Skip to main content

Advertisement

Log in

Visual recovery following acute optic neuritis

A clinical, electrophysiological and magnetic resonance imaging study

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract.

This study reports the prospective follow–up of a cohort of patients with acute optic neuritis examined with serial visual tests, visual evoked potentials (VEPs), conventional and triple–dose gadolinium (Gd)–enhanced magnetic resonance imaging (MRI) to examine which factors are important in visual recovery. Thirty–three patients were recruited with acute unilateral optic neuritis. A clinical and VEP assessment was performed on each. Optic nerve MRI was performed using fast spin echo (FSE) (on all) and triple-dose Gdenhanced T1–weighted sequences (n = 28). Optic nerve lesion lengths were measured. Serial assessments were performed on 22 of the patients up to one–year. Serial Gd–enhanced optic nerve imaging was performed on 15 of the patients until enhancement ceased. The final 30–2 Humphrey visual field mean deviation (MD) was 2.55 dB higher in patients in the lowest quartile of initial Gd–enhanced lesion length compared with the other quartiles (p < 0.01) but recovery was not related to the duration of enhancement. The initial recovery of Humphrey MD was 4.60 dB units per day in patients with good eventual recoveries (MD > –6.0 dB) and 0.99 dB per day in poor-recovery patients (p = 0.02).Good–recovery patients had mean central field VEP amplitudes 2.29 µV higher during recovery than poor-recovery patients (p = 0.047). The results suggest that factors which are associated with a better prognosis are: having a short acute lesion on triple–dose gadolinium enhanced imaging, higher VEP amplitudes during recovery and a steep gradient of the initial improvement in vision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Optic Neuritis Study Group (1991) The clinical profile of optic neuritis. Experience of the Optic Neuritis Treatment Trial. Arch Ophthalmol 109:1673–1678

    PubMed  Google Scholar 

  2. Baltagi H (1995) Econometric Analysis of Panel Data.New York: John Wiley & Sons

    Google Scholar 

  3. Barkhof F, Filippi M, Miller DH, et al. (1997) Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 120:2059–2069

    Article  PubMed  Google Scholar 

  4. Beck RW (1998) Optic Neuritis. In: Miller NR, Newman NJ (eds) Walsh and Hoyt’s Clinical Neuro-Ophthalmology. Baltimore: Williams and Wilkins: 599–647

  5. Beck RW, Cleary PA, Backlund JC (1994) The course of visual recovery after optic neuritis. Experience of the Optic Neuritis Treatment Trial. Ophthalmology 101:1771–1778

    CAS  PubMed  Google Scholar 

  6. Behan CMH, Hickman SJ, Scolding NJ, Miller DH, Compston DAS (2000) Identification of the clinically symptomatic lesion in multiple sclerosis – implications for remyelination therapy. Rev Neurol (Paris) 156(Suppl. 3):S28

    Google Scholar 

  7. Bradley WG, Whitty CW (1967) Acute optic neuritis: its clinical features and their relation to prognosis for recovery of vision. J Neurol Neurosurg Psychiatry 30:531–538

    PubMed  Google Scholar 

  8. Brusa A, Jones SJ, Plant GT (2001) Long-term remyelination after optic neuritis: A 2-year visual evoked potential and psychophysical serial study. Brain 124:468–479

    Article  CAS  PubMed  Google Scholar 

  9. Brusaferri F, Candelise L (2000) Steroids for multiple sclerosis and optic neuritis: a meta-analysis of randomized controlled clinical trials. J Neurol 247:435–442

    Google Scholar 

  10. Carpenter J, Bithell J (2000) Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med 19:1141–1164

    Article  Google Scholar 

  11. Compston DA, Batchelor JR, Earl CJ, McDonald WI (1978) Factors influencing the risk of multiple sclerosis developing in patients with optic neuritis. Brain 101:495–511

    CAS  PubMed  Google Scholar 

  12. Cox TA, Thompson HS, Corbett JJ (1981) Relative afferent pupillary defects in optic neuritis. Am J Ophthalmol 92:685–690

