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PubMed1980

Optic neuritis as an initial symptom in multiple sclerosis.

The present study is based on a multicenter documentation system which includes standardized information on a total of 1271 patients with multiple sclerosis (MS). In 441 (34.7%) cases the optic nerve was involved at the first appearance of the disease, and in 212 (16.6%) subjects optic neuritis (ON) was the sole initial sign. For all MS patients with ON at the onset of the disease the female to male ratio was 1.3, whereas it was 1.5 for the whole series. The mean age at onset was 2 years lower for patients with initial ON as compared with the whole series (29.0 and 31.1 years, respectively). Correlation of the disability of the patients to the duration of the disease revealed the best prognosis for patients with ON as the sole inital sign of MS. The frequency of brainstem/cerebellar and pyramidal signs was lowest among these patients at the time of the present examination. The difference was more pronounced during the first years of the disease and disappeared after longer duration. The correlation curves of disability to the present age of the patients confirmed this pattern. Our findings do not support the idea of initial ON as being a favorable sign of the later course. As an initial bout of MS, it reflect more precisely the mean age of onset of the disease than other signs.

Adult↗
PubMed1980

Active T cells and humoral immune variables in blood and cerebrospinal fluid in patients after acute unilateral idiopathic optic neuritis.

The active T cell rosette test--that is determination of T lymphocytes with high affinity for sheep erythrocytes after incubation at 37 degrees C for 1 h--defines a T cell subset that has been claimed to parallel cell-mediated immunocompetence in e.g. viral diseases. In 16 patients who have had acute unilateral idiopathic optic neuritis (ON), lower percentages of active T cells were found in CSF compared to blood, irrespective if the interval between the first bout of ON and the present study was 2 months or 26 years, and irrespective of degree of mononuclear pleocytosis or humoral immune variables in CSF. The same distribution of active T cells has previously been observed in multiple slcerosis (MS). The percentages of active T cells in peripheral blood from the patients with ON were normal. Determination of active T cell does not seem to discriminate those patients with ON who are likely to develop MS. One explanation could be that ON and MS have an etiologic agent in common but that a part of patients with ON have an until now undefined competence to limit the demyelinating process.

Adult↗
PubMed1981

Cell-mediated immunity in acute idiopathic optic neuritis and multiple sclerosis.

Lymphocyte transformation responses to phytohaemagglutinin, measles antigen and tuberculin and the absolute numbers of circulating T and SIg+ cells were determined in 16 patients with acute idiopathic optic neuritis (ON), 42 patients with multiple sclerosis (MS) and 78 healthy controls. Patients with acute ON showed impaired lymphocyte transformation responses in both autologous plasma and AB serum similar in extent to those seen in MS patients in relapse. They were not associated with a reduced total number of circulating T cells.

Acute Disease↗
PubMed1983

Optic neuritis: oligoclonal bands increase the risk of multiple sclerosis.

In 1974 we examined 30 patients 0.5-14 (mean 5) years after acute unilateral optic neuritis (ON), when no clinical signs of multiple sclerosis (MS) were discernible. 11 of the patients had oligoclonal bands in the cerebrospinal fluid (CSF). Re-examination after an additional 6 years revealed that 9 of the 11 ON patients with oligoclonal bands (but only 1 of the 19 without this CSF abnormality) had developed MS. The occurrence of oligoclonal bands in CSF in a patient with ON is--within the limits of the present observation time--accompanied by a significantly increased risk of the future development of MS. Recurrent ON also occurred significantly more often in those ON patients who later developed MS.

Adolescent↗
PubMed1985

The blink reflex and somatosensory evoked potential in optic neuritis in south India.

Optic Neuritis (ON) proceeds to multiple sclerosis (MS) in a considerable number of patients. The blink reflex (BR) and somatosensory evoked potential (SSEP) are useful non-invasive tests that can detect silent lesions in the central nervous system in patients with clinically suspect MS. In the present study, the BR and SSEP were done in 20 healthy controls and 20 patients with ON. Abnormalities of the SSEP were seen in 20%, and of the BR in 30% of the patients with ON. On combining the results of SSEP and BR studies, 45% of the ON patients were seen to have abnormalities. Over a short period of follow-up, 2 of the 20 ON patients developed clinical MS and both of them had had abnormalities of the BR. These findings suggest that ON proceeding to MS in India may be more common than suspected at present.

Adolescent↗
PubMed1985

Chronic experimental allergic neuritis (EAN) in juvenile guinea pigs: immunological comparison with acute EAN in adult guinea pigs.

