Neurological outcome and predictive factors of idiopathic optic neuritis in China

Clinical characteristics of double negative atypical inflammatory demyelinating disease: A prospective study

OBJECTIVE

This study aimed to investigate the clinical characteristics and predictors of relapse in double negative atypical inflammatory demyelinating disease (IDD) and to explore potential antigenic targets by tissue-based assays (TBA) using rat brain indirect immunofluorescence.

METHODS

We compared the clinical, laboratory, and MRI data of double negative atypical IDD with other IDD patients. Serum samples were collected for TBA. The predictors of relapse were examined over a minimum of 24 months follow-up.

RESULTS

In our cohort of 98 patients with double negative atypical IDD, there was no significant female predominance (58.2%, 57/98). The lesions primarily affected the spinal cord and brain stem, with fewer cases of involvement in the area postrema (5.1%, 5/98) and longitudinally extensive transverse myelitis (43.9%, 43/98). A total of 62.5% (50/80) patients tested positive for anti-astrocyte antibodies based on rat brain TBA. Over a median duration of 39.5 months, 80 patients completed the entire follow-up, and 47.5% (38/80) patients exhibited monophasic course. A total of 36% (18/50) patients positively for anti-astrocyte antibodies had a monophasic course, which is significantly lower than patients negatively for anti-astrocyte antibodies (66.7%, 20/30) (p = 0.008). The presence of anti-astrocyte antibodies (hazard ratio (HR), 2.243; 95% CI, 1.087-4.627; p = 0.029) and ≥4 cerebrum lesions at first attack (HR, 2.494; 95% CI, 1.224-5.078; p = 0.012) were risk factors for disease relapse, while maintenance immunotherapy during remission (HR, 0.361; 95% CI, 0.150-0.869; p = 0.023) was protective factor.

INTERPRETATION

Double negative atypical IDD are unique demyelinating diseases with a high relapse rate. Maintenance immunotherapy is helpful to the prevention of relapse, particularly in patients with anti-astrocyte antibodies or ≥4 cerebrum lesions at first attack.

Worldwide prevalence of neuromyelitis optica spectrum disorder (NMOSD) and neuromyelitis optica (NMO): a systematic review and meta-analysis

BACKGROUND

Neuromyelitis optica spectrum disorder (NMOSD) is a progressive demyelinating disease of the central nervous system that has overlapping symptoms with multiple sclerosis (MS) but differs from it in a variety of ways. Previous studies have reported conflicting results trying to estimate the number of individuals affected by them which is why we designed this systematic review and meta-analysis to estimate the worldwide prevalence and incidence of NMOSD/NMO based on current evidence.

METHODS

We searched PubMed, Scopus, EMBASE, Web of Science, and gray literature including references from the identified studies, review studies, and conference abstracts which were published up to February 1, 2022. We used all MeSH terms pertaining to "NMOSD," "NMO," and all the terms on "prevalence," "incidence," and "epidemiology" to identify the search components. Pooled effect sizes were measured using random-effect model by DerSimonian-Laird.

RESULTS

The prevalence and incidence rates of NMOSD/NMO ranged from 0.07 to 10 and 0.029 to 0.880 per 100,000 population, respectively. The overall pooled prevalence of NMO per 100,000 population was 1.54 (I²: 98.4%, 95% CI: 1.13-1.96, P< 0.001) based on the 2006 criteria, 1.51 (I²: 99.4%, 95% CI: 1.21-1.81, P < 0.001) based on the 2015 criteria and 2.16 (I²: 89.4%, 95% CI: 1.46-2.86, P < 0.001) based on the 2006/2015 criteria. The overall annual incidence of NMO per 100,000 population was 0.155 (I²: 95%, 95% CI: 0.115-0.195, P < 0.001) based on the 2006 criteria and 0.278 (I²: 100%, 95% CI: 0.135-0.420, P < 0.001) based on the 2015 criteria. The prevalence rates were highest in French West Indies and South Korea, and lowest in Cuba and Australia, based on the 2006 and 2015 criteria, respectively. Also, the highest annual incidence rates were obtained for Sweden and Slovak republic and the lowest for Cuba and Australia based on the 2006 and 2015 criteria, respectively. All estimated rates were higher among females compared to males.

