Author Of 1 Presentation
P0745 - Predictors of Diagnosis With A First Presenting Symptom Of Optic Neuritis (ID 1574)
Abstract
Background
Optic neuritis (ON) is a shared symptom between Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum Disorder(NMOSD) with aquaporin-4 antibody (AQP4-IgG), Myelin Oligodendrocyte Glycoprotein antibody (MOG-IgG) associated disease (MOGAD), double seronegative NMOSD, and several other inflammatory conditions. With the initial ON attack, the clinical phenotype may not be apparent at the time of initial evaluation and management. Predicting the clinical phenotype at the time of presentation can have important implications on acute immunotherapy, bridging treatment, selection of disease modifying therapy, and prognosis. Identifying characteristics of the ON presentation that predict the final phenotype can inform treatment decisions and expedite appropriate management.
Objectives
To evaluate the frequency and predictors of the final clinical phenotype following a first diagnosed attack of optic neuritis.
Methods
We performed a retrospective analysis of patients presenting to our hospital system with a first ON attack to determine eventual outcome. Only patients with an evaluation by an ophthalmologist within 3 weeks of symptom onset and at least 6-month follow-up following the initial attack were included. Patients with prior neurological attacks or known clinical phenotype prior to the ON presentation were excluded.
Results
Forty-three patients met inclusion criteria. Of those, 20 (47%) were eventually diagnosed with MS, 8 (19%) with idiopathic monophasic ON, 6 (14%) with MOGAD, 3 (7%) with NMOSD with AQP4-IgG, 1 (2%) with double seronegative NMOSD, 1 (2%) with chronic relapsing inflammatory optic neuritis (CRION), and 4 (9%) with optic neuritis secondary to a systemic disorder (Sarcoidosis, Scleroderma, or Mixed Connective Tissue Disease). Of those patients with mildly diminished visual acuity (20/40 or better), 85% were eventually diagnosed with MS. Of those patients with severely diminished visual acuity (light perception, counting fingers, or hand movement vision), only 40% were eventually diagnosed with MS, and 25% were diagnosed with MOGAD or NMOSD. All patients with bilateral optic nerve involvement at onset developed NMOSD, MOGAD, or idiopathic disease, and none developed.
Conclusions
Based on our data, MS is the most common final phenotype in patients whose first neurological presentation is optic neuritis followed by idiopathic monophasic disease. MOGAD was the third most common final phenotype and was more common than NMOSD with AQP4, double seronegative NMOSD, and seronegative CRION. Patients with a more severe visual acuity insult on presentation tended to develop MOGAD or NMOSD, while those with milder presentations were more likely to develop MS. Bilateral optic nerve involvement seemed to exclusively occur in patients who developed an MOGAD or NMOSD.