In order to approach the mechanism of chronic or relapsing course in human chronic inflammatory demyelinating polyradiculoneuropathy, we established a chronic model of experimental allergic neuritis (EAN) in juvenile guinea pigs, and investigated the underlying cellular immune phenomenon in comparison with acute EAN in adult animals of the same strain. Two-week-old Hartley guinea pigs, sensitized with bovine peripheral nerve homogenate, developed chronic or relapsing EAN, whereas all adult animals developed acute monophasic EAN. Morphological examination of both the chronic and acute forms revealed scattered demyelination and mononuclear cell infiltrates which were essentially restricted to the peripheral nervous system, and indistinguishable from each other. Both the in vitro lymphocyte mitogenic response and in vivo skin testing revealed a significantly lower response to neuritogenic antigens (P2 protein and peripheral nerve myelin) in juvenile chronic EAN than in adult acute EAN throughout their respective courses. In addition, we showed, by means of assessing peripheral blood lymphocyte number and its subpopulations, that normal 2-week-old Hartley guinea pigs have not fully developed immunologically. These observations suggested that there was some immunological incompetence especially in cellular immunity in 2-week-old juvenile guinea pigs and that this might be one possible factor leading to chronic EAN.

Acute Disease↗
PubMed1987

Evaluation of central nervous system involvement in uncomplicated optic neuritis after prolonged follow-up.

Magnetic resonance imaging (MRI), multimodal evoked responses (ER) and HLA antigens were examined in 10 patients with idiopathic acute optic neuritis (ON) without any clinical symptoms or signs of multiple sclerosis (MS) during 9-14 years. In MRI, abnormalities compatible with MS were seen in 4 patients. In spite of clinically unilateral ON, a bilateral abnormality in visual evoked responses (VER) was seen in 3 of 9 cases. Brain stem auditory evoked responses (BAER) were normal in all cases, short latency somatosensory evoked response (SER) in all but one. The cerebrospinal fluid at time of ON showed signs of demyelination in one case only. The frequency of HLA antigens DR2 (78%) and B18 (40%) was significantly increased in comparison to healthy controls. MRI seems to be the most sensitive method in the detection of cerebral lesions of MS, especially in mild or asymptomatic forms of the disease. The present techniques are, however, mostly unable to demonstrate optic nerve lesions which more reliably can be evaluated by VERs. The question whether idiopathic ON represents a form of MS solely, cannot be resolved.

Adult↗
PubMed1987

Neurophysiological and CSF immunological study of 19 patients affected by acute idiopatic optic neuritis.

We studied 19 patients affected by acute idiopatic optic neuritis (ON), with neurophysiological tests: visual (VEP), somatosensory (SSEP), acoustic (ABR) evoked potentials and study of the blink reflex (BR), and with cerebrospinal fluid (CSF) examination, in order to detect "silent" lesions in the central nervous system (CNS) and/or immunological alterations, suggestive of multiple sclerosis (MS). The percentage of cases with at least one altered CSF IgG parameter (IgG index, IgG synthesis/day and IgG oligoclonal bands) has been higher than that of cases with one or more altered neurophysiological tests, regardless of the apparently intact eye VEP. If we also included this last test, the 2 percentages become identical. The validity of these tests in predicting the evolution of ON in MS is discussed.

Acute Disease↗
PubMed1988

Lymphocytes subclasses and function in patients with optic neuritis in childhood with special reference to multiple sclerosis.

Ten patients with childhood optic neuritis (5 with a single attack of ON and 5 with later MS) were studied at various stages of the disease. Lymphocyte count and function were analysed in the peripheral blood of all patients, 3 repeatedly, and in one they were also analysed in the CSF. T-lymphocytes counts were normal in all but 2 MS cases who had high counts. In acute stages the T4/T8 ratio were high in 1/3 determinations, in recovery low in 2/2 determinations, and in stable stages normal in 6/8 determinations. Lymphocyte function, measured by PHA, ConA and PWM stimulation, was normal in all but one. One patient showed significantly higher T-cell percentages and a high number of stimulated lymphocytes in CSF but a lower count of suppressor cells than in the blood. We found no abnormalities specific to MS nor to childhood MS or to disease activity stage. Rather than peripheral blood, it would seem more worthwhile to study CSF to clarify the pathogenesis of ON and MS.

Adolescent↗
PubMed1988

Acute monocular disturbances mimicking optic neuritis in pituitary apoplexy.

Three patients with acute monocular central scotoma and headache had the initial diagnosis of optic neuritis. Computed tomography showed large pituitary adenomas with necrosis and cyst formation consistent with the clinical symptoms of a previous pituitary apoplexy. After transsphenoidal adenomectomy the visual disturbances disappeared.

Adenoma↗
PubMed1989

The role of infection and vaccination in the genesis of optic neuritis and multiple sclerosis in children.

