological and prognostic characteristics

Abstract

Purpose: To analyse the clinical characteristics of simultaneous bilateral ON patients in China. Methods: This retrospective study was done on 51 primary bilateral ON patients between April 2008 and July 2016 at the Chinese People's Liberation Army General Hospital. Fifty eight primary unilateral ON patients formed the control group. Demographic data, clinical course, serum autoantibody status, connective tissue disorders, magnetic resonance imaging and visual functions were compared.Results: The mean age at disease onset in the bilateral group was younger than that of the unilateral group (p = 0.001). Cerebrospinal fluid (CSF) total cell count and CSF total protein were significantly higher in the bilateral group (p = 0.001, p = 0.025). Aquaporin-4 (AQP4) antibodies were detected in 39% and 21% of the bilateral and unilateral patients, respectively (p = 0.03). Twenty two percent of the bilateral patients fulfilled the diagnosis of neuromyelitis optica (NMO); 7% in the unilateral group did so (p = 0.03). Serum autoantibodies (ANA, SSA, SSB, etc.) were found in 49% of the bilateral patients and 29% of the unilateral patients (p = 0.035). After treatment, the bilateral patients were significantly more prone to severe visual disability eventually than their unilateral counterparts (p = 0.002). Patients with MOG-IgG (myelin oligodendrocyte glycoprotein-IgG) represented 26% of the patients negative for AQP4-IgG. Myelin oligodendrocyte glycoprotein-IgG (MOG-IgG) sero-positive patients were more likely to recover than the other patients (p < 0.001). Conclusion: Simultaneous bilateral ON is a severe disorder closely related to serum AQP4-IgG and MOG-IgG, which are more likely to involve younger people and incur severe visual disability eventually. Myelin oligodendrocyte glycoprotein-IgG (MOG-IgG) sero-positive patients have higher risk of ON relapses and better visual prognosis.

Differences in Clinical Features of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis in White and Asian Race

“…A similarly lower prevalence of pain has also been reported in other Chinese MOG-ON cohorts, which met criteria for inclusion in our cohort, but for which case-level data could not be obtained. 16,34 However, it is difficult to conclude if differences in pain, a subjective perception, are a result of disease differences or other differences including a cultural difference in pain perception and evaluation. Interestingly, pain perception studies report lower pain threshold and tolerance levels in subjects who are Asian than for those who are White, which would not account for our observation.…”

Bilateral Optic Neuritis and Facial Palsy Following COVID-19 Infection

“…Typically, optic neuritis is associated with MS [ 6 ]. However, other associations of optic neuritis appear to be more common in Asian countries [ 1 , 7 ]. She had a bilateral presentation on imaging, absent demyelinating lesions in the brain and spine, and preceding COVID-19 infection.…”

“…Her optic neuritis responded rapidly to the recommended treatment (ONTT protocol), with visual recovery in a week following therapy. Among patients with bilateral optic neuritis, those associated with MOG-AD and parainfectious etiology report better visual recovery than NMOSD and autoantibody-associated disease, which carry a worse visual prognosis [ 7 , 11 ].…”

Myelin Oligodendrocyte Glycoprotein Antibody–Associated Optic Neuritis—A Review

“…Studies as detailed in Table 2 show that recovery of visual acuity is good for MOGAD, especially compared with AQP4-IgG NMOSD (36,38,44,46,47). Some studies show that visual disability is worse with more relapses (21,48), but others demonstrate no difference in visual disability at onset compared with relapse (22).…”