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High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial.

Abstract

OBJECTIVE

To identify factors associated with a high and low risk of developing multiple sclerosis after an initial episode of optic neuritis.

METHODS

Three hundred eighty-eight patients who experienced acute optic neuritis between July 1, 1988, and June 30, 1991, were followed up prospectively for the development of multiple sclerosis. Consenting patients were reassessed after 10 to 13 years.

RESULTS

The 10-year risk of multiple sclerosis was 38% (95% confidence interval, 33%-43%). Patients (160) who had 1 or more typical lesions on the baseline magnetic resonance imaging (MRI) scan of the brain had a 56% risk; those with no lesions (191) had a 22% risk (P<.001, log rank test). Among the patients who had no lesions on MRI, male gender and optic disc swelling were associated with a lower risk of multiple sclerosis, as was the presence of the following atypical features for optic neuritis: no light perception vision; absence of pain; and ophthalmoscopic findings of severe optic disc edema, peripapillary hemorrhages, or retinal exudates.

CONCLUSIONS

The 10-year risk of multiple sclerosis following an initial episode of acute optic neuritis is significantly higher if there is a single brain MRI lesion; higher numbers of lesions do not appreciably increase that risk. However, even when brain lesions are seen on MRI, more than 40% of the patients will not develop clinical multiple sclerosis after 10 years. In the absence of MRI lesions, certain demographic and clinical features seem to predict a very low likelihood of developing multiple sclerosis. This natural history information is a critical input for estimating a patient's 10-year multiple sclerosis risk and for weighing the benefit of initiating prophylactic treatment at the time of optic neuritis or other initial demyelinating events in the central nervous system.

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  • Authors+Show Affiliations

    ,

    Optic Neuritis Study Group Coordinating Center, Jaeb Center for Health Research, Tampa, FL 33647, USA. ontt@jaeb.org

    , , , , , , , , , , , , , , , , , , , , , ,

    Source

    MeSH

    Acute Disease
    Adolescent
    Adult
    Anti-Inflammatory Agents
    Brain
    Cohort Studies
    Female
    Humans
    Magnetic Resonance Imaging
    Male
    Methylprednisolone Hemisuccinate
    Middle Aged
    Multiple Sclerosis
    Optic Neuritis
    Prednisone
    Prospective Studies
    Risk Factors
    Sex Factors
    United States

    Pub Type(s)

    Clinical Trial
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    12860795

    Citation

    Beck, Roy W., et al. "High- and Low-risk Profiles for the Development of Multiple Sclerosis Within 10 Years After Optic Neuritis: Experience of the Optic Neuritis Treatment Trial." Archives of Ophthalmology (Chicago, Ill. : 1960), vol. 121, no. 7, 2003, pp. 944-9.
    Beck RW, Trobe JD, Moke PS, et al. High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial. Arch Ophthalmol. 2003;121(7):944-9.
    Beck, R. W., Trobe, J. D., Moke, P. S., Gal, R. L., Xing, D., Bhatti, M. T., ... Wall, M. (2003). High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial. Archives of Ophthalmology (Chicago, Ill. : 1960), 121(7), pp. 944-9.
    Beck RW, et al. High- and Low-risk Profiles for the Development of Multiple Sclerosis Within 10 Years After Optic Neuritis: Experience of the Optic Neuritis Treatment Trial. Arch Ophthalmol. 2003;121(7):944-9. PubMed PMID: 12860795.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial. AU - Beck,Roy W, AU - Trobe,Jonathan D, AU - Moke,Pamela S, AU - Gal,Robin L, AU - Xing,Dongyuan, AU - Bhatti,M Tariq, AU - Brodsky,Michael C, AU - Buckley,Edward G, AU - Chrousos,Georgia A, AU - Corbett,James, AU - Eggenberger,Eric, AU - Goodwin,James A, AU - Katz,Barrett, AU - Kaufman,David I, AU - Keltner,John L, AU - Kupersmith,Mark J, AU - Miller,Neil R, AU - Nazarian,Sarkis, AU - Orengo-Nania,Silvia, AU - Savino,Peter J, AU - Shults,William T, AU - Smith,Craig H, AU - Wall,Michael, AU - ,, PY - 2003/7/16/pubmed PY - 2003/8/6/medline PY - 2003/7/16/entrez SP - 944 EP - 9 JF - Archives of ophthalmology (Chicago, Ill. : 1960) JO - Arch. Ophthalmol. VL - 121 IS - 7 N2 - OBJECTIVE: To identify factors associated with a high and low risk of developing multiple sclerosis after an initial episode of optic neuritis. METHODS: Three hundred eighty-eight patients who experienced acute optic neuritis between July 1, 1988, and June 30, 1991, were followed up prospectively for the development of multiple sclerosis. Consenting patients were reassessed after 10 to 13 years. RESULTS: The 10-year risk of multiple sclerosis was 38% (95% confidence interval, 33%-43%). Patients (160) who had 1 or more typical lesions on the baseline magnetic resonance imaging (MRI) scan of the brain had a 56% risk; those with no lesions (191) had a 22% risk (P<.001, log rank test). Among the patients who had no lesions on MRI, male gender and optic disc swelling were associated with a lower risk of multiple sclerosis, as was the presence of the following atypical features for optic neuritis: no light perception vision; absence of pain; and ophthalmoscopic findings of severe optic disc edema, peripapillary hemorrhages, or retinal exudates. CONCLUSIONS: The 10-year risk of multiple sclerosis following an initial episode of acute optic neuritis is significantly higher if there is a single brain MRI lesion; higher numbers of lesions do not appreciably increase that risk. However, even when brain lesions are seen on MRI, more than 40% of the patients will not develop clinical multiple sclerosis after 10 years. In the absence of MRI lesions, certain demographic and clinical features seem to predict a very low likelihood of developing multiple sclerosis. This natural history information is a critical input for estimating a patient's 10-year multiple sclerosis risk and for weighing the benefit of initiating prophylactic treatment at the time of optic neuritis or other initial demyelinating events in the central nervous system. SN - 0003-9950 UR - https://www.unboundmedicine.com/medline/citation/12860795/full_citation L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/vol/121/pg/944 DB - PRIME DP - Unbound Medicine ER -