Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis



The goals of this study were threefold:

1) to identify clinical and demographic predictors of acute optic neuritis (AON) severity and recovery in an adult-onset MS (AOMS) sample;
2) to compare patients with pediatric MS (PMS) to patients with AOMS for AON severity/recovery;
3) to assess the association of vitamin D level immediately after an attack on AON severity/recovery.

Three groups of subjects participated in this study. The first group consisted of 253 subjects with AON as their initial presenting symptom. The second group included 38 patients with PMS or clinically isolated syndrome (CIS). The third group consisted of 101 subjects who had a serum sample drawn within six months after any AON attack. Demographic and clinical characteristics of patients were registered and serum samples were collected up to six months after the attack of optic neuritis.

None of the demographic features was significantly associated with severity of the first attack, while severity of the attack and male sex were each independently associated with worse attack recovery. The majority of patients had complete recovery from the first attack (79.8%), and a smaller percentage of patients had either a fair or poor recovery (20.2%). Disease category of MS or CIS had no effect on severity or recovery.

To assess whether severity/recovery from the first attack was associated with severity/recovery from the second attack, subjects with at least two attacks were identified (n=57). The severity of the first attack was not significantly associated with the severity of the second attack. Conversely, the recovery from the first attack was significantly associated with the recovery from the second attack. The severity of AON attacks at first symptoms in patients with PMS was not significantly different than the severity in the patients with AOMS. However, recovery from the initial presentation of AON in patients with AOMS was significantly worse than the recovery in patients with PMS. For 23 patients, the attack associated with the blood sample was the patient’s first attack. For an additional 35 patients, the attack was not the first attack of the disease, but it was the first episode of AON. For the remaining 43 patients, the attack was not the first AON attack in the disease course. The demographic characteristics of the patients in this group were similar to those of the AOMS group with a sample at the first attack. The season-adjusted vitamin D level was significantly associated with severity of the attack. The level of vitamin D was not associated with recovery from the attack.

Authors: Malik MT, Healy BC.
Source: Neurology. 2014 May 21. pii: 10.1212/WNL.0000000000000524. [Epub ahead of print]
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