A one year follow up about two cases of optic neuritis under golimumab therapy (anti-TNFa) for ankylosing spondylitis revealing demyelinating disorders and multiple sclerosis

We studied 88 patients with isolated idiopathic optic neuritis (IION) in order to evaluate the rate of progression to multiple sclerosis (MS) in Brazil. The patients were reassessed from one month to nine years after the development of the HON (mean follow-up was 4.6 years). There were 52 men and 36 women with ages ranging from three to 59 years (mean 24.3 years). Bilateral optic neuritis occurred in 19 patients whereas sequential involvement of the fellow eye after an interval longer than four weeks occurred in other 19 patients. Recurrences in the same eye occurred in seven cases. Nine patients (10.8%) developed clinically definitive MS - 13.9% of the women and 7.7% of the men with IION. The median age at the time of diagnosis of MS was 25 years. The mean interval between HON and the emergence of other MS signs varied from one month to five years - median one year. Sixty-seven percent of these, patients developed signs of spinal cord involvement. Our findings when compared to published series in different countries are closer to figures reported in Japan than those in the West.

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Faculty Opinions recommendation of Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1116185.589077 ◽

2008 ◽

Author(s):

George Ebers ◽

Andrew Weir

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Treatment Trial ◽

Multiple Sclerosis Risk ◽

Optic Neuritis Treatment Trial

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Biologic Therapy in Refractory Non-Multiple Sclerosis Optic Neuritis Isolated or Associated to Immune-Mediated Inflammatory Diseases. A Multicenter Study

Journal of Clinical Medicine ◽

10.3390/jcm9082608 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2608

Author(s):

Alba Herrero-Morant ◽

Carmen Álvarez-Reguera ◽

José L. Martín-Varillas ◽

Vanesa Calvo-Río ◽

Alfonso Casado ◽

...

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Multicenter Study ◽

Lupus Erythematosus ◽

Biologic Therapy ◽

Relapsing Polychondritis ◽

Immunosuppressive Drug ◽

Biologic Agent ◽

Open Label

We aimed to assess the efficacy of biologic therapy in refractory non-Multiple Sclerosis (MS) Optic Neuritis (ON), a condition more infrequent, chronic and severe than MS ON. This was an open-label multicenter study of patients with non-MS ON refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were Best Corrected Visual Acuity (BCVA) and both Macular Thickness (MT) and Retinal Nerve Fiber Layer (RNFL) using Optical Coherence Tomography (OCT). These outcome variables were assessed at baseline, 1 week, and 1, 3, 6 and 12 months after biologic therapy initiation. Remission was defined as the absence of ON symptoms and signs that lasted longer than 24 h, with or without an associated new lesion on magnetic resonance imaging with gadolinium contrast agents for at least 3 months. We studied 19 patients (11 women/8 men; mean age, 34.8 ± 13.9 years). The underlying diseases were Bechet’s disease (n = 5), neuromyelitis optica (n = 3), systemic lupus erythematosus (n = 2), sarcoidosis (n = 1), relapsing polychondritis (n = 1) and anti-neutrophil cytoplasmic antibody -associated vasculitis (n = 1). It was idiopathic in 6 patients. The first biologic agent used in each patient was: adalimumab (n = 6), rituximab (n = 6), infliximab (n = 5) and tocilizumab (n = 2). A second immunosuppressive drug was simultaneously used in 11 patients: methotrexate (n = 11), azathioprine (n = 2), mycophenolate mofetil (n = 1) and hydroxychloroquine (n = 1). Improvement of the main outcomes was observed after 1 year of therapy when compared with baseline data: mean ± SD BCVA (0.8 ± 0.3 LogMAR vs. 0.6 ± 0.3 LogMAR; p = 0.03), mean ± SD RNFL (190.5 ± 175.4 μm vs. 183.4 ± 139.5 μm; p = 0.02), mean ± SD MT (270.7 ± 23.2 μm vs. 369.6 ± 137.4 μm; p = 0.03). Besides, the median (IQR) prednisone-dose was also reduced from 40 (10–61.5) mg/day at baseline to. 2.5 (0–5) mg/day after one year of follow-up; p = 0.001. After a mean ± SD follow-up of 35 months, 15 patients (78.9%) achieved ocular remission, and 2 (10.5%) experienced severe adverse events. Biologic therapy is effective in patients with refractory non-MS ON.

