Journal of Neurology

, Volume 252, Issue 4, pp 396–402 | Cite as

Predicting the Outcome of Optic Neuritis

Evaluation of risk factors after 30 years of follow–up
  • P. Nilsson
  • E.-M. Larsson
  • P. Maly-Sundgren
  • R. Perfekt
  • Magnhild Sandberg-Wollheim
ORIGINAL COMMUNICATION

Abstract

Background

Multiple sclerosis (MS) is a common disease with considerable risk for disability. Optic neuritis (ON) is a common first symptom of MS but it can also remain an isolated episode. Therefore, predicting the outcome of ON has gained in importance, particularly in light of current discussions of early disease modifying treatments in individuals at risk of developing MS. We reported previously on our cohort of 86 patients with acute monosymptomatic unilateral ON of whom 33 had progressed to MS after up to 18 years. Three patients had died. The present study extends the observation period to 31 years.

Methods

Patients were followed for up to 31 years or until a diagnosis of MS was made. Cerebrospinal fluid (CSF) was examined at onset. HLA class I and II antigens were determined. Magnetic Resonance Imaging (MRI) was performed during follow up.

Findings

Only one of 50 patients at risk developed clinical manifestations of MS during the extended follow up period. The estimated 15–year–risk of MS was 40 % (confidence interval [CI] 31%–52%). Most cases, 20 of 34 or 60%, occurred within three years. Among factors present at onset, CSF with mononuclear pleocytosis and/or oligoclonal Ig increased the risk for subsequent MS significantly, 49% (CI 38%–65%) compared with 23 % (CI 12%–44%) for those with normal CSF, p = 0·02. Younger patients and those with winter onset also had greater risk. Recurrence of ON similarly elevated the risk significantly, p < 0·001. After 19–31 years MRI lesions suggestive of demyelinating disease were detected in 20 of 30 individuals although no clinical manifestations of MS had occurred.

Conclusion

The risk of MS in this large population–based prospective ON patient series was 40% and significantly higher in those with inflammatory CSF abnormalities at onset. Clinically silent MRI lesions suggestive of MS were detected in a majority of those with “ON-only”. This finding should be taken into account when discussing prognosis and early intervention in patients with clinically isolated ON.

