A long-term prospective study of optic neuritis: Evaluation of risk factors
Corresponding Author
Magnhild Sandberg-Wollheim Dr., MD PhD
Department of Neurology, University Hospital, Lund, Sweden
Department of Neurology, University Hospital, S-221 85 Lund, SwedenSearch for more papers by this authorHans Bynke MD PhD
Department of Ophthalmology, University Hospital, Lund, Sweden
Search for more papers by this authorSten Cronqvist MD PhD
Department of Diagnostic Radiology, University Hospital, Lund, Sweden
Search for more papers by this authorStig Holtås MD PhD
Department of Diagnostic Radiology, University Hospital, Lund, Sweden
Search for more papers by this authorPer Platz MD
Tissue Typing Laboratory, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
Search for more papers by this authorLars P. Ryder PhD
Tissue Typing Laboratory, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
Search for more papers by this authorCorresponding Author
Magnhild Sandberg-Wollheim Dr., MD PhD
Department of Neurology, University Hospital, Lund, Sweden
Department of Neurology, University Hospital, S-221 85 Lund, SwedenSearch for more papers by this authorHans Bynke MD PhD
Department of Ophthalmology, University Hospital, Lund, Sweden
Search for more papers by this authorSten Cronqvist MD PhD
Department of Diagnostic Radiology, University Hospital, Lund, Sweden
Search for more papers by this authorStig Holtås MD PhD
Department of Diagnostic Radiology, University Hospital, Lund, Sweden
Search for more papers by this authorPer Platz MD
Tissue Typing Laboratory, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
Search for more papers by this authorLars P. Ryder PhD
Tissue Typing Laboratory, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
Search for more papers by this authorAbstract
Eighty-six patients with monosymptomatic optic neuritis of unknown cause were followed prospectively for a median period of 12.9 years. At onset, cerebrospinal fluid (CSF) pleocytosis was present in 46 patients (53%) but oligoclonal immunoglobulin in only 40 (47%) of the patients. The human leukocyte antigen (HLA)-DR2 was present in 45 (52%). Clinically definite multiple sclerosis (MS) was established in 33 patients. Actuarial analysis showed that the cumulative probability of developing MS within 15 years was 45%. Three risk factors were identified: low age and abnormal CSF at onset, and early recurrence of optic neuritis. Female gender, onset in the winter season, and the presence of HLA-DR2 antigen increased the risk for MS, but not significantly. Magnetic resonance imaging detected bilateral discrete white matter lesions, similar to those in MS, in 11 of 25 patients, 7 to 18 years after the isolated attack of optic neuritis. Nine were among the 13 with abnormal CSF and only 2 belonged to the group of 12 with normal CSF (p = 0.01). Normal CSF at the onset of optic neuritis conferred better prognosis but did not preclude the development of MS.
References
- 1 Sandberg M, Bynke H. Cerebrospinal fluid in 25 cases of optic neuritis. Acta Neurol Scand 1973; 49: 443–452
- 2 Sandberg-Wollheim M, Platz P, Ryder LP, et al. HL-A histocompatibility antigens in optic neuritis. Acta Neurol Scand 1975; 52: 161-166
- 3 Sandberg-Wollheim M. Optic neuritis: studies on the cerebrospinal fluid in relation to clinical course in 61 patients. Acta Neurol Scand 1975; 52: 167–178
- 4 Sandberg-Wollheim M. Optic neuritis: cerebrospinal fluid findings and clinical course. In: K Shimizu, JA Oosterhuis, eds. XXIII Concilium Ophthalmologicum, Kyoto. International Congress Series No 450. Amsterdam: Excerpta Medica, 1978: 347–350
- 5 Link H, Müller R. Immunoglobulins in multiple sclerosis and infections of the nervous system. Arch Neurol 1971; 25: 326–344
- 6 Johansson B. Agarose gel electrophoresis. Scand J Clin Lab Invest 1972; 29: (suppl 124) 7–19
- 7 Terasaki PI, McCurdy B, McClelland J. Microdroplet lymphocyte cytotoxicity test. In: JG Ray, RC Scott, DB Hare, et al., eds. Manual of tissue typing techniques. Washington, DC: National Institutes of Health, 1972: 50–63
- 8 Thomsen M, Ryder LP, Morling N, et al. Frequency of nine HLA-D antigens in the Danish population. Tissue Antigens 1982; 19: 25–39
- 9 PI Terasaki, ed. Histocompatibility testing 1977. Los Angeles: UCLA, 1980: 1–1227
- 10
Platz P,
Ryder LP,
Thomsen M, et al.
