Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis

Abstract

Objective: To identify clinical and demographic features associated with the severity and recovery from acute optic neuritis (AON) episodes in patients with multiple sclerosis (MS).Methods: Adult (n 5 253) and pediatric (n 5 38) patients whose first symptom was AON were identified from our MS database. Severity measured by loss of visual acuity (mild attack #20/40, moderate attack 20/50-20/190, and severe attack $20/200) and recovery in visual acuity at 1 year after the attack (complete recovery #20/20, fair recovery 20/40, and poor recovery $20/50) were recorded. Demographic and clinical features associated with attack severity and recovery were identified using proportional odds logistic regression. For another group of patients, blood samples were available within 6 months of an AON attack. In this group, the impact of vitamin D level on the severity/recovery was also assessed.Results: Men (adjusted odds ratio [OR] 5 2.28, p 5 0.03) and subjects with severe attacks (adjusted OR 5 5.24, p , 0.001) had worse recovery. AON severity was similar between the pediatric and adult subjects, but recovery was significantly better in pediatric subjects in the unadjusted analysis Acute optic neuritis (AON) is an inflammatory disorder of the optic nerve and the initial presenting symptom of multiple sclerosis (MS) in approximately 15% to 20% of patients.1,2 There is wide variability in the severity and recovery from AON among patients with MS, and clinical predictors of AON severity or recovery are not well understood. Previous work has demonstrated that severity and recovery from the initial relapse are associated with severity and recovery for subsequent relapses, but factors specifically affecting AON attacks have not been sufficiently studied.

Pediatric optic neuritis

“…13 The rate of VF defects in acute ON in children is unknown, but they occur in 97.5% of adult ON. 14 In children, prolonged P100 latencies on visual evoked potential (VEP) testing are frequent in the acute phase, 15 but it is unclear whether children, who may have excellent recovery from ON, 16 are more likely than adults to have normalized VEP waveforms in long-term follow-up. 17 Of importance, although ON may be clinically limited to one eye in many cases, electrophysiologic studies of pediatric MS suggest that bilateral involvement occurs frequently in pediatric MS even in the absence of overt ON in the fellow eye.…”

“…18 FUNCTIONAL AND STRUCTURAL OUTCOMES The majority (58%-97%) of children have been found to experience full high-contrast visual acuity (HCVA) recovery (better than 20/30 or 20/40) in separate observational US (n 5 15 and n 5 29), Canadian (n 5 36), and UK (n 5 44) cohorts. 2,7,16,19 Although recovery of HCVA is excellent, children often report subjective visual abnormalities after ON that HCVA cannot capture, likely secondary to injury to the optic nerve, including axonal degeneration.…”

Bilateral and Simultaneous Retrobulbar Optic Neuritis Revealing Multiple Sclerosis

“…However, this optic neuropathy may be the initial symptom of the disease in approximately 15 to 20% of cases [11]. In the Tunisian series of Sidhom et al 20% of adult patients with multiple sclerosis began their disease with isolated optic neuritis [9].…”

Time to steroid treatment in severe acute optic neuritis

“…Among patients with severe ON, an inverse relationship between pRNFL thickness (i.e., optic disc edema) and visual acuity was observed for nontreated patients, which is in agreement with previous findings (Beck et al., 1992; Henderson et al., 2010; Malik et al., 2014). The possible mechanism for the steroid treatment effect may involve a suppression of the inflammation associated with acute ON, which in turn may limit the neuronal damage and accelerate visual function recovery (Beck et al., 1992; Kapoor et al., 1998; Sellebjerg, Nielsen, Frederiksen, & Olesen, 1999).…”