Visual recovery following acute optic neuritis--a clinical, electrophysiological and magnetic resonance imaging study.
This study reports the prospective follow-up of a cohort of patients with acute optic neuritis examined with serial visual tests, visual evoked potentials (VEPs), conventional and triple-dose gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) to examine which factors are important in visual recovery. Thirty-three patients were recruited with acute unilateral optic neuritis. A clinical and VEP assessment was performed on each. Optic nerve MRI was performed using fast spin echo (FSE) (on all) and triple-dose Gd-enhanced T1-weighted sequences (n = 28). Optic nerve lesion lengths were measured. Serial assessments were performed on 22 of the patients up to one-year. Serial Gd-enhanced optic nerve imaging was performed on 15 of the patients until enhancement ceased. The final 30-2 Humphrey visual field mean deviation (MD) was 2.55 dB higher in patients in the lowest quartile of initial Gd-enhanced lesion length compared with the other quartiles (p < 0.01) but recovery was not related to the duration of enhancement. The initial recovery of Humphrey MD was 4.60 dB units per day in patients with good eventual recoveries (MD > -6.0 dB) and 0.99 dB per day in poor-recovery patients (p = 0.02).Good-recovery patients had mean central field VEP amplitudes 2.29 microV higher during recovery than poor-recovery patients (p = 0.047). The results suggest that factors which are associated with a better prognosis are: having a short acute lesion on triple-dose gadolinium enhanced imaging, higher VEP amplitudes during recovery and a steep gradient of the initial improvement in vision.
NMR Research Unit, Dept. of Neuroinflammation, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK.
Simon J
SJ
Hickman
Ahmed T
AT
Toosy
Katherine A
KA
Miszkiel
Stephen J
SJ
Jones
Daniel R
DR
Altmann
David G
DG
MacManus
Gordon T
GT
Plant
Alan J
AJ
Thompson
David H
DH
Miller
D000328:Adult; D005074:Evoked Potentials, Visual / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009902:Optic Neuritis / Q000473:pathology / Q000503:physiopathology*; D011446:Prospective Studies; D011930:Reaction Time; D020127:Recovery of Function / Q000502:physiology*; D013997:Time Factors; D014785:Vision, Ocular / Q000502:physiology*; D014794:Visual Fields / Q000502:physiology
D005682:Gadolinium