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Pediatric Optic Neuritis: Description of Four Cases and Review of the Literature

Children ◽

10.3390/children8100855 ◽

2021 ◽

Vol 8 (10) ◽

pp. 855

Author(s):

Anna Presicci ◽

Maria Serra ◽

Mariaclara Achille ◽

Elvita Caputo ◽

Lucia Margari

Keyword(s):

Optic Neuritis ◽

Recent Literature ◽

Systemic Disease ◽

Treatment Options ◽

Igg Antibodies ◽

Careful Evaluation ◽

Demyelinating Disorders ◽

Infective Etiology

Pediatric optic neuritis (PON) may be a clinically isolated and self-limiting event or may present in the context of underlying neurologic, infective, or systemic disease. PON has a high impact on the quality of life as it may or may not evolve into other acquired demyelinating syndromes (ADSs), such as multiple sclerosis (MS), neuromyelitis optica (NMO), or other syndromes related to the myelin oligodendrocyte glycoprotein IgG antibodies (MOG-IgG). These different PON phenotypes present variable clinical and radiological features, plasma and liquor biomarkers, and prognosis. We describe four pediatric cases presenting clinically with ON, with different etiopathogenetic pictures: one case had a probable infective etiology, while the others were associated with different demyelinating disorders (MS, NMO, syndrome related to MOG-IgG). We discuss the possible evolution of presenting ON in other ADSs, based on recent literature. A careful evaluation of the clinical and investigation findings and the natural course of PON is necessary to define its pathogenic pathway and evolution. Further prolonged follow-up studies are needed to highlight the predictors of PON evolution, its potential sequelae, and the best treatment options.

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Clinical Features and Visual outcome in Acute and Recurrent Case of Optic Neuritis.

Nepal Medical Journal ◽

10.37080/nmj.19 ◽

2018 ◽

Vol 1 (01) ◽

pp. 56-63

Author(s):

Jyoti Bastola Paudel ◽

Ananda Kumar Sharma ◽

Sanjeeta Sitaula ◽

Madhu Thapa

Keyword(s):

Multiple Sclerosis ◽

Natural History ◽

Optic Neuritis ◽

Clinical Features ◽

Visual Evoked Potential ◽

Evoked Potential ◽

Oral Steroid ◽

Visual Recovery ◽

Visual Evoked

Introduction: Optic neuritis is an inflammation of the optic nerve that usually affects young females. In Western countries, natural history and treatment of optic neuritis(ON) has been studied extensively. However aetiology, natural history, clinical features of ON and their relation to multiple sclerosis in Asian population needs to be defined yet. Methods: 30 patients who were diagnosed as optic neuritis were included between June 2013 to December 2014 at BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). A detailed history was obtained followed by examination of anterior and posterior segment. Assessment of visual acuity, color vision, contrast sensitivity, visual evoked potential (VEP),visual field and MRI of orbit and brain was done in all cases. All patients were treated with intravenous Methylprednisolone 500mg twice daily for 3 days followed by oral steroid for 11 days which was tapered in the next 4 days.The patients were reassessed at 2 weeks, 1 month and 3months. Results: Commonest presenting symptom was diminution of vision(65%). MRI showed multiple paraventricular oval plaques definite of multiple sclerosis in one patient and one was diagnosed as probable MS who had a single periventricular plaque. Visual evoked potential (VEP) showed increase in the mean P100 latency at 60’ and reduction in amplitude in eyes affected with optic neuritis compared to normal eyes. At 3 months follow up, 70% had good visual recovery (>6/18). The cause of non-improvement in vision was disc pallor. Optic disc pallor was detected in 37.5% of the eyes during follow up. Conclusions: Good visual recovery was observed in most eyes with acute optic neuritis. Multiple sclerosis was seen in 1 patient who had recurrent optic neuritis.

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Diffusion tensor imaging in multiple sclerosis: a tool for monitoring changes in normal-appearing white matter

Multiple Sclerosis Journal ◽

10.1191/1352458504ms997oa ◽

2004 ◽

Vol 10 (2) ◽

pp. 188-196 ◽

Cited By ~ 57

Author(s):

Emmanuelle Cassol ◽

Jean-Philippe Ranjeva ◽

Danielle Ibarrola ◽

Claude Mékies ◽

Claude Manelfe ◽

...

