Pirko Istvan, Blauwet Lori A, Lesnick Timothy G, Weinshenker Brian G
Department of Neurology, Mayo Medical School, 200 First Street SW, Rochester, MN 55905, USA.
Arch Neurol. 2004 Sep;61(9):1401-5. doi: 10.1001/archneur.61.9.1401.
Optic neuritis (ON) may occur in isolation or may herald multiple sclerosis (MS) or neuromyelitis optica (NMO). Occasionally, ON may recur many times without intervening evidence of dissemination in space.
To define the clinical course and prognosis of patients with recurrent ON.
Retrospective medical record review and telephone follow-up survey.
Clinic-based practice in a large tertiary referral institution.
Survival analysis of conversion to MS and NMO and final visual impairment. We studied the association of clinical and demographic factors, the presence of brain lesions on magnetic resonance images, and the use of corticosteroid treatment at the time of the first ON occurrence with conversion to MS and NMO.
We identified 1274 patients with ON between 1994 and 2000 and selected 72 (5.7%) with recurrent ON without intervening symptoms of a disseminated demyelinating condition for further analysis. The 5-year conversion rate to NMO was 12.5% and to MS, 14.4%. Among 5 patients with 2 or more lesions consistent with MS on brain magnetic resonance images, 2 (40.0%) converted to MS and none to NMO, while among 11 patients without such lesions, none converted to MS and 2 (18.2%) converted to NMO (P =.16). Conversion to MS occurred in 7 (19.4%) of 36 individuals treated for their first ON episode with corticosteroids vs 4 (44.4%) of 9 untreated individuals (P =.19). There was no difference in the conversion rate to MS between those treated with intravenous steroids (4 [16.7%] of 24) vs oral steroids (3 [25.0%] of 12) (P =.33). Conversion to NMO occurred earlier than conversion to MS (2.3 +/- 1.6 vs 5.3 +/- 4.3 years, respectively; P =.01). Women tended to convert to NMO more frequently than men (female-male ratio for NMO converters, 7:1; MS converters, 2:1; nonconverters, 2:1; P =.56), as did those with a higher annual frequency of ON episodes (NMO converters, 2.0 +/- 1.3; MS converters, 1.0 +/- 1.0; nonconverters, 0.6 +/- 0.5; P =.04). The number of ON events in the first 2 years following the first ON episode was higher in the NMO group (NMO converters, 2.4 +/- 0.9; MS converters, 1.9 +/- 1.1; nonconverters, 1.7 +/- 0.7; P =.04). The final visual impairment was greatest in the NMO group (P =.02).
Patients with rapid succession of severe ON events are more likely to develop a generalized demyelinating disease. Patients with NMO had a worse visual outcome.
视神经炎（ON）可能单独出现，也可能是多发性硬化（MS）或视神经脊髓炎（NMO）的先兆。偶尔，ON可能多次复发，而无空间播散的中间证据。
明确复发性ON患者的临床病程及预后。
回顾性病历审查及电话随访调查。
大型三级转诊机构的门诊实践。
转化为MS和NMO的生存分析及最终视力损害情况。我们研究了临床和人口统计学因素、磁共振成像上脑病变的存在情况以及首次发生ON时使用皮质类固醇治疗与转化为MS和NMO之间的关联。
我们在1994年至2000年间确定了1274例ON患者，并选取了72例（5.7%）复发性ON且无播散性脱髓鞘疾病中间症状的患者进行进一步分析。5年转化为NMO的比例为12.5%，转化为MS的比例为14.4%。在脑磁共振成像上有2个或更多符合MS病变的5例患者中，2例（40.0%）转化为MS，无1例转化为NMO；而在无此类病变的11例患者中，无1例转化为MS，2例（18.2%）转化为NMO（P = 0.16）。首次ON发作接受皮质类固醇治疗的36例个体中有7例（19.4%）转化为MS，而9例未治疗个体中有4例（44.4%）转化为MS（P = 0.19）。静脉注射类固醇治疗者（24例中的4例[16.7%]）与口服类固醇治疗者（12例中的3例[25.0%]）转化为MS的比例无差异（P = 0.33）。转化为NMO比转化为MS更早（分别为2.3±1.6年和5.3±4.3年；P = 0.01）。女性比男性更易转化为NMO（NMO转化者的女性与男性比例为7:1；MS转化者为2:1；未转化者为2:1；P = 0.56），首次ON发作后每年发作频率较高者也是如此（NMO转化者为2.0±1.3；MS转化者为1.0±1.0；未转化者为0.6±0.5；P = 0.04）。NMO组在首次ON发作后的前2年中ON发作次数更多（NMO转化者为2.4±0.9；MS转化者为1.9±1.1；未转化者为1.7±0.7；P = 0.04）。NMO组最终视力损害最严重（P = 0.02）。
严重ON事件迅速连续发生的患者更易发展为全身性脱髓鞘疾病。NMO患者的视力预后更差。