HLA and multiple sclerosis–genetic considerations.
In: D Karcher,
A Lowenthal,
AD Strosberg, eds.
Humoral immunity in neurological diseases.
NATO Advanced Study Institutes Series.
New York: Plenum Press,
1979:
131–145
10.1007/978-1-4684-1003-7_17 Google Scholar
- 11 Engell T, Raun NE, Thomsen M, Platz P. HLA and heterogeneity of multiple sclerosis. Neurology (NY) 1982; 32: 1043–1046
- 12 McDonald WI, Halliday AM. Diagnosis and classification of multiple sclerosis. Br Med Bull 1977; 33: 4–8
- 13 Peto R, Pike MC, Armitage P, et al. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples. Br J Cancer 1977; 35: 1–39
- 14 Edwards JH. The recognition and estimation of cyclic trends. Ann Hum Genet 1961; 25: 83–87
- 15 Cox DR, Oakes D. Analysis of survival data. Monographs on statistics and applied probability. New York: Chapman & Hall, 1984
- 16 Sandberg-Wollheim M, Vandvik B, Nadj C, Norrby E. The intrathecal immune response in the early stage of multiple sclerosis. J Neurol Sci 1987; 81: 45–53
- 17 Taub RG, Rucker CW. The relationship of retrobulbar neuritis to multiple sclerosis. Am J Ophthalmol 1954; 37: 494–497
- 18 Kurland LT, Auth TL, Beebe GW, et al. Studies on the natural history of multiple sclerosis. II. Progression from optic neuropathy to multiple sclerosis. Trans Am Neurol Assoc 1963; 88: 233–235
- 19 Collis WJ. Acute unilateral retrobulbar neuritis. Arch Neurol 1965; 13: 409–412
- 20 Bradley WG, Whitty CWM. Acute optic neuritis: prognosis for development of multiple sclerosis. J Neurol Neurosurg Psychiatry 1968; 31: 10–18
- 21 Percy AK, Nobrega FT, Kurland LT. Optic neuritis and multiple sclerosis. Arch Ophthalmol 1972; 87: 135–139
- 22 Appen RE, Allen JC. Optic neuritis under 60 years of age. Ann Ophthalmol 1974; 6: 143–146
- 23 Hely MA, McManis PG, Doran TJ, et al. Acute optic neuritis: a prospective study of risk factors for multiple sclerosis. J Neurol Neurosurg Psychiatry 1986; 49: 1125–1130
- 24 Lynn BH. Retrobulbar neuritis. A survey of the present condition of cases occurring over the last fifty-six years. Trans Ophthalmol Soc UK 1959; 79: 701–716
- 25 Francis DA, Compston DAS, Batchelor JR, McDonald WI. A reassessment of the risk of multiple sclerosis developing in patients with optic neuritis after extended follow up. J Neurol Neurosurg Psychiatry 1987; 50: 758–765
- 26 McAlpine D. The benign form of multiple sclerosis. Brain 1961; 84: 186–203
- 27 Adie WJ. Aetiology and symptomatology of disseminated sclerosis. Br Med J 1932; 2: 997–1000
- 28 McAlpine D, Compston N. Some aspects of the natural history of disseminated sclerosis. Q J Med 1952; 21: 135–167
- 29 Rizzo JF, Lessell S. Risk of developing multiple sclerosis after uncomplicated optic neuritis: a long-term prospective study. Neurology 1988; 38: 185–190
- 30 Cohen MM, Lessell S, Wolf PA. A prospective study of the risk of developing multiple sclerosis in uncomplicated optic neuritis. Neurology 1979; 29: 208-213
- 31 Nikoskelainen E, Frey H, Salmi A. Prognosis of optic neuritis with special reference to cerebrospinal fluid immunoglobulins and measles virus antibodies. Ann Neurol 1981; 9: 545–550
- 32 Corridori F, Salmaggi A, Bortolami C, et al. Prognostic value of cerebrospinal fluid electrophoresis in optic neuritis and suspected multiple sclerosis. Ital J Neurol Sci 1987; suppl 6: 77–80
