2021 CMSC Annual Meeting

Clinical and Diagnostic Spectrum of Optic Neuritis: A Single-Center Retrospective Study of Disorders Associated with Multiple Sclerosis, Aquaporin-4 Antibody, and Myelin Oligodendrocyte Glycoprotein Antibody


Background: Optic neuritis (ON) is an immune-mediated optic neuropathy associated with multiple immune-mediated neurological conditions. Objectives: To identify clinical, and diagnostic features of initial episodes of multiple sclerosis (MS)-associated (typical) and antibody-related (atypical) ON. Methods: Retrospective, single institution, medical record review. We analyzed demographic, clinical, laboratory, and radiographic findings of 139 patients who presented with first episodes of MS-associated ON (MS-ON), aquaporin-4 antibody-associated ON (AQP4-ON), and myelin oligodendrocyte glycoprotein antibody-associated ON (MOG-ON) between January 2015 and October 2019. Simple hypothesis testing assessed differences between groups. Results: Of 139 patients (109 [79%] women; 29 [21%] men; mean age 47 [SD, 14] years), 106 had MS-ON, 25 had AQP4-ON, and 8 had MOG-ON. Patients with MOG-ON had the highest recurrence rate (88%) relative to MS-ON (28%) and AQP4-ON (56%) patients (P<.001). Patients with AQP4-ON had the highest mean visual functional system scores (4.3 [SD, 1.8]) relative to MS-ON (2.0 [SD, 1.9]) and MOG-ON patients (2.8 [SD, 2.0]) (P<.001). Intracanalicular segment involvement was observed in 10 (40%) AQP4-ON, 12 (11%) MS-ON, and no MOG-ON patients (P=.001). Conclusions: Patients presenting with initial episodes of ON exhibit a range radiographic and laboratory features depending on the underlying associated disease. Understanding the variable characteristics of typical (MS-associated) and atypical (antibody-associated) ON may help physicians accurately diagnose and effectively treat ON