CONCLUSION

Although rare, NMOSD/NMO impact affected individuals in devastating ways. Several large-scale prospective studies are required to reach a comprehension of the epidemiological aspects of these notorious demyelinating conditions.

Development of a Prognostic Model for Predicting Multiple Sclerosis After Optic Neuritis: A Secondary Analysis of Data From the Optic Neuritis Treatment Trial

BACKGROUND

Optic neuritis can be the initial manifestation of multiple sclerosis (MS). The purpose of this study was to develop a prognostic model for predicting the risk of MS development among patients with optic neuritis.

METHODS

The data from 388 patients with optic neuritis were retrieved from the Optic Neuritis Treatment Trial (ONTT). Cox proportional hazards regression analysis was used to develop a prognostic model. The performance of the model was assessed by using Harrell's C-index and calibration curves. The rates of MS development were estimated using the Kaplan-Meier method.

RESULTS

Among the enrolled subjects, a total of 154 (39.7%) patients developed clinically definite MS during a median follow-up period of 15.8 years (interquartile range, 7.2-16.9 years). The factors associated with the development of MS were the presence of brain lesions as on baseline MRI, previous nonspecific neurologic symptoms, commencing low-dose corticosteroids treatment, ocular pain, and absence of optic disc/peripapillary hemorrhage. After incorporating these 5 factors into the prognostic model, a C-index of 0.72 (95% confidence interval [CI], 0.69-0.76) and good calibration curves were obtained. The C-index of the model was significantly higher than the C-indexes of any single factor (P < 0.001 in all cases). The model was able to stratify the ONTT patient cohort into 3 risk groups with significantly different intergroup rates of developing MS (rates for developing MS within a 15-year period: high-risk group, 75.7% [95% CI, 65.6%-82.9%], intermediate-risk group, 44.7% [95% CI, 31.4%-55.4%]; and low-risk group, 20.8% [95% CI, 14.2%-26.8%]; log-rank P < 0.001).

CONCLUSIONS

This prognostic model had a better prediction ability when compared with the standard practice that relies solely on using brain lesions on MRI. It can, therefore, help guide decision-making to initiate earlier disease-modifying therapy for patients with optic neuritis at risk of developing MS.

Conversion of Optic Neuritis to Relapsing Remitting Multiple Sclerosis: A Retrospective Comorbidity Cohort Study

OBJECTIVE

The aim of the study was to determine the risk of multiple sclerosis (MS) conversion after optic neuritis (ON) and to identify the predictive factors on conversion in Turkish patients.

METHODS

Patients whose first clinical attacks had been ON were included in the study. The primary end point was the diagnosis of clinical relapse-remitting MS.

RESULT

Except for the bilateral involvement rate, the clinical and demographic characteristics of the cohort are similar to Western studies. Though one-third of the patients with ON had bilateral involvement, bilateral involvement reduces the risk of conversion. Also, active lesions at the initial cranial magnetic resonance imagination increase the conversion rate.

CONCLUSION

This research confirms previous findings and contributes additional evidence that if the patients have unilateral involvement and active lesions, they should be closely monitored. Moreover, our research supports the hypothesis that risk factors may be affected by racial, environmental, and genetic factors.

Clinical characteristics of myelin oligodendrocyte glycoprotein seropositive optic neuritis: a cohort study in Shanghai, China

