Abstract
Longitudinal studies have shown that brain white matter lesions are strong predictors of the conversion of unilateral optic neuritis to multiple sclerosis (MS) in Caucasian populations. Consequently brain MRI criteria have been developed to improve the prediction of the development of clinically definite multiple sclerosis (CDMS). In Asian populations, optic neuritis may be the first sign of classical or optic-spinal MS. These signs add to the uncertainty regarding brain MRI changes with respect to the course of unilateral optic neuritis. The aim of this study was to examine the association between brain lesion activity and conversion to CDMS in Chinese patients with unilateral optic neuritis. A small prospective cohort study of 40 consecutive Chinese patients who presented with unilateral optic neuritis was conducted. Brain lesion activity was recorded as the incidence of Gd-enhanced lesions and new T2 lesions. Brain lesions on MRI that were characteristic of MS were defined according to the 2010 revisions of the McDonald criteria. The primary endpoint was the development of CDMS. We found that nineteen patients (48%) had brain lesions that were characteristic of MS on the initial scan. One of these patients (3%) had Gd-enhanced brain lesions. A significantly lower percentage of the patients (10%, p<0.001) presented with new T2 brain lesions on the second scan. During a median of 5 years of follow-up, seven patients (18%) developed CDMS. There was no significant difference in the conversion rate to CDMS between patients with and without brain lesions that were characteristic of MS (4/19 and 3/21, respectively; Fisher exact test, one-sided, p = 0.44). We conclude that brain lesions characteristic of MS are common in Chinese patients with unilateral optic neuritis; however, these patients exhibit low lesion activity. The predictive value of brain lesion activity for CDMS requires investigation in additional patients.
Highlights
Longitudinal studies have shown that brain white matter lesions are strong predictors of the conversion of unilateral optic neuritis to multiple sclerosis (MS) in Caucasian populations
This study found that 55% of Chinese patients with unilateral optic neuritis demonstrated brain lesions and that 48% of the patients had brain lesions that were characteristic of MS
We found no significant difference in the conversion rate to clinically definite multiple sclerosis (CDMS) between patients with and without brain lesions that were characteristic of MS on the initial scan (21% and 14%, respectively)
Summary
Longitudinal studies have shown that brain white matter lesions are strong predictors of the conversion of unilateral optic neuritis to multiple sclerosis (MS) in Caucasian populations. The cumulative probability of developing clinically definite multiple sclerosis (CDMS) within 5 or 15 years after the onset of optic neuritis is 51% and 72%, respectively, among those displaying white matter lesions on brain MRI at baseline [1, 2]. Unilateral Optic Neuritis in Chinese to CDMS (89% of 42 patients) was reported after 10 years of follow-up [3]. A recent study found that the presence of lesions characteristic of MS displayed high specificity (>90%) for predicting conversion to CDMS in patients who have experienced a clinically isolated syndrome [4]. That study included 67 patients with unilateral optic neuritis
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