Key words

optic neuritis multiple sclerosis cerebrospinal fluid MRI prognosis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Barkhof F, Filippi M, Miller DH, Scheltens P, Campi A, Polman CH, Comi G, Ader HJ, Losseff N, Valk J (1997) Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 120:2059–2069Google Scholar
  2. 2.
    Brex PA, O’Riordan JI, Miszkiel KA, Moseley IF, Thompson AJ, Plant GT, Miller DH (1999) Multisequence MRI in clinically isolated syndromes and the early development of MS. Neurology 53:1184–1190Google Scholar
  3. 3.
    Cole SR, Beck RW, Moke PS, Kaufman DI, Tourtellotte WW (1998) The predictive value of CSF oligoclonal banding for MS 5 years after optic neuritis. Optic Neuritis Study Group. Neurology 5:885–887Google Scholar
  4. 4.
    Comi G, Filippi M, Barkhof F, Durelli L, Edan G, Fernandez O, Hartung H, Seeldrayers P, Sörensen PS, Rovaris M, Martinelli V, Hommes OR (2001) Early Treatment of Multiple Sclerosis Study Group. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet 357:1576–1582Google Scholar
  5. 5.
    Fazekas F, Offenbacher H, Fuchs S, Schmidt R, Niederkorn K, Horner S, Lechner H (1988) Criteria for an increased specificity of MRI interpretation in elderly subjects with suspected multiple sclerosis. Neurology 38:1822–1825Google Scholar
  6. 6.
    Francis DA, Compston DA, Batchelor JR, McDonald WI (1987) A reassessment of the risk of multiple sclerosis developing in patients with optic neuritis after extended follow-up. J Neurol Neurosurg Psychiatry 50:758–765Google Scholar
  7. 7.
    Frith JA, Mcleod JG, Hely M (2000) Acute optic neuritis in Australia: a 13 year prospective study. J Neurol Neurosurg Psychiatry 68:246Google Scholar
  8. 8.
    Ghezzi A, Martinelli V, Torri V, Zaffaroni M, Rodegher M, Comi G, Zibetti A, Canal N (1999) Long-term followup of isolated optic neuritis: the risk of developing multiple sclerosis, its outcome and the prognostic role of paraclinical tests. J Neurol 246:770–775Google Scholar
  9. 9.
    Ghezzi A, Martinelli V, Rodegher M, Zaffaroni M, Comi G (2000) The prognosis of idiopathic optic neuritis. Neurol Sci 21:S865–S869Google Scholar
  10. 10.
    Hickman SJ, Dalton CM, Miller DH, Plant GT (2002) Management of acute optic neuritis. Lancet 360:1953–1962Google Scholar
  11. 11.
    Jacobs LD, Beck RW, Simon JH, Kinkel RP, Brownscheidle CM, Murray TJ, Simonian NA, Slasor PJ, Sandrock AW (2000) Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med 343:898–904Google Scholar
  12. 12.
    Jacobs LD, Kaba SE, Miller CM, Priore RL, Brownscheidle CM (1997) Correlation of clinical, magnetic resonance imaging, and cerebrospinal fluid findings in optic neuritis. Ann Neurol 41:392–398Google Scholar
  13. 13.
    Jacobs L, Munschauer FE, Kaba SE (1991) Clinical and magnetic resonance imaging in optic neuritis. Neurology 41:15–19Google Scholar
  14. 14.
    Kalbfleisch JD, Prentice RL (1980) The Statistical Analysis of Failure Time Data. Wiley, New York Google Scholar
  15. 15.
    Marubini E, Valsecchi MG (1995) Analysing Survival Data from Clinical Trials and Observational studies. Wiley, New York Google Scholar
  16. 16.
    McDonald WI, Compston A, Edan G, Goodkin D,Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinschenker BY, Wolinsky JS (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127Google Scholar
  17. 17.
    Optic Neuritis Study Group (1997) The 5-year risk of MS after optic neuritis. Experience of the optic neuritis treatment trial. Neurology 49:1404–1413Google Scholar
  18. 18.
    Optic Neuritis Study Group (2003) High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial. Arch Ophthalmol 121:944–949Google Scholar
  19. 19.
    Paty DW, Oger JJ, Kastrukoff LF, Hashimoto SA, Hooge JP, Eisen AA, Eisen KA, Purves SJ, Low MD, Brandejs V, Robertson WD, Li DK (1988) MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding and CT. Neurology 38:180–185Google Scholar
  20. 20.
    Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231Google Scholar
  21. 21.
    Rizzo JF 3rd, Lessell S (1988) Risk of developing multiple sclerosis after uncomplicated optic neuritis: a long term prospective study. Neurology 38:185–190Google Scholar
  22. 22.
    Rodriguez M, Siva A, Cross SA, O’Brien PC, Kurland LT (1995) Optic neuritis: a population-based study in Olmsted County, Minnesota. Neurology 45:244–250Google Scholar
  23. 23.
    Sandberg-Wollheim M (1975) Optic neuritis: studies on the cerebrospinal fluid in relation to clinical course in 61 patients. Acta Neurol Scand 52:167–178Google Scholar
  24. 24.
    Sandberg-Wollheim M, Bynke H, Cronqvist S, Holtås S, Platz P, Ryder LP (1990) A long-term prospective study of optic neuritis: evaluation of risk factors. Ann Neurol 27:386–393Google Scholar
  25. 25.
    Söderström M, Jin YP, Hillert J, Link H (1998) Optic Neuritis. Prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology 50:708–714Google Scholar
  26. 26.
    Tintore M, Rovira A, Martinez MJ, Rio J, Diaz-Villoslada P, Brieva L, Borras C, Grive E, Capellades J, Montalban X (2000) Isolated demyelinating syndromes: comparison of different MR imaging criteria to predict conversion to clinically definite multiple sclerosis. AJNR Am J Neuroradiol 21:702–706Google Scholar
  27. 27.
    Yin YP, de Pedro-Cuesta J, Huang YH, Söderström M (2003) Predicting multiple sclerosis at optic neuritis onset. Mult Scler 9:135–141Google Scholar

Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • P. Nilsson
    • 1
  • E.-M. Larsson
    • 2
  • P. Maly-Sundgren
    • 2
  • R. Perfekt
    • 3
  • Magnhild Sandberg-Wollheim
    • 1
  1. 1.Department of NeurologyUniversity HospitalLundSweden
  2. 2.Department of NeuroradiologyUniversity HospitalLundSweden
  3. 3.Regional Tumour RegistryLund University HospitalLundSweden

Personalised recommendations