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Isolated optic neuritis and its prognosis for multiple sclerosis: a clinical and paraclinical study with evoked potentials. CSF examination and brain MRI

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Abstract

Our study evaluated the frequency of developing multiple sclerosis (MS) after acute isolated optic neuritis (ON), the possible association with risk factors (gender, age), and the diagnostic and prognostic role of paraclinical tests. We studied 100 ON patients (mean age 28.9 years: SD 8.9): 85 patients were regularly followed up. Sixty-six patients underwent multimodality evoked potential (EP) test, CSF examination and brain MRI within six months of the onset of ON.

Over a mean follow-up of 5.2 years, MS occurred in 28/85 cases. The risk of developing MS after four years was 0.35 at life-table analysis, regardless of gender or age at the onset of ON. Visual EPs in unaffected eyes were abnormal in 25.4%, brainstem auditory EPs in 6.5%, somatosensory EPs in 8.1%, upper limb motor EPs in 6.8% of the tested patients; intrathecal IgG synthesis was revealed in 51.7% and MRI lesions in 73.8%. Fifty-one of the patients who underwent paraclinical tests were followed up for more than one year, and MS occurred in 13 cases. All of these presented MRI lesions, nine intrathecal IgG synthesis, and two abnormal extraocular EPs. The risk of developing MS after four years was 0.33 in patients with MRI lesions; the simultaneous presence of intrathecal IgG synthesis increased the risk to 0.46.

Sommario

Il nostro studio ha valutato la frequenza di sviluppo di sclerosi multipla (SM) dopo un attacco acuto di nevrite ottica retrobulbare (NORB), la possibile associazione con fattori di rischio quali l'età e il sesso, il ruolo diagnostico e prognostico di test paraclinici. Sono stati studiati 100 pazienti affetti da NORB con età media 28,9 anni (SD 8,9), 85 dei quali seguiti in follow-up ad intervalli periodici. Sessantasei pazienti sono stati sottoposti a potenziali evocati (PE) multimodali, esame liquorale ed esame di risonanza magnetica cerebrale entro 6 mesi dalla NORB.

Dopo un follow-up medio di 5,2 anni, la SM si è sviluppata in 28/85 casi. A 4 anni il rischio di sviluppare la SM è risultato pari allo 0,35 allo studio mediante tavole di sopravvivenza, indipendentemente dal sesso e dall'età dei pazienti. I PE visivi sono apparsi alterati nel 25,4% degli occhi non colpiti da NORB, i PE acustici nel 6,5%, i sensoriali nell'8,1%, i motori dell'arto superiore nel 6,8% (su 44 casi).

Cinquantacinque pazienti sottoposti a test paraclinici presentavano un follow-up maggiore di 1 anno. La SM si è sviluppata in 13: tutti presentavano lesioni all'esame RMN, 9 presentavano indici di sintesi intratecale di IgG, 2 alterazioni ai PE extravisivi. Il rischio di sviluppare la SM a 4 anni è risultato di 0.33 nei pazienti con lesioni RMN, la presenza di indici di sintesi intratecale di IgG aumentava il rischio a 0,46.

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Authors and Affiliations

  1. Centro Studi Sclerosi Multipla, Università di Milano, Ospedale di Gallarate, Italy

    Ghezzi A. & Zaffaroni M.

  2. Istituto Mario Negri, Milano

    Torri V.

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  1. Ghezzi A.
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  2. Torri V.
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This study was partially supported by Associazione Amici Centro Studi Sclerosi Multipla, Gallarate, Italy.

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Ghezzi, A., Torri, V. & Zaffaroni, M. Isolated optic neuritis and its prognosis for multiple sclerosis: a clinical and paraclinical study with evoked potentials. CSF examination and brain MRI. Ital J Neuro Sci 17, 325–332 (1996). https://doi.org/10.1007/BF01999894

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