MULTIPLE SCLEROSIS RISK AFTER OPTIC NEURITIS

[sllowe]

     Check this out - results from follow up study/trial:
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Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up

Optic Neuritis Study Group.
Collaborators (28)

Brodsky M, Nazarian S, Orengo-Nania S, Hutton GJ, Buckley EG, Massey EW, Bhatti MT, Greer M, Goodwin J, Wall M, Savino PJ, Leist T, Miller NR, Irani D, Trobe JD, Cornblath W, Kaufman DI, Eggenberger E, Kupersmith MJ, Shults WT, McAllister L, Hamilton S, Beck RW, Dontchev M, Gal RL, Kollman C, Keltner JL, Smith CH.

OBJECTIVE: To assess the risk of developing multiple sclerosis (MS) after optic neuritis and the factors predictive of high and low risk. DESIGN: Subjects in the Optic Neuritis Treatment Trial, who were enrolled between July 1, 1988, and June 30, 1991, were followed up prospectively for 15 years, with the final examination in 2006. SETTING: Neurologic and ophthalmologic examinations at 13 clinical sites. PARTICIPANTS: Three hundred eighty-nine subjects with acute optic neuritis. MAIN OUTCOME MEASURES: Development of MS and neurologic disability assessment. RESULTS: The cumulative probability of developing MS by 15 years after onset of optic neuritis was 50% (95% confidence interval, 44%-56%) and strongly related to presence of lesions on a baseline non-contrast-enhanced magnetic resonance imaging (MRI) of the brain. Twenty-five percent of patients with no lesions on baseline brain MRI developed MS during follow-up compared with 72% of patients with 1 or more lesions. After 10 years, the risk of developing MS was very low for patients without baseline lesions but remained substantial for those with lesions. Among patients without lesions on MRI, baseline factors associated with a substantially lower risk for MS included male sex, optic disc swelling, and certain atypical features of optic neuritis. CONCLUSIONS: The presence of brain MRI abnormalities at the time of an optic neuritis attack is a strong predictor of the 15-year risk of MS. In the absence of MRI-detected lesions, male sex, optic disc swelling, and atypical clinical features of optic neuritis are associated with a low likelihood of developing MS. This natural history information is important when considering prophylactic treatment for MS at the time of a first acute onset of optic neuritis.

I will post the link to our favorites links HP!

-Shell

[LATW]

This is interesting to me because I presented with ON last May and had one old lesion and one new lesion on the MRI.  The radiologist said in his report that the lesions were not in the typical area for MS, right frontal lobe, but could still be related to a demyelination disease.

So I went to two neurologist who could not make up their minds on what caused these lesions because they were not in the "typical" place for MS.  I had a second occurrence of ON in the same eye within 8 months of the first.  I finally went to an official MS clinic and was diagnosed with MS that day.

Right now I am in a flare or progressing.  My MS doctor has sent me to PT and changed some of my meds to help him determine what is going on.  I have progressed to the point of needing assistance to walk because of falls.

I do ok around my house because I can hold onto things but outside I do need the rollator.  Anyway, this is interesting.  So maybe times I have wondered if I have the correct diagnosis. Denial!  Guess maybe I do.  

LA

[Quixotic1]

Wow, I've been waiting for the final analysis of the ONTT (Optic Neuritis Treatment Trial) to come out.  This is great and gives us much more info.

Things to take away -

ON coupled with ONE or more brain lesions has a 72% likelihood of developing to MS within the next decade and a half.

ON without any lesions still had a 25% chance of developing it - even less if they had swelling of the optic disc with the ON, were male or - I'll have to read the whole study to see what the other parameters that made MS less likely.

Optic Neuritis is one of the types of Isolated Clinical Syndrome and so these additional predictive factors will help doctors make the decision whether to treat.

Is anyone willing to look at the whole ONTT and summarize it for a Health Page - maybe along with a description of optic neuritis?

Quix