ABSTRACT
PURPOSE: To study the symptoms and signs one year after optic neuritis. METHODS: Seventy population-based untreated patients, (44F, 26M; median age 35 years, range 14-48 years) were eligible for study, but the 11 bilateral cases were excluded. Among 59 patients participating in a one-year follow-up of the visual function, 58 answered a questionnaire. RESULTS: At follow-up 59% of the patients complained of visual impairment, though 49% of these patients had a Snellen visual acuity of 6/9 or better. The affected eyes showed decreased visual acuity in 34%, decreased contrast sensitivity in 63%, an abnormal score in 40% with the Lanthony D-15 desaturated panel, and in 13% with the Ishihara test, prolonged latencies of VEP in 58%, and decreased amplitudes of VEP in 41%. CONCLUSIONS: All tests except for VEP correlated significantly to the degree of perceived visual impairment. Subjective visual complaints and more sensitive tests than visual acuity should be used to evaluate the visual function following optic neuritis.
Subject(s)
Color Perception/physiology , Contrast Sensitivity/physiology , Evoked Potentials, Visual/physiology , Optic Neuritis/etiology , Vision Disorders/physiopathology , Visual Acuity/physiology , Acute Disease , Adolescent , Adult , Child , Female , Follow-Up Studies , Humans , Male , Middle Aged , Optic Neuritis/physiopathology , Surveys and QuestionnairesABSTRACT
Prospectively referred patients with unilateral acute optic neuritis (ON) (n = 223; aged 12-57; 158 women), either idiopathic or part of clinically definite multiple sclerosis (CDMS), were systematically examined by the same physician. We analysed whether the 161 patients with retrobulbar neuritis and the 62 patients with papillitis differed from each other clinically or according to paraclinical tests. The following characteristics were observed in retrobulbar ON respectively papillitis: median age 33 and 33 years, women 70% and 73%, clinically definite MS 30% and 27%. Abnormal results in retrobulbar ON and in papillitis (indicated in brackets) did not differ significantly and were found as follows: cerebral MRI in 56% (63%), VEP from the eye with acute ON in 82% (88%), VEP from the eye without acute ON in 38% (33%), SEP from median nerves in 9% (10%), SEP from tibial nerves in 22% (22%) and biotesiometry in 32% (27%). In the CSF, oligoclonal bands were present in 42% (53%), increased IgG-index in 40% (44%) and increased leucocyte count in 39% (29%). The HLA-DRI5 tissue type was present in 47% (43%). There were no significant differences between retrobulbar ON and papillitis when the idiopathic cases and cases with clinically definite MS were analysed separately. Our data document that unilateral retrobulbar ON and papillitis are both part of the MS spectrum and not different from each other with regard to clinical and paraclinical parameters, indicating that the two groups can be pooled in future treatment trials.
Subject(s)
Multiple Sclerosis/complications , Optic Disk/pathology , Optic Neuritis/etiology , Acute Disease , Adolescent , Adult , Child , Female , Functional Laterality/physiology , Humans , Male , Middle Aged , Prospective Studies , Sensitivity and SpecificityABSTRACT
OBJECTIVE: To study the intrathecal synthesis of anti-myelin basic protein (MBP) and anti-proteolipid protein (PLP) antibodies in patients in the early stages of multiple sclerosis. DESIGN AND SETTING: A study of consecutive patients with acute optic neuritis (ON) who were undergoing lumbar punctures in an ambulatory unit. PATIENTS: Eleven patients with acute idiopathic ON and 14 patients with acute ON as a symptom of definite multiple sclerosis (the diagnosis of which was supported by clinical or laboratory findings). Nineteen patients with other neurological diseases (10 with inflammatory diseases) served as controls. MAIN OUTCOME MEASURES: Numbers of anti-MBP and anti-PLP antibody-secreting cells in peripheral blood and cerebrospinal fluid samples that were enumerated with an immunospot assay. RESULTS: Cerebrospinal fluid cells that secreted anti-MBP or anti-PLP antibodies were detected in 10 of 15 and in 21 of 23 patients with acute ON, while they were detected in nine of 18 and in six of 18 patients with other neurological diseases, respectively. Patients with ON had significantly more anti-PLP-secreting cells than did patients with other neurological diseases (P < .01). No difference was observed for anti-MBP-secreting cells. A significant correlation between the time from onset and the number of anti-PLP-secreting cells was found in patients with idiopathic ON (P < .02). CONCLUSIONS: These data suggest that anti-PLP antibodies are a more specific finding in demyelinating disease than anti-MBP antibodies. Furthermore, they suggest that anti-PLP antibodies may arise as a consequence of the demyelinating process.