Qualitative and quantitative visual outcomes of Asian optic neuritis (ON) patients with seropositive myelin oligodendrocyte glycoprotein (MOG) antibodies remain unknown. We retrospectively evaluated a cohort of new-onset ON patients in Shanghai, China between January 2015 and December 2016. Serum MOG and aquaporin-4 (AQP4) antibodies were detected using cell-based assays, and patients were followed-up for at least 6 months. The clinical characteristics and optical coherence tomography (OCT) results were evaluated in the MOG-seropositive optic neuritis (MOG-ON), AQP4-seropositive (AQP4-ON), and double seronegative (Seronegative-ON) patients. Best-corrected visual acuity (BCVA) and peripapillary retinal nerve fiber layer (RNFL) thickness after 6 months of follow-up were compared. Among MOG-ON (n = 49, 64 eyes), AQP4-ON (n = 76, 102 eyes), and Seronegative-ON patients (n = 100, 116 eyes), the percentages of BCVAs better than 0.8 (20/25) at the 6-month visit were 67.19, 19.60, and 72.41%, respectively, which showed no statistical difference between MOG-ON and Seronegative-ON patients (p = 0.198), but were better than the AQP4-ON patients (P = 0.001). The average peripapillary RNFLs measured 6 months after the attack were 58.03 ± 8.73, 64.34 ± 12.88, and 78.12 ± 13.34 μm for the MOG-ON, AQP4-ON, and Seronegative-ON patients, respectively. There was no statistical difference between MOG-ON and AQP4-ON patients (P = 0.089), but both were thinner than Seronegative-ON patients (P = 0.001). The visual acuity in MOG-ON patients was as good as Seronegative-ON patients, whereas the RNFL of the optic nerve head showed a significant thinning as in the AQP4-ON patients.

Clinical characteristics and long-term visual outcome of optic neuritis in neuromyelitis optica spectrum disorder: A comparison between Thai and American-Caucasian cohorts

BACKGROUND

Neuromyelitis optica spectrum disorder (NMOSD) occurs more commonly in Asian than Caucasian populations. Few studies have examined the clinical features and visual outcome of optic neuritis (ON) within NMOSD in different racial populations. The objective of this study was to compare the clinical characteristics and long-term visual outcome of a Thai and an American-Caucasian cohort with NMOSD-related ON.

METHODS

Medical records including brain and orbital magnetic resonance imaging (MRI) of 16 consecutive subjects who developed visual loss due to ON as part of NMOSD evaluated at a single American tertiary referral center between 2006 and 2015 were reviewed and compared to those of 16 consecutive similar subjects evaluated at a single Thai tertiary referral center between 2010 and 2016. These cohorts represented the total number of NMOSD-related ON subjects seen during that time at those institutions. Statistical analyses were used for continuous and categorical data sets, and multiple regression analysis was used to adjust for differences in duration of follow-up and number of episodes of ON in each affected eye.

RESULTS

All subjects within the Thai cohort were Asian, while the American cohort initially consisted of 14 Caucasian, 1 Asian and 1 African-American subject, but the latter two were excluded from analysis. In the Thai cohort, ON occurred in 21 eyes, with a total of 19 episodes, while in the American-Caucasian cohort ON occurred in 22 eyes, with a total of 21 episodes. Aquaporin 4 (AQP4)-antibody was positive in all subjects except for one American-Caucasian subject. The mean follow-up time was 17.8 (± 16.0) and 52.8 (± 51.9) months for the Thai and American-Caucasian populations, respectively. There was no difference between the two cohorts with respect to gender, age of NMOSD and NMOSD-related ON onset, initial clinical presentation of NMOSD, initial visual acuity and automated visual fields, prevalence of swollen optic disc in the acute phase, presence of pain on the affected side, mean time of onset of ON symptoms to MRI examination, distribution of segmental involvement of the anterior visual pathway abnormalities based on MRI findings, mean time of onset of ON symptoms to treatment, final visual acuity and automated visual fields. However, a higher proportion of Thai affected eyes were found to have an initial visual acuity of 20/200 or worse compared with the American-Caucasian cohort. Azathioprine was the most common maintenance treatment (75%) used among Thai subjects in contrast to rituximab (78.6%) among American-Caucasian subjects.

CONCLUSION

Despite the different prevalence among Thai and American-Caucasian populations, the clinical characteristics of ON in the NMOSD were very similar across these two populations, other than for more severe visual loss initially among Thai subjects. Notably, long-term visual outcome did not differ between these cohorts despite significant difference in the maintenance treatment regimen. This study did not assess neurological status or outcome.

