Neurological outcome and predictive factors of idiopathic optic neuritis in China.

BACKGROUND: The neurological outcome and predictive factors of idiopathic optic neuritis (ION) in China are largely unknown. OBJECTIVE: The aim of this paper is to study the neurological outcome of Chinese ION and to investigate the early predictors for multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). METHOD: Retrospective medical record review and supplementary follow-up of 107 ION patients was performed. Statistical analysis of the baseline characteristics as risk factors for ION patients converting into MS or NMOSD was performed. RESULTS: With an average disease course of 9.5years, 19 of the 107 (17.7%) ION patients developed either MS (9, 8.4%) or NMOSD (10, 9.3%). The estimated 5-year and 10-year combined accumulative risk rates were 14.1% and 26.0%, respectively. Significantly higher estimated accumulative conversion risk was found in female versus male (P=0.047), adult versus children (P=0.032), patients with brain MRI lesions versus patients without leasions (P=0.026), patients with CSF positive oligoclonal bands and/or elevated IgG index versus without (P=0.003) and patients with poor visual recovery versus patients with good recovery (P=0.007). Furthermore, brain white matter lesions and good visual recovery were statistically more common typically in MS converters compared with the NMOSD converters (P=0.01 and P=0.006, respectively). CONCLUSION: The combined conversion rate for ION to MS/NMO in Chinese population was lower than the reported rate for Western countries. In addition to some previously reported high risk factors, white matter lesions on the brain MRI at baseline and good visual recovery were found to be good predictors for Chinese ION converting into MS whereas poor visual recovery with a normal brain MRI suggested a higher likelihood of the ION converting into NMOSD.

[Etiologic analysis of 487 cases of ophthalmoplegia].

OBJECTIVE: To study the etiology of ophthalmoplegia cases. METHODS: A retrospective case series study. We summarized and analyzed etiological diagnosis of 487 ophthalmoplegia patients from January 2005 to September 2010 in Beijing Tongren Hospital of Capital Medical University and Beijing Tongren Eye Center. Clinical data included the case history, clinical manifestations, and results of examinations of neurology, ophthalmology, endocrinology and iconography. The analysis of variance (ANOVA) and Chi-Square test were used in our study. RESULTS: Nineteen different kinds of causes were identified. In terms of age onset, microvascular ischemic (MVI) patients were the oldest (60.38 +/- 11.16) in all groups. It significantly distinguished from myasthenia gravis (MG) and local non-specific inflammation (F = 24.46, P = 0.000). From the view of ophthalmoplegia characters, bilateral asymmetry ophthalmoplegia was the character of MG. We also found that all MVI patients had lesions in unilateral single ocular movement nerve. Unilateral multiple nerves or muscles lesions were the main feature of local non-specific inflammation. In addition, from the view of concomitant symptoms, local aching was very frequent in local non-specific inflammation (all 60 cases) and MVI (44 cases) patients (Chi2 = 36.346, P = 0.000). The mild pupil changing could be found in about one half patients of the two diseases (Chi2 = 0.026, P = 0.875). CONCLUSIONS: The causes of ophthalmoplegia are very complicate. MG, MVI and local non-specific inflammation are the most frequent causes. In more than half of patients, the lesions are located in neurological system, about one third located in neuromuscular junction and the least in the muscles.