Acute optic neuritis: What are the clues to the aetiological diagnosis in real life?

Romain Deschamps; Natalia Shor; Catherine Vignal; Jessica Guillaume; Caroline Bensa; Augustin Lecler; Romain Marignier; Vivien Vasseur; Caroline Papeix; Marine Boudot de la Motte; Cedric Lamirel

doi:10.1016/j.msard.2023.104764

Acute optic neuritis: What are the clues to the aetiological diagnosis in real life?

Mult Scler Relat Disord. 2023 Aug:76:104764. doi: 10.1016/j.msard.2023.104764. Epub 2023 May 15.

Authors

Affiliations

¹ Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France. Electronic address: rdeschamps@for.paris.
² Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France; Department of Neuro-Radiology, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière - Sorbonne Université, Paris, France.
³ Department of Neuro-Ophthalmology, Hôpital Fondation Adolphe de Rothschild, Paris, France.
⁴ Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France.
⁵ Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France.
⁶ Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France.
⁷ Department of Neurology and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hospices civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon/Bron, France.

PMID: 37270881
DOI: 10.1016/j.msard.2023.104764

Abstract

Background: Previous cross-sectional studies have reported distinct clinical and radiological features among the different acute optic neuritis (ON) aetiologies. Nevertheless, these reports often included the same number of patients in each group, not taking into account the disparity in frequencies of ON aetiologies in a real-life setting and thus, it remains unclear what are the truly useful features for distinguishing the different ON causes. To determine whether clinical evaluation, ophthalmological assessment including the optical coherence tomography (OCT), CSF analysis, and MRI imaging may help to discriminate the different causes of acute ON in a real-life cohort.

Methods: In this prospective monocentric study, adult patients with recent acute ON (<1 month) underwent evaluation at baseline and 1 and 12 months, including, high- and low-contrast visual acuity, visual field assessment and OCT measurements, baseline CSF analysis and MRI.

Results: Among 108 patients, 71 (65.7%) had multiple sclerosis (MS), 19 (17.6%) had idiopathic ON, 13 (12.0%) and 5 (4.6%) had myelin oligodendrocyte glycoprotein and aquaporin-4 antibodies, at last follow up respectively.At baseline, the distribution of bilateral ON, CSF-restricted oligoclonal bands, optic perineuritis, optic nerve length lesions and positive dissemination in space and dissemination in time criteria on MRI were significantly different between the four groups (p <0.001). No significant difference in visual acuity nor inner retinal layer thickness was found between the different ON aetiologies.

Conclusions: In this large prospective study, bilateral visual involvement, CSF and MRI results are the most useful clues in distinguishing the different aetiologies of acute ON, whereas ophthalmological assessments including OCT measurements revealed no significant difference between the aetiologies.

Keywords: Aquaporin-4; Multiple sclerosis; Myelin oligodendrocyte glycoprotein; Optic neuritis; Optical coherence tomography.

MeSH terms

Humans
Multiple Sclerosis*
Myelin-Oligodendrocyte Glycoprotein
Optic Nerve / pathology
Optic Neuritis* / diagnostic imaging
Optic Neuritis* / etiology
Prospective Studies
Tomography, Optical Coherence
Vision Disorders

Substances

Myelin-Oligodendrocyte Glycoprotein