Keyword(s):

Multiple Sclerosis ◽

Diffusion Tensor Imaging ◽

White Matter ◽

Diffusion Tensor ◽

Lesion Load ◽

Normal Appearing White Matter ◽

Relapsing Remitting ◽

One Year ◽

Diffusion Tensor Imaging Dti

Our objectives were to determine the reproducibility of diffusion tensor imaging (DTI) in volunteers and to evaluate the ability of the method to monitor longitudinal changes occurring in the normal-appearing white matter (NAWM) of patients with multiple sclerosis (MS). DTI was performed three-mo nthly for one year in seven MS patients: three relapsing-remitting (RRMS), three secondary progressive (SPMS) and one relapsing SP. They were selected with a limited cerebral lesion load. Seven age- and sex-matched controls also underwent monthly examinations for three months. Diffusivity and anisotropy were quantified over the segmented whole supratentorial white matter, with the indices of trace (Tr) and fractional anisotropy (FA). Results obtained in volunteers show the reproducibility of the method. Patients had higher trace and lower anisotropy than matched controls (P B-0.0001). O ver the follow-up, both Tr and FA indicated a recovery after the acute phase in RRMS and a progressive shift towards abnormal values in SPMS. A lthough this result is not statistically significant, it suggests that DTI is sensitive to microscopic changes occurring in tissue of normal appearance in conventional images and could be useful for monitoring the course of the disease, even though it was unable to clearly distinguish between the various physiopathological processes involved.

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Rituximab in patients with pediatric multiple sclerosis and other demyelinating disorders of the CNS: Practical considerations

Multiple Sclerosis Journal ◽

10.1177/1352458520932798 ◽

2020 ◽

pp. 135245852093279 ◽

Cited By ~ 1

Author(s):

Angelo Ghezzi ◽

Brenda Banwell ◽

Amit Bar-Or ◽

Tanuja Chitnis ◽

Russell C Dale ◽

...

Keyword(s):

Multiple Sclerosis ◽

Pediatric Patients ◽

Neurological Diseases ◽

Duration Of Treatment ◽

Pediatric Multiple Sclerosis ◽

Immune Mediated ◽

The Central Nervous System ◽

Anti Cd20 ◽

Demyelinating Disorders

Anti-CD20 therapies have established efficacy in the treatment of immune-mediated neurological and non-neurological diseases. Rituximab, one of the first B-cell-directed therapies, is relatively inexpensive compared to newer anti-CD20 molecules, is available in many countries, and has been used off-label in pediatric patients with neuroimmune conditions. The objective of this paper is to describe the experience with rituximab in pediatric multiple sclerosis and other inflammatory immune-mediated disorders of the central nervous system (CNS), and to define a protocol for its use in clinical practice, in particular addressing doses, interval of administration, duration of treatment, and tests to perform at baseline and during follow-up.

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SaGA S, the Short and Graphic A bility Score: an alternative scoring method for the motor components of the Multiple Sclerosis Functional C omposite

Multiple Sclerosis Journal ◽

10.1191/1352458504ms1000oa ◽

2004 ◽

Vol 10 (2) ◽

pp. 231-242 ◽

Cited By ~ 10

Author(s):

C Vaney ◽

S Vaney ◽

D T Wade

Keyword(s):

Multiple Sclerosis ◽

Correlation Coefficients ◽

Scoring Method ◽

Left Hand ◽

Disability Status ◽

Study Population ◽

The Mean ◽

One Year ◽

Independent Assessment

The timed performances of the 10-m timed walk (TMTW) and the nine-ho le peg test (NHPT) of 881 consecutive patients with multiple sclerosis (MS) undergoing a rehabilitation stay, were expressed as a logarithmic function of time in two subscores to form a composite score called the Short and G raphic A bility Score (SaGA S). The subscores (sS) were constructed in such a way that any interval of 0.5 unit corresponds to a change of 25% in the tests. The SaGA S was computed as the mean of four subscores: SaGAS=(2×2-TMTWsS+NHPTsS right hand+NHPTsS left hand). With the aid of a nomogram, the timed values of the tests are easily transformed into the corresponding subscores, which are then displayed graphically to facilitate follow-up over time. The correlation coefficients between the SaGA S and the two motor components of the MS Functional C omposite (MSFC) (r =0.987), the Expanded Disability Status Scale (EDSS)(r = -0.83), the Nottingham EADL Index (r =0.80) and the Rivermead Mobility Index (RMI) (r =0.90) were all statistically significant (P B-0.001), supporting the validity of the measure. SaGA S had a similar sensitivity to the RMI, but was significantly more sensitive than the EDSS in detecting changes occurring during the rehabilitation stay (14.9% versus 5.0%; P B-0.001) and over a one-year follow-up (35.3% versus 19.7%; P B-0.001). C ompared with the motor components of the MSFC, with which it shares several features, SaGA S has several advantages: it does not depend on the stratification of the study population; it does not skew the results of the NHPT towards improvement at the lower end; and it offers an independent assessment of both hands. SaGA S is a simple, intuitive, nonphysician-based measure, which could provide consistent scoring in future clinical trials.

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