Idiopathic Optic Neuritis Research Articles

Cerebrospinal fluid antibodies to myelin basic protein in acute idiopathic optic neuritis

Free and bound levels of anti-myelin basic protein (anti-MBP) antibodies were measured by radioimmunoassay in the cerebrospinal fluid of 20 patients with acute idiopathic optic neuritis, 133 patients with multiple sclerosis (MS) divided into three clinical subgroups, and 76 normal control subjects. Patients with idiopathic optic neuritis had elevated levels of anti-MBP predominantly in free form, resulting in an elevated (above unity) free/bound anti-MBP ratio similar to that of MS patients with acute relapses. These data suggest that acute idiopathic optic neuritis, like active MS, is associated with anti-MBP.

Evaluation of central nervous system involvement in uncomplicated optic neuritis after prolonged follow-up.

Magnetic resonance imaging (MRI), multimodal evoked responses (ER) and HLA antigens were examined in 10 patients with idiopathic acute optic neuritis (ON) without any clinical symptoms or signs of multiple sclerosis (MS) during 9-14 years. In MRI, abnormalities compatible with MS were seen in 4 patients. In spite of clinically unilateral ON, a bilateral abnormality in visual evoked responses (VER) was seen in 3 of 9 cases. Brain stem auditory evoked responses (BAER) were normal in all cases, short latency somatosensory evoked response (SER) in all but one. The cerebrospinal fluid at time of ON showed signs of demyelination in one case only. The frequency of HLA antigens DR2 (78%) and B18 (40%) was significantly increased in comparison to healthy controls. MRI seems to be the most sensitive method in the detection of cerebral lesions of MS, especially in mild or asymptomatic forms of the disease. The present techniques are, however, mostly unable to demonstrate optic nerve lesions which more reliably can be evaluated by VERs. The question whether idiopathic ON represents a form of MS solely, cannot be resolved.

A reassessment of the risk of multiple sclerosis developing in patients with optic neuritis after extended follow-up.

One hundred and one of 146 patients presenting with isolated idiopathic optic neuritis, previously reviewed in 1978, were reassessed clinically, and retyped for HLA antigens and Factor B alleles, after a mean follow-up of 11.6 years. Fifty eight patients (57%) had developed multiple sclerosis at the time of reassessment in the present study, of whom 51 (88%) had clinically definite disease. This compared with 40% of the original group, in 1978, of whom 62% then had clinically definite multiple sclerosis. When the life-table method of analysis was used, the probability of developing multiple sclerosis was 75%, 15 years after the initial episode of optic neuritis. The frequencies of HLA-DR2 and the recently defined D-region antigen, DQw1, were significantly increased in patients with isolated optic neuritis and those who subsequently developed multiple sclerosis compared with normal controls, but neither allele appears to influence progression from optic neuritis to multiple sclerosis. Patients with optic neuritis who were HLA-DR3 positive had an increased risk for the development of multiple sclerosis (RR = 2.8) and this risk was further enhanced when DR3 occurred in combination with DR2 (RR = 6.7). The overall increased risk of developing multiple sclerosis for patients with this combination was 26 times that for the normal population. When the patients' original tissue-typing was considered BT 101 no longer influenced conversion of optic neuritis to multiple sclerosis. This may partly be explained by improved methods of tissue-typing, since not all BT 101 patients were subsequently found to be positive for HLA-DR2 or HLA-DQw1 and vice versa and by extended follow-up as multiple sclerosis conversion in HLA-DR2 negative individuals increased with time. All 101 patients were typed for Factor B alleles. No significant differences in frequencies were found between individuals with isolated optic neuritis or those who progressed to multiple sclerosis compared with the control population. Recurrent episodes of optic neuritis were associated with an increased risk for the development of multiple sclerosis in this study.

Silent brain lesions in patients with isolated idiopathic optic neuritis: by L. Jacobs, P.R. Kinkel and W.R. Kinkel. Arch Neurol 43:452–455, 1986

Silent brain lesions in patients with isolated idiopathic optic neuritis: by L. Jacobs, P.R. Kinkel and W.R. Kinkel. Arch Neurol 43:452–455, 1986

Silent brain lesions in patients with isolated idiopathic optic neuritis. A clinical and nuclear magnetic resonance imaging study.

Eight of 16 patients with isolated idiopathic optic neuritis were found to have one to several brain lesions by nuclear magnetic resonance scanning. The brain lesions were predominantly located in the periventricular white matter; their appearances, locations, and extents were similar to those seen in recent nuclear magnetic resonance studies of patients with definite multiple sclerosis. All of these brain lesions were clinically silent and were missed by computerized tomography. Idiopathic optic neuritis may be the only manifestation of a multicentric disease process that is disseminated in the central nervous system in the majority of cases.

Optic neuritis or multiple sclerosis.

The primary question at hand is how often after a first bout of isolated idiopathic optic neuritis (ON) is there progression to multiple sclerosis (MS). Dr Ebers has summarized admirably many of the problems underlying studies of this point, which studies have led to results as disparate as seven cases of MS out of eight ON cases and one case out of eight. He concludes that recurrent ON is MS, and suspects that isolated ON is also MS. Until we know the etiology, I believe we must continue with the pragmatic definition of MS as a clinical entity whose signs and symptoms indicate lesions scattered in time and space in the central nervous system white matter. Two optic nerves are not discrete enough to be multiple, in my view. Also, MS is a prognosis as well as a diagnosis: we predict that further dysfunction will ensue over time in

Ischemic Optic Neuropathy: Still the Ophthalmologist's Dilemma

Ischemic optic neuropathy, in its arteritic and idiopathic varieties, presents both diagnostic and therapeutic challenges to the clinician, specificially: the role of temporal artery biopsy in management of giant cell arteritis; the preferred treatment regimen for giant cell arteritis, including decisions to begin tapering therapy and stopping therapy; action to take if major steroid complications arise while the disease is still active; distinguishing anterior ischemic optic neuropathy from idiopathic optic neuritis; whether cerebral arteriography is indicated in the assessment of idiopathic ischemic optic neuropathy; and whether steroid therapy is of any value in the treatment of idiopathic ischemic optic neuropathy.