    CAS  PubMed  Google Scholar 

  13. Ferguson B, Matyszak MK, Esiri MM, Perry VH (1987) Axonal damage in acute multiple sclerosis lesions. Brain 120:393–399

    Google Scholar 

  14. Ferris FL III, Kassoff A, Bresnick GH, Bailey I (1982) New visual acuity charts for clinical research. Am J Ophthalmol 94:91–96

    Google Scholar 

  15. Filippi M, Yousry T, Campi A et al. (1996) Comparison of triple dose versus standard dose gadolinium-DTPA for detection of MRI enhancing lesions in patients with MS. Neurology 46:379–384

    CAS  PubMed  Google Scholar 

  16. Francis DA, Compston DA, Batchelor JR, McDonald WI (1987) A reassessment of the risk of multiple sclerosis developing in patients with optic neuritis after extended follow-up. J Neurol Neurosurg Psychiatry 50:758–765

    CAS  PubMed  Google Scholar 

  17. Ghezzi A, Martinelli V, Torri V et al. (1999) Long-term follow-up of isolated optic neuritis: the risk of developing multiple sclerosis, its outcome, and the prognostic role of paraclinical tests. J Neurol 246:770–775

    CAS  Google Scholar 

  18. Grimaud J, Lai M, Thorpe J et al. (1996) Quantification of MRI lesion load in multiple sclerosis: a comparison of three computer-assisted techniques. Magn Reson Imaging 14:495–505

    Article  CAS  PubMed  Google Scholar 

  19. Guy J, Fitzsimmons J, Ellis EA, Beck B, Mancuso A (1992) Intraorbital optic nerve and experimental optic neuritis. Correlation of fat suppression magnetic resonance imaging and electron microscopy. Ophthalmology 99:720–725

    CAS  PubMed  Google Scholar 

  20. Hickman SJ, Brierley CM, Brex PA et al. (2002) Continuing optic nerve atrophy following optic neuritis: a serial MRI study. Mult Scler 8:339–342

    Article  CAS  PubMed  Google Scholar 

  21. Hickman SJ, Dalton CM, Miller DH, Plant GT. Management of acute optic neuritis. Lancet 360:1953–1962

  22. Jin YP, Pedro-Cuesta J, Soderstrom M, Stawiarz L, Link H (1998) Incidence of optic neuritis in Stockholm, Sweden 1990–1995: I.Age, sex, birth and ethnic-group related patterns. J Neurol Sci 159:107–114

    CAS  PubMed  Google Scholar 

  23. Katz D, Taubenberger JK, Cannella B, McFarlin DE, Raine CS, McFarland HF (1993) Correlation between magnetic resonance imaging findings and lesion development in chronic, active multiple sclerosis. Ann Neurol 34:661–669

    CAS  PubMed  Google Scholar 

  24. Keltner JL, Johnson CA, Spurr JO, Beck RW (1993) Baseline visual field profile of optic neuritis. The experience of the optic neuritis treatment trial. Optic Neuritis Study Group. Arch Ophthalmol 111:231–234

    CAS  PubMed  Google Scholar 

  25. Kupersmith MJ, Alban T, Zeiffer B, Lefton D (2002) Contrast-enhanced MRI in acute optic neuritis: relationship to visual performance. Brain 125:812–822 1005

    Article  PubMed  Google Scholar 

  26. Levatin P (1959) Pupillary escape in disease of the retina or optic nerve. Arch Ophthalmol 62:768–779

    CAS  PubMed  Google Scholar 

  27. MacDonald BK, Cockerell OC, Sander JW, Shorvon SD (2000) The incidence and lifetime prevalence of neurological disorders in a prospective communitybased study in the UK. Brain 123:665–676

    Article  PubMed  Google Scholar 

  28. Miller DH, Newton MR, van der Poel JC, et al. (1988) Magnetic resonance imaging of the optic nerve in optic neuritis. Neurology 38:175–179

    PubMed  Google Scholar 

  29. Noseworthy JH, O’Brien PC, Petterson TM, et al. (2001) A randomized trial of intravenous immunoglobulin in inflammatory demyelinating optic neuritis. Neurology 56:1514–1522

