Clinical Characteristics, Diagnostic and Outcome Differences in Patients with Optic Neuritis
Siegel D, Van Harn MV, Wenner R, Bansal P, Cerghet M, and Memon A. Clinical Characteristics, Diagnostic and Outcome Differences in Patients with Optic Neuritis. Neurology 2019; 92(15).
Objective: To identify differences in demographics, clinical characteristics, diagnostic studies and outcomes in patients with optic neuritis. Background: Optic neuritis (ON) can be the initial presenting symptom of a variety of immunemediated neurological diseases such as multiple sclerosis(MS), neuromyelitis optica(NMO), neurosarcoidosis(NS) lupus and myelin oligodendrocyte glycoprotein-IgG-associated(MOG) optic neuritis. Design/Methods: Retrospective chart review was performed on patients with the diagnosis of optic neuritis seen between January 2016 through December 2017. Patients demographics, etiology, clinical presentation, final diagnosis, laboratory, imaging data, recurrence rate, and visual outcome were recorded. Univariate two-group comparisons are carried out using chi-square or Fisher's exact tests for categorical variables and using Wilcoxon rank-sum tests for continuous variables. Results: 184 patients with diagnosis of ON were included. MS was the most common etiology 88(48%) followed by isolated optic neuritis (ION) 48(26%), NMO 17(9.2%), clinically isolated syndrome(CIS) 16(8.7%), NS 5(2.7%), chronic relapsing inflammatory optic neuropathy (CRION) 5(2.7%) and MOG 5(2.7%). There were significantly more patients on oral steroids(96% vs 46%, p<0.001), more recurrence (81% vs 27%, p<0.001), more MRI orbit enhancement(67% vs 42%, p=0.039), lower CSF WBC count(3.7±3.9 versus 11.4±15.4, p=0.003), lower CSF IgG index(0.7±0.7 vs 1.0±0.7, p=0.005), fewer positive CSF O bands(17% vs 54%, p=0.005), and more normal optic coherence tomography(OCT)(58% vs 29%, p=0.015) in the NMO/CRION/MOG group as compared to the MS/Sarcoid/ION/CIS group. Patients with intracanalicular segment of ON(25) were compared to non-intracanalicular segment of ON(117)and there were significantly more patients positive for MRI orbit enhancement in the Intracanalicular group(80% versus 38%, p<0.001) with high rate of recurrence(64% vs 36%, p=0.009). Conclusions: MS remains the most common etiology for ON followed by NMO. A High rate of recurrence and MRI orbit enhancement with initial normal OCT can be seen in, patient with ON associated with NMO/CRION/MOG. The intracanalicular segment of ON can be associated with optic nerve enhancement and high risk of recurrence.