This article describes the association between previous infection and/or vaccination and the development of optic neuritis (ON) in 18 children. Ten of these children subsequently developed clinically definite multiple sclerosis (MS), while in 8 patients a clinically definite etiology could not be confirmed. Vaccination preceded the first ON attack in 6 patients, all but one of whom subsequently developed MS. It also preceded subsequent demyelinating events in 6 patients. Ten of the patients had a bacterial or viral infection within the 2 weeks prior to the first symptoms of ON. Intrathecal antibody synthesis against 2 or more viruses could be shown in 5 out of 8 patients studied; 5 out of 6 patients had oligoclonal antibodies in CSF and 12 out of 16 patients a high IgG index. Neither intrathecal antibody synthesis against 2 or more viruses nor elevated IgG indexes could be found in the control patients. Measles and mumps occurred at a significantly later age in the children who subsequently developed MS than in the control children, and these patients had significantly more events that might have impaired the blood-brain barrier than the controls. These results indicate that immunological events leading to MS may be triggered during childhood. Vaccination and infection often precede ON in childhood. Intrathecal viral antibody production can occur already in childhood at the time of the first symptoms of MS.

Adolescent↗
PubMed1989

Magnetic resonance imaging of the brain in patients with acute monosymptomatic optic neuritis.

Ophthalmologists and neurologists from a catchment area of 1.5 million people were asked to refer all patients with symptoms and signs of optic neuritis (ON) to our neurological department immediately. A total of 68 consecutive patients were extensively screened for known etiologies of ON. Eleven had definite multiple sclerosis (MS); 7 patients could not participate for various reasons. The cerebrum, cerebellum and brainstem of the remaining 50 untreated patients with monosymptomatic ON were MRI scanned at 1.5 T with 2 sequences (slice thickness 4 mm, voxel size 1.2 x 1.2 x 4 mm3): double spin-echo (TR = 1.8 s, TE = 30 and 90 ms, 12 slices axially) and inversion recovery (TR = 2.45 s, TI = 400 ms, TE = 30 ms, 5 slices sagittaly). Magnetic resonance imaging (MRI) was performed within 3-49 (median 16) days from onset of symptoms. MRI demonstrated multiple asymptomatic central nervous system (CNS) lesions in 62% of patients. The appearance, locations and extents of lesions were consistent with demyelination. A scoring system based on number and size of lesions is proposed. Seven of 50 patients developed definite MS during a median follow-up of 11 months; they all had CNS lesions on the first scan. MRI has thus improved the pathophysiological knowledge of idiopathic ON, which from the very onset is a manifestation of MS in at least two thirds of cases. Patients who have early CNS lesions run a much higher risk of later developing clinically definite MS.

Adolescent↗
PubMed1989

A possible harmful late effect of methylprednisolone therapy on a time cluster of optic neuritis.

Clinical records of all patients (n = 26) suffering from optic neuritis during the last 16 years re-evaluated in relation to treatment. The patients were treated in 3 ways: with prednisone; with "pulse" megadoses of methylprednisolone; and untreated. A possibly frightening conversion to multiple sclerosis was seen in the group of patients with methylprednisolone, compared with the other 2 groups.

Adolescent↗
PubMed1990

Oestrogen treatment reduces duration of experimental allergic neuritis in rats and suppresses T cell responses to myelin.

The effects of oestrogen and pregnancy on the disease course of experimental allergic neuritis (EAN) in rats were investigated. Pregnant rats were totally protected from EAN and long term 17-beta-oestradiol treatment significantly shortened the disease duration. Lymph node cells from oestrogen treated rats had a suppressed proliferative response when stimulated with myelin or PPD, both when the response was measured immediately after cell preparation and after 72 h cell culture in vitro. Serum levels of IgG antibodies against myelin, P2 or PPD did not differ between treated and non-treated rats although oestrogen treated rats had significantly higher levels of total IgG. Immunohistochemical stainings of nerve roots showed less intensive invasion of T lymphocytes in the oestrogen treated group while immunoreactivity to both class I and II major histocompatibility complex antigens did not differ in between the groups. These findings show that oestrogen ameliorates EAN and suggest that this effect is mediated by suppression of T cell dependent immunity. Factors in addition to oestrogen may be operative during pregnancy when a total protection from EAN is obtained.

Animals↗
PubMed1991

MRI, VEP, SEP and biothesiometry suggest monosymptomatic acute optic neuritis to be a first manifestation of multiple sclerosis.