The incidence of optic neuritis and its prognosis for multiple sclerosis.

An incidence study of idiopathic optic neuritis (ON) was carried out in 2 geographic areas of Finland for the 9-year period 1970 to 1978. The southern province of Uusimaa composes a medium-risk and the western province of Vaasa a high-risk area for multiple sclerosis (MS). The risk for subsequent MS was determined. A total of 315 attacks on ON were recorded in 296 patients. The mean annual age-adjusted incidence for ON in Uusimaa was 2.2 and in Vaasa 2.5 per 100,000 population. The incidence figures remained unchanged all the time. The mean age at onset was 30 years. 19% of ON patients developed MS during the mean follow-up period of 5.1 years. When the life-table method of analysis was used, the probability of developing MS was 38% in Uusimaa and 24% in Vaasa 9 years after acute optic neuritis. In Uusimaa the risk of women for MS was significantly higher than in men. In 47%, the MS symptoms and signs developed within 1 year and in 90% within 5 years after the initial bout of ON. It is possible that only one part of idiopathic ON cases do have a relationship with MS.

HLA-DW2, viral immunity and family studies in multiple sclerosis

Fifty patients with definite multiple sclerosis (MS) (as defined by McAlpine's criteria on clinical examination including visual evoked responses) were typed for 13 HLA-A locus and 19 HLA-B locus antigens. The frequency of HLA-A3 was 46% (Sydney normal 28%) and that of HLA-B7 was also 46% (normal 27%). The frequency of HLA-BW17 was reduced at 2% (normal 10%). Forty patients were studied in mixed lymphocyte culture with homozygous HLA-DW2 (LD 7a) typing cells. Twenty of these patients were HLA-B7 positive and 20 HLA-B7 negative. Twenty-five of the 40 (62.5%) were positive for HLA-DW2 (relative response range 1–15%). By contrast only 6 of 34 normals (18%) were positive for HLA-DW2. Of the 20 HLA-B7 positive patients 17 were also HLA-DW2 positive (85%), while 8 of the 20 HLA-B7 negative patients were HLA-DW2 positive (40%). Nine of the patients had suffered from optic neuritis as the sole presenting manifestation of disease. Four of these were HLA-B7 positive and only 5 were HLA-DW2 positive, i.e. the absence of HLA-DW2 in a patient with idiopathic optic neuritis does not exclude MS. Both humoral (antibody titre) and cell-mediated (lymphocyte transformation) immunity to 5 viruses (measles, rubella, parainfluenza 3, mumps and herpes simplex) were studied in 40 MS patients using their normal spouses as controls. No significant difference in viral responses was found and no correlation between HLA typing (A, B locus or HLA-DW2) and viral immunity was detected. A linkage study on all available Australian families with more than 1 member suffering from MS is in progress. To date, the affected members of 4 families have failed to share an HLA haplotype.

Optic neuritis and multiple sclerosis. An epidemiologic study.

Since optic neuritis occurs frequently in multiple sclerosis (MS), it has been thought to herald the onset of MS in the young adult where no specific cause can be identified. This study was designed to examine the incidence of optic neuritis in the resident population of Rochester, Minn, in order to clarify the relationship between optic neuritis and MS. Thirteen to fifteen percent of the patients with MS in the Rochester population presented with optic neuritis, and 27% to 37% of the MS patients showed evidence of optic neuritis during the course of their disease. Prospective analysis of idiopathic optic neuritis cases revealed that the chance of its progressing to MS was approximately 17%. The unfavorable prognosis previously associated with idiopathic optic neuritis may be the result of a bias of clinical series.

An overview of idiopathic optic neuritis in eastern Nepal

Inflammation of the optic nerve is a common cause of visual loss due to optic nerve pathology. To report the clinical features, demographic pattern and response to pulse steroid therapy in patients with idiopathic optic neuritis in eastern Nepal. The hospital data of patients with idiopathic optic neuritis admitted to the department of ophthalmology in a tertiary level center in eastern Nepal between Jan 2000 to Dec 2006 were retrospectively analyzed. The parameters studied were demographic pattern, clinical features, visual acuity and field defects. Thirty-six patients (52 eyes) were found to have optic neuritis (papillits in 36 and retrobulbar optic neuritis in 16 eyes). The male to female ratio was 1.25:1. The mean age of the patients was 33.56 +/- 17.88 years (95% CI = 24.66-42.45). The most common modes of presentation were loss of visual acuity and color vision defect. One patient had features suggestive of multiple sclerosis. Vision improved in 42 eyes at discharge from the hospital. Response to pulse methylprednisolone therapy was good in most (42 eyes) of the cases except for the patients having initial visual acuity of no light perception. Response to pulse methylprednisolone therapy is good in patients with initial visual acuity of at least perception of light. Demographic and clinical features of our patients were different from those reported from the western world. Some similarity was observed between studies reported from the oriental countries.