Question Title: Optic Neuritis: is it MS, is it isolated ON? two diagnoses! Help!

Forum: The Eye Care Forum
Topic: Misc (Eye Problems)

Hello all.

I've been reading the optic neuritis subject with interest and have not found my question so I'd thought I'd post.

I'm a 42 year old white female with near perfect health record until the past year and one half. (Except thqt 9 years ago had a fever 100-101 after batteries of tests diagnosed as "FUO" (fever of unknown origin.)) And between Octo 97 and Jan 98 had six attacks of pancreatitis.

Last May I had my first bout of Optic Neuritis in my left eye, as diagnosed by my Ophthamologist. I had an MRI, which was "clear" -- ruling out MS. The bout lasted a couple of months, and my vision did not return to normal. (mainly color reduction of reds and golds -- I'd say 20% but still had 20/20 acuity and bad pain, aching & upon movement) Neurologists ordered a Visual Evoked Potential which slight damage to left eye. Visual Field test should some blind spots

Diagnoses was isolated ON. And was seconded by a second opinion buy Neuro-ophamologist at Jules Stein Eye Inst.

In Dec/Jan of this year had a worsening of vision, but not pain. Ophthamologist confirmed another bout of ON in same eye. Spinal Tap was performed by Neurlogist.

Abnormal results were: "Oligoclonal bands present in the CSF but not in the corresponding serum. This finding indicates abnormal synthesis of IgG in the CSF and is supportive evidence for MS."

synthesis rate IgG, CSF: High: +7.9 in ref range: -9.9 to +3.3
IgG Index, CSF: High: +1.09 in ref range: less than 0.66

All else in CSF appears normal.

Had a second MRI : Results still "clear"

Neurologists have diagnosed me with MS based upon the two bouts of ON & the abnormal findings in the spinal tap. Neurologists recommending ABC therapy for MS even though I don't technically meet the criteria (2 bouts in 2 separate parts of body separated by a month). I have no other MS symtoms.

BUT

My Ophthamologist says his opinion is that I've had two separate bouts of isolated Optic Neuritis and that his opinion is that I do NOT have MS and should NOT take the drugs. He said that the spinal tap is not enough eveidence to diagnose MS and that of course the readings would be "off" as I was still in a state of ON. (It was ~4 weeks after his exam)

When I presented that argument to the neurologist he said the ophthamolgist was not correct. The neurologist agrees with the Ophthamolgist that I do not technically meet the MS criteria, but in his opinion says I have MS.

My Internist is siding with the Neurologist. He says take the drugs.

All of them say it is "my decision" (re: drug therapy). It feels like I have to make the decision which doctor to believe and to that end: I am deciding if I have MS or just isolated ON.

Other possibly pertinent data: ANA was elevated. Lupus has been ruled out by Rheumatologist. Lyme has been tested for: neg. My Anticardiiolipin Antibodies ARE elevated at positive 25.

I don't want this disease. I don't want to make the wrong decision. Any advice???

Torn between two doctors....

Thanks so much,

Christine

(apologies for misspellings.)

christine-
i understand your confusion and frustration. MS is a very difficult disease to diagnose, and i have to tell u that it is a CLINICAL diagnosis- that is to say u diagnose it based on signs and symptoms- NOT on tests like an MRI. officially one is looking for 2 occurences separated by "time and space". this means that technically 2 bouts of optic neuritis alone do not meet the criteria- however while ophthalmologists such as myself are well versed on ON and how it relates to MS, most of us would not begin to argue with a qualified neurologist over the treatment of potential MS- so i will not attempt to decide which doctor is "right"- that would be impossible, if not unethical, in a forum like this. i will say that there is one other type of doctor u may want to consult with if u have not already, and that is a NEURO-OPHTHALMOLOGIST- they are well versed in all aspects of MS and it's relationship to ON. i wish u the best of luck.

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