    CAS  PubMed  Google Scholar 

  30. Perkin GD, Rose FC (1979) Optic neuritis and its differential diagnosis. Oxford: Oxford University Press

  31. Plummer DL (1992) DispImage: a display and analysis tool for medical images. Riv Neuroradiol 5:489–495

    Google Scholar 

  32. Poser CM, Paty DW, Scheinberg L, et al. (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231

    Google Scholar 

  33. Rodriguez M, Siva A, Cross SA, O’Brien PC,Kurland LT (1995) Optic neuritis: a population-based study in Olmsted County, Minnesota. Neurology 45:244–250

    CAS  PubMed  Google Scholar 

  34. Silver N, Lai M, Symms M, Barker G, McDonald I, Miller D (1999) Serial gadolinium-enhanced and magnetization transfer imaging to investigate the relationship between the duration of blood-brain barrier disruption and extent of demyelination in new multiple sclerosis lesions. J Neurol 246:728–730

    Article  CAS  PubMed  Google Scholar 

  35. Silver NC, Good CD, Barker GJ, et al. (1997) Sensitivity of contrast enhanced MRI in multiple sclerosis. Effects of gadolinium dose, magnetization transfer contrast and delayed imaging. Brain 120:1149–1161

    Article  PubMed  Google Scholar 

  36. Simon JH, Kinkel RP, Jacobs L, Bub L, Simonian N (2000) A Wallerian degeneration pattern in patients at risk for MS. Neurology 54:1155–1160

    CAS  PubMed  Google Scholar 

  37. Slamovits TL, Rosen CE, Cheng KP, Striph GG (1991) Visual recovery in patients with optic neuritis and visual loss to no light perception. Am J Ophthalmol 111:209–214

    PubMed  Google Scholar 

  38. Smith KJ, McDonald WI (1999) The pathophysiology of multiple sclerosis: the mechanisms underlying the production of symptoms and the natural history of the disease. Philos Trans R Soc Lond B Biol Sci 354:1649–1673

    CAS  PubMed  Google Scholar 

  39. Snedecor GW, Cochran WG (1989) Statistical Methods. Ames, Iowa: Iowa State University Press

  40. Steel DH, Waldock A (1998) Measurement of the retinal nerve fibre layer with scanning laser polarimetry in patients with previous demyelinating optic neuritis. J Neurol Neurosurg Psychiatry 64:505–509

    CAS  PubMed  Google Scholar 

  41. Tortorella C, Codella M, Rocca MA et al. (1999) Disease activity in multiple sclerosis studied by weekly tripledose magnetic resonance imaging. J Neurol 246:689–692

    CAS  PubMed  Google Scholar 

  42. Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mork S, Bo L (1998) Axonal transection in the lesions of multiple sclerosis. N Engl J Med 338:278–285

    Article  CAS  PubMed  Google Scholar 

  43. Wakakura M, Minei-Higa R, Oono S, et al. (1999) Baseline features of idiopathic optic neuritis as determined by a multicenter treatment trial in Japan. Optic Neuritis Treatment Trial Multicenter Cooperative Research Group (ONMRG). Jpn J Ophthalmol 43:127–132

    Article  CAS  PubMed  Google Scholar 

  44. Werring DJ, Bullmore ET, Toosy AT, et al. (2000) Recovery from optic neuritis is associated with a change in the distribution of cerebral response to visual stimulation: a functional magnetic resonance imaging study. J Neurol Neurosurg Psychiatry 68:441–449

    CAS  PubMed  Google Scholar 

  45. Youl BD, Turano G, Miller DH, et al. (1991) The pathophysiology of acute optic neuritis. An association of gadolinium leakage with clinical and electrophysiological deficits. Brain 114: 2437–2450

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D. H. Miller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hickman, S.J., Toosy, A.T., Miszkiel, K.A. et al. Visual recovery following acute optic neuritis. J Neurol 251, 996– 1005 (2004). https://doi.org/10.1007/s00415-004-0477-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-004-0477-1

Key words

Navigation