Optic neuritis: a 5-year follow-up study of Chinese patients based on aquaporin-4 antibody status and ages

Little work has been performed on the long-term outcome of optic neuritis (ON) according to the status of aquaporin-4 antibody (AQP4-Ab) and long-term prognosis in older patients in China. This study retrospectively analyzed medical records in a cohort of Chinese patients with 5-year follow-up according to AQP4-Ab status and ages from January 2009 to December 2010. The clinical features, laboratory findings and risk factors for prognosis were analyzed. A total of 128 ON patients were included, 66.4 % of whom were female. The median age at onset was 36.8 years (range 18-73). Serum AQP4-Ab was positive in 45 (35.2 %) patients, with greater frequency in the female, bilateral, and recurrent ON groups (48.2, 42.5 and 53.6 %, respectively). Seropositive AQP4-Ab ON patients had worse visual recovery compared to seronegative patients (p = 0.033). The average and four quadrants of retinal nerve fiber layer (RNFL) thickness were significantly thinner in the seropositive group than in the seronegative group (p < 0.05). At 5-year follow-up, the ON recurrence rate was higher in the seropositive AQP4-Ab patients (37/45, 82.3 %) than in the seronegative patients (35/83, 42.2 %, p < 0.001). Among the seropositive patients, 40 % (18/45) developed neuromyelitis optica (NMO). Only 1.2 % (1/83) of the seronegative patients developed NMO and 4.8 % (4/83) developed to MS. Further, the multivariate analysis in seropositive AQP4-Ab patients showed that two risk factors for transverse myelitis (TM) episode were ocular pain and recurrence within 1 year. The older patients had worse visual outcome after the first episode of ON than the younger patients (p = 0.007). However, the two groups did not differ significantly with regard to prevalence of AQP4-Ab, long-term visual recovery and the risk of developing to NMO/MS.

Change of Th17 Lymphocytes and Treg/Th17 in Typical and Atypical Optic Neuritis

Background

Typical and atypical optic neuritis (ON) are two clinical types of autoimmune inflammatory diseases of the optic nerve that causes acute vision loss, and are difficult to distinguish in their early stages. The disturbance in the balance of Th17 and Treg lymphocytes is thought to play an essential role in these autoimmune inflammatory diseases.

Objectives

To detect the clinical relevance of Th17 and Treg in peripheral blood and the ratio of Treg/Th17 in patients with typical and atypical ON. To determine whether analysis of Th17 and Treg lymphocytes will provides insights into the different disease phenotypes of typical and atypical ON.

Methods

We studied a consecutive series of patients aged 14–70 years who presented to our neurological department with typical ON (n = 30) or atypical ON (n = 33) within 4 weeks of their acute attacks. Routine clinical tests and ophthalmological examination were performed in all patients. Blood samples were collected from untreated patients and from gender- and age-matched healthy controls (n = 30). The proportion of peripheral blood Th17 cells and Treg cells was determined by flow cytometry.

Results

Patients with atypical ON had a higher proportion of Th17 cells than patients with typical ON (3.61±1.56 vs 2.55±1.74, P<0.01) or controls (1.45±0.86, P<0.01). The proportion of Th17 cells in patients with typical ON was also markedly higher than in controls (P<0.01). The mean percentage of Treg cells in atypical ON (6.31±2.11) and typical ON (6.80±2.00) were significantly lower when compared to controls (8.29±2.32, both P<0.01). No significant difference in Treg frequency was observed between typical ON and atypical ON (p>0.05).

Conclusions

The frequency of Th17 cells is higher in atypical ON than typical ON, and patients with atypical ON have a greater imbalance of pro-inflammatory and regulatory cells than patients with typical ON when compared with controls. These changes are indicative of distinct pathological mechanisms and may provide useful information to distinguish typical and atypical ON.

Evaluation of Retinal Nerve Fiber Layer and Ganglion Cell Complex in Patients with Optic Neuritis or Neuromyelitis Optica Spectrum Disorders Using Optical Coherence Tomography in a Chinese Cohort

We evaluate a cohort of optic neuritis and neuromyelitis optica (NMO) spectrum disorders patients in a territory hospital in China. The peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) were measured using spectral-domain OCT after 6 months of acute onset. The results showed that both the peripapillary RNFL and macular GCC were significantly thinner in all optic neuritis subtypes compared to controls. In addition, the recurrent optic neuritis and NMO groups showed more severe damage on the RNFL and GCC pattern.