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Clinical and epidemiological profile of patients with atypical optic neuritis

Grant number: 15/18940-5
Support type:Scholarships in Brazil - Scientific Initiation
Effective date (Start): January 01, 2016
Effective date (End): December 31, 2016
Field of knowledge:Health Sciences - Medicine - Medical Clinics
Principal researcher:Frederico Castelo Moura
Grantee:Natália Naomi Suzuki
Home Institution: Hospital de Clínicas (HC). Universidade Estadual de Campinas (UNICAMP). Campinas , SP, Brazil

Abstract

Several conditions can affect the optic nerve and the most common are inflammatory optic neuropathies. Optic neuritis is the main disease of the group of inflammatory optic neuropathies because to its relation to multiple sclerosis (MS). When optic neuritis presents with common clinical features according to the study ONTT ("optic neuritis treatment trial") is classified as classical or typical optic neuritis (TON). The clinical and epidemiological profiles of optic neuritis (ON) are based on ONTT study. Typical epidemiological characteristics are female, aged 20-50 years and whites. Typical clinical features are central visual loss associated with eye pain that worsens with movement. Most patients present visual loss between 20/25 and 20/800. The changes of the optic nerve in optic neuritis are commonly focal and located in the intraorbital segment on magnetic resonance imaging. The main change CSF in patients with optic neuritis is the presence of oligoclonal bands confirms the nature of demyelinating optic neuropathy, although it is not specific for MS. Most patients in ONTT show no significant changes in cellularity and protein levels. The natural history of optic neuritis in ONTT shows that the recovery of vision beginning 3-4 weeks in 80% of patients continued to improve up to 1 year in which 95% of patients have vision equal to or better than 20/40. All patients with initial suspicion of optic neuritis showing one or more clinical characteristics that differ from most of the study patients ONTT (including patient age, degree of vision loss, laterality, visual recovery and recurrence rate) should be directed to research the differential diagnoses. In particular, a group of inflammatory optic neuropathies should be investigated due to present with visual loss and eye pain, although they have other unusual clinical features to optic neuritis. This group can be termed atypical optic neuritis (AON) and includes neuromyelitis optica (NMO), recurrent optic neuritis, autoimmune optic neuropathy and CRION (chronic relapsing inflammatory optic neuropathy). The NMO is a demyelinating disease, immune-mediated inflammatory and central nervous system manifest by optic neuritis and myelitis. Visual loss of NMO is often severe, with less chance of visual recovery of that optic neuritis associated with MS. After the discovery of the anti-aquaporin 4 antibody, limited ways of including NMO described were isolated optic neuritis. Recurrent optic neuritis is a condition classified as AON. The occurrence of recurrent optic neuritis is not a rare event may occur in 5% of cases of typical optic neuritis. Classically, the recurrence of optic neuritis raises the suspicion of NMO, although it may be associated with MS. The optic neuropathy autoimmune isolated (or primary) is a rare disease characterized by optic neuritis associated with autoantibodies (antinuclear antibodies and anticardiolipin) and exuberant response to corticosteroids associated with later corticodependence. There is no associated systemic disease. The CRION is a form of optic neuritis with atypical characteristic as intense and prolonged ocular pain, recurrent and visual loss associated with corticoid. Although the incidence of atypical optic neuritis is much smaller than the typical, the biggest risk for visual function, and sometimes to the neurological status, justifies the present study involving atypical optic neuritis and the determination of its clinical and epidemiological profile. (AU)

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