Predicting Multiple Sclerosis At Optic Neuritis Onset
Jin YP, de Pedro-Cuesta J, Huang YH, Soderstrom M
Mult Scler 2003 Mar;9(2):135-41
Karolinska Institute, Huddinge University Hospital, Division of Neurology, NeuroEpidemiology Unit, S-141 86 Huddinge, Sweden
Using multivariate analyzes, individual risk of Clinically Definite Multiple Sclerosis (CDMS) after MonoSymptomatic Optic Neuritis (MON) was quantified in a prospective study with clinical MON onset during 1990-95 in Stockholm, Sweden.
During a mean follow-up time of 3.8 years, the presence of MS-like Brain Magnetic Resonance Imaging (MRI) lesions and OligoClonal ImmunoGlobulin (Ig) G bands in CerebroSpinal Fluid (CSF) were strong prognostic markers of CDMS.
With relative hazard ratios of 4.68 [95% confidence interval (CI) 2.21-9.91] and 5.39 (95% CI 1.56-18.61), respectively.
Age and season of clinical onset were also significant predictors, with relative hazard ratios of 1.76 (95% CI 1.02-3.04) and 2.21 (95% CI 1.13-3.98), respectively.
Based on the above two strong predictors, individual probability of CDMS development after MON was calculated in a three-quarter sample drawn from a cohort, with completion of follow-up at three years.
The highest probability, 0.66 (95% CI 0.48-0.80), was obtained for individuals presenting with three or more Brain MRI lesions and OligoClonal Bands in the CSF, and the lowest, 0.09 (95% CI 0.02-0.32), for those not presenting with these traits.
Medium values, 0.29 (95% CI 0.13-0.53) and 0.32 (95% CI 0.07-0.73), were obtained for individuals discordant for the presence of Brain MRI lesions and OligoClonal Bands in the CSF. These predictions were validated in an external one-quarter sample.
The Effects Of Intramuscular Interferon-beta-1a (Avonex) In Patients At High Risk For Development Of Multiple Sclerosis: A Post Hoc Analysis Of Data From CHAMPS
O'Connor P; CHAMPS
Clin Ther 2003 Nov;25(11):2865-74
University of Toronto, Division of Neurology, St. Michael's Hospital, Toronto, Ontario, Canada
In the Controlled High Risk Subjects Avonex Multiple Sclerosis Prevention Study (CHAMPS), intramuscular (IM) Interferon-ß-1a (IFN-ß-1a) delayed the development of Clinically Definite Multiple Sclerosis (CDMS).
In patients with a single DeMyelinating event who had Magnetic Resonance Imaging (MRI) evidence of previous subclinical disease activity (defined as > or = 2 T2-weighted HyperIntense lesions, 1 of which was PeriVentricular or ovoid, on unenhanced MRI scans).
This post hoc analysis was conducted to assess the effects of IM IFN-ß-1a on delaying the development of CDMS in a subgroup of CHAMPS patients who met a more stringent definition of high risk than was used in that trial.
Patients from the overall CHAMPS population were included in the present analysis if they had > or = 9 T2-weighted HyperIntense lesions and > or = 1 Gadolinium-enhanced lesion on the baseline MRI scan.
The cumulative probability of developing CDMS in each treatment group was calculated using the Kaplan-Meier product-limit method and compared using the log-rank test.
The actual proportions of patients who developed CDMS in each treatment group were calculated and compared using the chi-square test.
Ninety-one patients met the more stringent definition of high risk and were included in the subgroup analysis.
Fifty-one patients (56.0%) received IFN-ß-1a 30 microg IM once weekly and 40 (44.0%) received placebo. Baseline demographic and clinical characteristics were similar between the 2 groups.
Seventy-four patients (81.3%) were female, 80 (87.9%) were white, and the mean age was 33.0 years.
Overall, IM IFN-ß-1a reduced the rate of development of CDMS by 66% compared with the placebo group (P = 0.002, log-rank test) over the 3-year follow-up period.
At 2 years, the Kaplan-Meier estimate of the cumulative probability of developing CDMS was 21% in the IM IFN-ß-1a group and 56% in the placebo group.
