Optic neuritis: a 5-year follow-up study of Chinese patients based on aquaporin-4 antibody status and ages

Abstract

Little work has been performed on the long-term outcome of optic neuritis (ON) according to the status of aquaporin-4 antibody (AQP4-Ab) and long-term prognosis in older patients in China. This study retrospectively analyzed medical records in a cohort of Chinese patients with 5-year follow-up according to AQP4-Ab status and ages from January 2009 to December 2010. The clinical features, laboratory findings and risk factors for prognosis were analyzed. A total of 128 ON patients were included, 66.4 % of whom were female. The median age at onset was 36.8 years (range 18-73). Serum AQP4-Ab was positive in 45 (35.2 %) patients, with greater frequency in the female, bilateral, and recurrent ON groups (48.2, 42.5 and 53.6 %, respectively). Seropositive AQP4-Ab ON patients had worse visual recovery compared to seronegative patients (p = 0.033). The average and four quadrants of retinal nerve fiber layer (RNFL) thickness were significantly thinner in the seropositive group than in the seronegative group (p < 0.05). At 5-year follow-up, the ON recurrence rate was higher in the seropositive AQP4-Ab patients (37/45, 82.3 %) than in the seronegative patients (35/83, 42.2 %, p < 0.001). Among the seropositive patients, 40 % (18/45) developed neuromyelitis optica (NMO). Only 1.2 % (1/83) of the seronegative patients developed NMO and 4.8 % (4/83) developed to MS. Further, the multivariate analysis in seropositive AQP4-Ab patients showed that two risk factors for transverse myelitis (TM) episode were ocular pain and recurrence within 1 year. The older patients had worse visual outcome after the first episode of ON than the younger patients (p = 0.007). However, the two groups did not differ significantly with regard to prevalence of AQP4-Ab, long-term visual recovery and the risk of developing to NMO/MS.

Distinct clinical characteristics of atypical optic neuritis with seronegative aquaporin-4 antibody among Chinese patients

“…The female:male ratio (1:2.1) was significantly lower in our atypical ON than in our typical ON (1.8:1) and NMOSD-ON (9:1) groups and was also lower than that previously reported by the ONTT (3:1),20 Lin et al (1:1),21 Zhou  et al (2:1)10 and Quek et al (ranging from 3:1 to 9:1) 22. This gender difference has not been previously reported.…”

“…Most previous studies of atypical ON were biased by a mixed population of AQP4 antibody seropositive and seronegative 2 12. It is well known that ON with AQP4 antibody seropositivity is associated with more bilateral involvement, more severe vision loss and poor vision recovery 10. The clinical features of atypical ON with seronegative AQP4 antibody in China remain elusive and should be studied in depth as a separate entity.…”

Bilateral and Simultaneous Retrobulbar Optic Neuritis Revealing Multiple Sclerosis

“…In the more recent series and due to the recognition of new specific entities (neuromyelitis optica spectrum disorder and anti-myelin oligodendrocyte glycoprotein autoantibody-related demyelinating diseases) and their association with specific auto-antibodies (antiaquaporin 4 and anti-MOG); the transformation of initially isolated optic neuritis to multiple sclerosis becomes significantly less, particularly in subjects negative for anti-aquaporin 4-autoantibodies: only four patients/83 (4.8%) after a five year follow-up in the Zhou et al series [3].…”

“…However, bilateral, simultaneous and revealing presentations of the disease remain exceptional and unusual [3,4]. We report an observation.…”

“…Its age-adjusted incidence in the Nordic countries is estimated at 2.2 to 2.5 per 100,000 [2]. It is usually acute, unilateral and often recurrent [3]. The etiological diagnosis of this optic neuropathy represents a real challenge for the clinician given the multitude of possible causes.…”