- 33 Hutchinson WM. Acute optic neuritis and the prognosis for multiple sclerosis. J Neurol Neurosurg Psychiatry 1976; 39: 283–289
- 34 Kahana E, Alter M, Feldman S. Optic neuritis in relation to multiple sclerosis. J Neurol 1976; 213: 87–95
- 35 Compston DAS, Batchelor JR, Earl CJ, McDonald WI. Factors influencing the risk of multiple sclerosis developing in patients with optic neuritis. Brain 1978; 101: 495–511
- 36 McAlpine D, Lumsden CE, Acheson ED. Multiple sclerosis. A reappraisal. Edinburgh: Livingstone, 1965: 107–114
- 37 Sanders EACM, Reulen JPH, Hogenhuis LAH. Central nervous system involvement in optic neuritis. J Neurol Neurosurg Psychiatry 1984; 47: 241–249
- 38 Vandvik B, Norrby E, Nordal HJ. Optic neuritis: local synthesis in the central nervous system of oligoclonal antibodies to measles, mumps, rubella, and herpes simplex viruses. Acta Neurol Scand 1979; 60: 204–213
- 39 Stendahl-Brodin L, Link H, Möller E, Norrby E. Optic neuritis and distribution of genetic markers of the HLA-system. Acta Neurol Scand 1978; 57: 418–431
- 40 Stendahl-Brodin L, Link H. Optic neuritis: oligoclonal bands increase the risk of multiple sclerosis. Acta Neurol Scand 1983; 67: 301–304
- 41 Sibley WA, Foley JM. Infection and immunization in multiple sclerosis. Ann NY Acad Sci 1965; 122: 457–468
- 42 Paty DW, Isaac CD, Grochowski E, et al. Magnetic resonance imaging (MRI) in multiple sclerosis (MS): a serial study in relapsing and remitting patients with quantitative measurements of lesion size. Neurology 1986; 36 (suppl 1): 177
- 43 Willoughby E, Grochowski E, Li D, et al. A prospective study of MRI scanning in multiple sclerosis. Neurology 1987; 37 (suppl 1): 231
- 44 Nilsson O, Larsson E-M, Holtås S. Myelopathy patients studied with magnetic resonance for multiple sclerosis plaques. Acta Neurol Scand 1987; 76: 272–277
- 45 Paty DW, Oger JJF, Kastrukoff LF, et al. MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT. Neurology 1988; 38: 180–185
- 46 Ormerod IEC, McDonald WI, du Boulay EPGH, et al. Disseminated lesions at presentation in patients with optic neuritis. J Neurol Neurosurg Psychiatry 1986; 49: 124–127
- 47 Jacobs L, Kinkel PR, Kinkel WR. Silent brain lesions in patients with isolated optic neuritis. A clinical and nuclear magnetic resonance imaging study. Arch Neurol 1986; 43: 452–455
- 48 Rudick RA, Jacobs L, Kinkel PR, Kinkel WR. Isolated idiopathic optic neuritis. Analysis of free k-light chains in cerebrospinal fluid and correlation with nuclear magnetic resonance findings. Arch Neurol 1986; 43: 456–458
- 49 Ormerod IEC, Miller DH, McDonald WI, et al. The role of NMR imaging in the assessment of multiple sclerosis and isolated neurological lesions: a quantitative study. Brain 1987; 110: 1579–1616
- 50 Gilbert JJ, Sadler M. Unsuspected multiple sclerosis. Arch Neurol 1983; 40: 533–536
- 51 Ryder LP, Andersen E, Svejgaard A, et al. HLA and disease registry. Third Report. Copenhagen: Munksgaard, 1979
- 52 Svejgaard A, Hauge M, Jersild C, et al. The HLA system. An introductory survey. In: L Beckman, M Hauge, eds. Monographs in human genetics, vol 7. Basel: Karger, 1975: 1–103
- 53 Jakobsen BK, Morling N, Platz P, et al. HLA-DR phenotype and HLA-B, DR haplotype frequencies in 704 unrelated Danes. Tissue Antigens 1981; 18: 270–275