Representing a 63% reduction in risk for CDMS with IFN-ß-1a (P = 0.002, log-rank test). The results based on the actual proportions of patients developing CDMS were similar to the Kaplan-Meier estimates.
The results of this subgroup analysis are compatible with IM IFN-ß-1a reducing the risk of a second DeMyelinating event in patients meeting the more stringent definition of high risk.
Although, the treatment effect of IFN-ß-1a was significant in both the overall CHAMPS population (44% risk reduction vs placebo; P = 0.002) and in this high-risk subgroup (66%).
The results of the present analysis suggest that the magnitude of treatment benefit with IFN-ß-1a may be greater in patients with more disease activity, as measured by MRI parameters.
Optic Neuritis: Clinical Analysis Of 27 Cases
Bee YS, Lin MC, Wang CC, Sheu SJ
Kaohsiung J Med Sci 2003 Mar;19(3):105-12
Kaohsiung Veterans General Hospital, Department of Ophthalmology, Kaohsiung, Taiwan
We retrospectively reviewed 27 cases diagnosed as idiopathic Optic Neuritis between 1992 and 2001 at Kaohsiung Veterans General Hospital.
To assess the clinical features, Visual prognosis, NeuroImaging, laboratory studies, and development of Multiple Sclerosis in Chinese patients with Optic Neuritis.
Patient age ranged from 13 to 54 years (mean, 35.8 +/- 11.3 years). Five cases presented as BiLateral Optic Neuritis and 22 as UniLateral.
Visual function improved gradually from 2 weeks after treatment. Twelve (44.4%) cases showed Disc swelling and Ocular pain was also noted in 44.4% of patients.
All cases that underwent Visual Field and Visual Evoked Potential tests showed abnormality in lesion Eyes.
Of the 23 cases that underwent NeuroImaging studies, including computerized tomography (17 patients) and Magnetic Resonance Imaging (6 patients), 10 revealed Optic Nerve thickening. Four cases (14.8%) developed Multiple Sclerosis during follow-up (mean, 4.3 years).
The incidence of Disc swelling was higher than that reported by the Optic Neuritis Treatment Trial.
But the incidence of initial Ocular Pain, the presence of PeriVentricular plaques, and the development of Multiple Sclerosis were lower in our study. The UniLateral group had significantly better Visual outcome than the BiLateral group.
Optic Neuritis: Characteristics And Visual Outcome
Chuenkongkaew W, Chirapapaisan N
J Med Assoc Thai 2003 Mar;86(3):238-43
Mahidol University, Faculty of Medicine, Department of Ophthalmology, Siriraj Hospital, Bangkok, Thailand
To determine clinical characteristics of patients with Optic Neuritis and Visual outcome after IntraVenous MethylPrednisolone treatment.
A total of 81 patients with Optic Neuritis were reviewed retrospectively with regard to their clinical characteristics by dividing into two groups as follows:
Group I had Isolated Optic Neuritis and Group II had Optic Neuritis with DeMyelinative Disease. The Visual outcome in these patients before and after IntraVenous MethylPrednisolone treatment was analyzed.
Of 81 patients with Optic Neuritis, 63 patients (77.8%) had Isolated Optic Neuritis and 18 (22.2%) patients were Optic Neuritis with DeMyelinative Disease.
The ages of the patients ranged from 16 to 59 years (mean = 35.3 years) in patients with Isolated Optic Neuritis and from 16 to 73 years of age (mean = 35.8 years) in patients with Optic Neuritis with DeMyelinative Disease.
After treatment, 45 patients (52 eyes) with Isolated Optic Neuritis and 14 patients (25 eyes) with Optic Neuritis with DeMyelinative Disease who were followed-up for more than 10 days were studied.
After treatment, 60 per cent of the Isolated Optic Neuritis patients and 24 per cent of the Optic Neuritis patients with DeMyelinative Disease had a Visual Acuity of 6/12 or better respectively.
The Isolated Optic Neuritis who had an onset interval to treatment of less than 8 days had a Visual Acuity better than 6/9 in 75 per cent.
The final Visual outcome in patients with Isolated Optic Neuritis who received earlier treatment was better than those who received treatment later.