Volume 27, Issue 4 pp. 386-393
Article
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A long-term prospective study of optic neuritis: Evaluation of risk factors

Magnhild Sandberg-Wollheim Dr., MD PhD

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 author
Hans Bynke MD PhD

Hans Bynke MD PhD

Department of Ophthalmology, University Hospital, Lund, Sweden

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Sten Cronqvist MD PhD

Sten Cronqvist MD PhD

Department of Diagnostic Radiology, University Hospital, Lund, Sweden

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Stig Holtås MD PhD

Stig Holtås MD PhD

Department of Diagnostic Radiology, University Hospital, Lund, Sweden

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Per Platz MD

Per Platz MD

Tissue Typing Laboratory, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark

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Lars P. Ryder PhD

Lars P. Ryder PhD

Tissue Typing Laboratory, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark

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First published: April 1990
Citations: 101

Abstract

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.

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