A cohort of 50 consecutive patients with acute monosymptomatic optic neuritis (ON) from a defined catchment area joined a prospective study. The aim of this study was to compare the sensitivity of magnetic resonance imaging (MRI), electrophysiological methods (VEP and SEP) and biothesiometry to detect abnormalities in other parts of the CNS than the optic nerves during the acute phase of ON. For each method, a scoring system is proposed. This investigation also hoped to achieve a better understanding of the natural history of ON. MRI proved to be the most sensitive tool (63% abnormal) in confirming a second site of involvement, followed by VEP in the clinically unaffected fellow eye (42%), biothesiometry (32%) and SEP (17%). The combination of all these methods, except for MRI (and VEP in eyes with acute ON), revealed abnormalities in 63% of the patients. When the neurophysiological methods were combined with MRI, 79% of the patients had abnormal findings suggesting additional lesions in the CNS. Hence, MRI and neurophysiological examinations supplement each other and together provide evidence that monosymptomatic ON is usually a first manifestation of MS. The development of definite MS at 1-20 months of follow up in 7 patients (all with abnormal MRI initially) supports this view.

Adolescent↗
PubMed1991

Paraclinical tests in acute-onset optic neuritis: basal data and results of a short follow-up.

Up to now it is still doubtful whether there is a real risk of developing multiple sclerosis (MS) after initial monosymptomatic optic neuritis (ON). In this study we evaluated 43 patients with isolated acute-onset ON, in order to demonstrate the presence of oligoclonal bands (OBs) in the cerebrospinal fluid (CSF) and any additional clinically silent central nervous system (CNS) lesions. All examinations were performed from 5 days to 4 months (mean 43 days), from the onset of visual disturbances. Brain magnetic resonance imaging (MRI) detected white matter areas with increased signal in 21 patients (49%), while somatosensory and brainstem auditory evoked potentials revealed CNS abnormalities in only 5 patients (12%). OBs were present in the CSF of 20 patients (46%). Visual evoked potentials were abnormal in 39 patients (91%). Seven out of the 37 patients (19%) with at least one year follow-up, (mean duration of the follow-up = 32 months, range = 12-74), developed clinically definite MS (CDMS). All 7 patients had positive brain MRI and 6 had positive CSF examination at the basal evaluation. Our data suggest that MRI and CSF-OBs are the most reliable means of identifying patients with isolated ON who subsequently develop CDMS. They may therefore have a predictive value in defining MS risk.

Acute Disease↗
PubMed1992

Gd-DTPA-enhanced lesions in the brain of patients with acute optic neuritis.

The cerebral hemispheres of 19 patients with acute monosymptomatic optic neuritis (AMON) were investigated using magnetic resonance imaging (MRI) and Gadolinium-DTPA (Gd-DTPA). Using T1-weighted and T2-weighted imaging sequences it was disclosed that 14 of 19 patients had lesions and that enhancement was seen in seven patients. It is known that patients with AMON and silent lesions in the CNS have a highly increased risk of developing multiple sclerosis (MS) later on. If it is accepted that a silent lesion in patients with AMON does represent a multiple sclerosis (MS) plaque, and that an enhancing silent lesion represents an acute MS lesion, we may hypothesize that the disease process ultimately leading to MS starts long before the first symptom or sign ever appears. It would seem that at least half of the silent lesions in the cerebral hemispheres of patients with AMON had existed before the onset of the AMON, and that the disease actually started before the onset of the AMON.

Adult↗
PubMed1992

Correlation of magnetic resonance imaging and CSF findings in patients with acute monosymptomatic optic neuritis.

Acute monosymptomatic optic neuritis (AMON) may be the first indication of multiple sclerosis (MS), and this sign offers a special opportunity to study the very early clinical stages of MS. This prospective investigation compares results of CSF findings and magnetic resonance imaging (MRI) in a large, homogeneous and well-defined group of patients with AMON. Of 68 consecutively referred patients, 11 had clinically definite MS, another 5 refused a lumbar puncture, and 7 could not participate for various reasons. With the remaining 45 untreated patients, aged 12-52 (mean 31) years, with idiopathic AMON, we have studied interrelationships of CSF findings (leucocyte count, IgG-index and in 29 of the patients oligoclonal bands (OB)) and MRI. Lumbar puncture and MRI were performed within median 24 and 16 days of onset, respectively. In the CSF one or more abnormalities (in 17/45 = 38% pleocytosis, in 16/45 = 36% increased IgG-index, and in 20/29 = 69% OB) was found in a total of 23/29 = 79% of patients. MRI at 1.5 T (double SE and IR sequences) showed multiple cerebral lesions in 65% of patients. A significant relation was observed between results of MRI and leucocyte count (p < 0.05) and between results of MRI and IgG-index (p < 0.05), but not between results of MRI and OB (p > 0.20). Over a median observation period of 27 months, 13 patients developed clinically definite MS. All of these patients had lesions on MRI at onset, illustrating the prognostic importance of MRI findings. Results of CSF had until now no marked predictive value for developing clinically definite MS.

Adolescent↗