title: High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial.
abstract: OBJECTIVE
  To identify factors associated with a high and low risk of developing multiple sclerosis after an initial episode of optic neuritis.
  
  
  METHODS
  Three hundred eighty-eight patients who experienced acute optic neuritis between July 1, 1988, and June 30, 1991, were followed up prospectively for the development of multiple sclerosis. Consenting patients were reassessed after 10 to 13 years.
  
  
  RESULTS
  The 10-year risk of multiple sclerosis was 38% (95% confidence interval, 33%-43%). Patients (160) who had 1 or more typical lesions on the baseline magnetic resonance imaging (MRI) scan of the brain had a 56% risk; those with no lesions (191) had a 22% risk (P<.001, log rank test). Among the patients who had no lesions on MRI, male gender and optic disc swelling were associated with a lower risk of multiple sclerosis, as was the presence of the following atypical features for optic neuritis: no light perception vision; absence of pain; and ophthalmoscopic findings of severe optic disc edema, peripapillary hemorrhages, or retinal exudates.
  
  
  CONCLUSIONS
  The 10-year risk of multiple sclerosis following an initial episode of acute optic neuritis is significantly higher if there is a single brain MRI lesion; higher numbers of lesions do not appreciably increase that risk. However, even when brain lesions are seen on MRI, more than 40% of the patients will not develop clinical multiple sclerosis after 10 years. In the absence of MRI lesions, certain demographic and clinical features seem to predict a very low likelihood of developing multiple sclerosis. This natural history information is a critical input for estimating a patient's 10-year multiple sclerosis risk and for weighing the benefit of initiating prophylactic treatment at the time of optic neuritis or other initial demyelinating events in the central nervous system.
authors.affiliation: Optic Neuritis Study Group Coordinating Center, Jaeb Center for Health Research, Tampa, FL 33647, USA. ontt@jaeb.org
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Trobe
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Moke
authors.forename: Robin L
authors.initials: RL
authors.lastname: Gal
authors.forename: Dongyuan
authors.initials: D
authors.lastname: Xing
authors.forename: M Tariq
authors.initials: MT
authors.lastname: Bhatti
authors.forename: Michael C
authors.initials: MC
authors.lastname: Brodsky
authors.forename: Edward G
authors.initials: EG
authors.lastname: Buckley
authors.forename: Georgia A
authors.initials: GA
authors.lastname: Chrousos
authors.forename: James
authors.initials: J
authors.lastname: Corbett
authors.forename: Eric
authors.initials: E
authors.lastname: Eggenberger
authors.forename: James A
authors.initials: JA
authors.lastname: Goodwin
authors.forename: Barrett
authors.initials: B
authors.lastname: Katz
authors.forename: David I
authors.initials: DI
authors.lastname: Kaufman
authors.forename: John L
authors.initials: JL
authors.lastname: Keltner
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Kupersmith
authors.forename: Neil R
authors.initials: NR
authors.lastname: Miller
authors.forename: Sarkis
authors.initials: S
authors.lastname: Nazarian
authors.forename: Silvia
authors.initials: S
authors.lastname: Orengo-Nania
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Savino
authors.forename: William T
authors.initials: WT
authors.lastname: Shults
authors.forename: Craig H
authors.initials: CH
authors.lastname: Smith
authors.forename: Michael
authors.initials: M
authors.lastname: Wall
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008776:Methylprednisolone Hemisuccinate; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011241:Prednisone; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000893:Anti-Inflammatory Agents; D008776:Methylprednisolone Hemisuccinate; D011241:Prednisone