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Optic Neuritis and Multiple Sclerosis: Long-term Prognostic Considerations

Optic Neuritis and Multiple Sclerosis: Long-term Prognostic Considerations The recent report from the 10-year follow-up from the Optic Neuritis Study Group cohort, pertaining to neurological impairment, provides valuable multiple sclerosis prognostic information and illustrates the value of prolonged follow-up in the evaluation of any therapeutic intervention in a chronic disease such as multiple sclerosis.1 As one of the original participants in the initial study, I still remember our collective enthusiasm when we learned that the 2-year clinically definite multiple sclerosis diagnosis was delayed in those patients who received methylprednisolone as compared with placebo.2 This benefit was not present thereafter. Now, 10 to 12 years later, nearly half of the patients with clinically definite multiple sclerosis have a relapsing-remitting course with no cumulative disability measured with the Expanded Disability Status Scale. The majority of these patients have a low disability Expanded Disability Status Scale score without disease-modifying treatment. It will be important to know what percentage of these patients had actually been initially randomized to methylprednisolone. These statistics provide a good 10- to 12-year outlook for patients with optic neuritis regardless of a diagnosis of clinically definite multiple sclerosis and presence of several brain lesions on magnetic resonance imaging. Although the Expanded Disability Status Scale score is not likely to reflect the effect of supratentorial, periventricular lesions, it is unlikely that these patients have any significant cognitive deficit. Turning our attention to those patients with moderate or severe disability, it was surprising to learn that the lesion burden seen on magnetic resonance imaging failed to correlate with a 10- to 12-year neurologic impairment and Expanded Disability Status Scale score. How can we then identify those patients at risk and intervene therapeutically as needed? Frequent follow-up neurologic examinations and a low threshold to obtain magnetic resonance imaging studies of the cervical and thoracic spinal cord, which were not included in the protocol utilized in this study, should be recommended. Although severe disability (20%) and death (2 patients) occurred in a small percentage of patients, it would be critical to identify them early and to provide disease-modifying treatment when the patient’s clinical course profile is not the predicted benign course seen in their good prognosis counterparts. Back to top Article Information Correspondence: Dr Kattah, Department of Neurology, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Ave, Peoria, IL 61637 (kattahj@uic.edu) References 1. Beck RWSmith CHGal RL et al. Optic Neuritis Study Group, Neurologic impairment 10 years after optic neuritis. Arch Neurol 2004;611386- 1389PubMedGoogle ScholarCrossref 2. Beck RWCleary PATrobe JD et al. Optic Neuritis Study Group, The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis. N Engl J Med 1993;3291764- 1769PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Optic Neuritis and Multiple Sclerosis: Long-term Prognostic Considerations

Kattah, Jorge C.
Archives of Neurology , Volume 62 (3) – Mar 1, 2005
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References (3)

Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.62.3.506
Publisher site
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Abstract

The recent report from the 10-year follow-up from the Optic Neuritis Study Group cohort, pertaining to neurological impairment, provides valuable multiple sclerosis prognostic information and illustrates the value of prolonged follow-up in the evaluation of any therapeutic intervention in a chronic disease such as multiple sclerosis.1 As one of the original participants in the initial study, I still remember our collective enthusiasm when we learned that the 2-year clinically definite multiple sclerosis diagnosis was delayed in those patients who received methylprednisolone as compared with placebo.2 This benefit was not present thereafter. Now, 10 to 12 years later, nearly half of the patients with clinically definite multiple sclerosis have a relapsing-remitting course with no cumulative disability measured with the Expanded Disability Status Scale. The majority of these patients have a low disability Expanded Disability Status Scale score without disease-modifying treatment. It will be important to know what percentage of these patients had actually been initially randomized to methylprednisolone. These statistics provide a good 10- to 12-year outlook for patients with optic neuritis regardless of a diagnosis of clinically definite multiple sclerosis and presence of several brain lesions on magnetic resonance imaging. Although the Expanded Disability Status Scale score is not likely to reflect the effect of supratentorial, periventricular lesions, it is unlikely that these patients have any significant cognitive deficit. Turning our attention to those patients with moderate or severe disability, it was surprising to learn that the lesion burden seen on magnetic resonance imaging failed to correlate with a 10- to 12-year neurologic impairment and Expanded Disability Status Scale score. How can we then identify those patients at risk and intervene therapeutically as needed? Frequent follow-up neurologic examinations and a low threshold to obtain magnetic resonance imaging studies of the cervical and thoracic spinal cord, which were not included in the protocol utilized in this study, should be recommended. Although severe disability (20%) and death (2 patients) occurred in a small percentage of patients, it would be critical to identify them early and to provide disease-modifying treatment when the patient’s clinical course profile is not the predicted benign course seen in their good prognosis counterparts. Back to top Article Information Correspondence: Dr Kattah, Department of Neurology, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Ave, Peoria, IL 61637 (kattahj@uic.edu) References 1. Beck RWSmith CHGal RL et al. Optic Neuritis Study Group, Neurologic impairment 10 years after optic neuritis. Arch Neurol 2004;611386- 1389PubMedGoogle ScholarCrossref 2. Beck RWCleary PATrobe JD et al. Optic Neuritis Study Group, The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis. N Engl J Med 1993;3291764- 1769PubMedGoogle ScholarCrossref

Journal

Archives of Neurology – American Medical Association

Published: Mar 1, 2005

Keywords: multiple sclerosis,optic neuritis

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