Author Of 2 Presentations
P0499 - The epidemiology of optic neuritis in the United Kingdom and implications for consensus diagnostic criteria for multiple sclerosis. (ID 409)
The epidemiology of optic neuritis (ON) has been studied less carefully than the epidemiology of multiple sclerosis (MS). The association of ON with many other diseases poses one of several challenges for inclusion of ON in consensus diagnostic criteria for MS.
To investigate current trends in ON incidence, prevalence and associations with systemic and neurological diseases in the United Kingdom (UK).
We used The Health Improvement Network (THIN), a nationally representative primary care records database to conduct a retrospective cross-sectional and population cohort study (1997-2018), and matched case-control and cohort study (1995-2020) (matched 4:1 on age, sex, region and Townsend Deprivation Index[TDI]).
We included 11,086,469 patients with 75 million patient-years of follow-up. Amongst 2,895 incident cases with ON, 69.5%(n=2011) were female (mean age at diagnosis 41.6 (sd15.6)), 92.5% (n=1,227/1,326) were white and 24.9% were in TDI quintile 1 (no deprivation). The annual point prevalence (per 100,000 people) steadily increased from 69.3 (95%CI 57.2-81.3) in 1997 to 114.8 (95%CI 111.0-118.6) in 2018. The annual incidence rate was stable over 22 years, at 3.7 (95% CI 3.6-3.9) per 100,000 person-years. Highest risk of incident ON was associated with female sex, obesity, reproductive age, mixed or South Asian ethnicity, smoking, and Scottish residence; compared to children ≤10 years at cohort entry, adjusted incident rate ratio was >6-fold higher in women aged 21-40 years (p<0.001). In multivariable logistic regression, ON cases had significantly higher odds of prior diagnosis of MS (17.3%, OR 98.2, 95%CI 65.4-147.5), syphilis (0.2%, OR 5.8, 95%CI 1.4-23.7), mycoplasma (0.2%, OR3.90,1.09-13.93), vasculitis(0.5%, OR3.70,1.68-8.15), sarcoidosis(0.5%, OR2.50,1.21-5.18), Epstein Barr virus(3.8% OR2.29,1.80-2.92), Crohn’s disease(0.7%, OR1.97,1.13-3.43), and psoriasis(4.3%, OR1.28,1.03-1.58). ON patients had significantly higher hazard of incident MS(adjusted HR285.0,167.9-483.8), Behçet’s disease(HR17.4,1.6-195.5), sarcoidosis(HR14.8,4.9-45.1), vasculitis(HR4.9,1.8-13.1), Sjögren’s syndrome(HR3.5,1.4-8.8), and herpetic infection (HR1.7,1.2-2.3).
This large, population-representative study reveals stable incidence of ON in the UK over a 22-year period, and provides evidence-based guidance for investigation of MS and non-MS ON. Careful exclusion of non-MS ON patients, a sizable proportion, will be relevant for future revision of consensus MS diagnostic criteria, to minimize misdiagnosis.
P0764 - A prognostically relevant functional-structural relationship in acute optic neuritis (ID 1569)
In the setting of acute optic neuritis (ON) it can be difficult to accurately predict clinical recovery and differentiate between the various associated syndromes.
To prospectively investigate if comprehensive electrodiagnostic testing in acute optic neuritis (ON) can predict functional recovery or identify differences between ON subtypes.
Patients presenting with acute typical demyelinating ON and controls underwent pattern visual evoked potentials (PVEP), pattern electroretinography (PERG) and optical coherence tomography (OCT) within 14 days of symptom onset. OCT and visual acuity evaluation were repeated after approximately 3 months.
We recruited 25 ON patients (11 isolated ON, 9 multiple sclerosis associated ON and 6 myelin-oligodendrocyte glycoprotein (MOG) seropositive ON) and 5 controls. All subjects were included acutely, with investigations done on average 6.7 days from first symptoms. Nine patients had conduction block at baseline. PVEP peak times were increased and amplitudes were decreased in ON. The PERGs showed that N95 and P50 amplitudes as well as P50 peak times were decreased in ON. None of the PVEP and PERG measures differed across the ON subtypes. A PVEP amplitude reduction was related to more severe GCL loss and thinner pRNFL layer at follow up (r=-0.58; p=0.008 and r=0.72; p=0.021). No such correlation existed at baseline. PVEP peak times and PERG measures were not similarly prognostic for structural outcome.
These data suggest that in acute ON, reduced neuronal function, as indirectly assessed by the reduced PVEP amplitudes, is predictive of subsequent neuronal loss. PVEP amplitudes may be helpful in guiding treatment decisions in acute ON.