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June 17, 2014; 82 (24) Article

Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis

Muhammad Taimur Malik, Brian C. Healy, Leslie A. Benson, Pia Kivisakk, Alexander Musallam, Howard L. Weiner, Tanuja Chitnis
First published May 21, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000524
Muhammad Taimur Malik
From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston.
MD
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Brian C. Healy
From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston.
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Leslie A. Benson
From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston.
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Pia Kivisakk
From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston.
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Alexander Musallam
From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston.
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Howard L. Weiner
From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston.
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Tanuja Chitnis
From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston.
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Full PDF
Citation
Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis
Muhammad Taimur Malik, Brian C. Healy, Leslie A. Benson, Pia Kivisakk, Alexander Musallam, Howard L. Weiner, Tanuja Chitnis
Neurology Jun 2014, 82 (24) 2173-2179; DOI: 10.1212/WNL.0000000000000524

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Abstract

Objective: To identify clinical and demographic features associated with the severity and recovery from acute optic neuritis (AON) episodes in patients with multiple sclerosis (MS).

Methods: Adult (n = 253) and pediatric (n = 38) patients whose first symptom was AON were identified from our MS database. Severity measured by loss of visual acuity (mild attack ≤20/40, moderate attack 20/50–20/190, and severe attack ≥20/200) and recovery in visual acuity at 1 year after the attack (complete recovery ≤20/20, fair recovery 20/40, and poor recovery ≥20/50) were recorded. Demographic and clinical features associated with attack severity and recovery were identified using proportional odds logistic regression. For another group of patients, blood samples were available within 6 months of an AON attack. In this group, the impact of vitamin D level on the severity/recovery was also assessed.

Results: Men (adjusted odds ratio [OR] = 2.28, p = 0.03) and subjects with severe attacks (adjusted OR = 5.24, p < 0.001) had worse recovery. AON severity was similar between the pediatric and adult subjects, but recovery was significantly better in pediatric subjects in the unadjusted analysis (p = 0.041) and the analysis adjusted for sex (p = 0.029). Season-adjusted vitamin D level was significantly associated with attack severity (OR for 10-U increase in vitamin D level = 0.47; 95% confidence interval: 0.32, 0.68; p < 0.001). Vitamin D level was not associated with recovery from the attack (p = 0.98) in univariate analysis or after accounting for attack severity (p = 0.10).

Conclusion: Vitamin D levels affect AON severity, whereas younger age, attack severity, and male sex affect AON recovery. Underlying mechanisms and potential therapeutic targets may identify new measures to mitigate disability accrual in MS.

GLOSSARY

AOMS=
adult-onset multiple sclerosis;
AON=
acute optic neuritis;
CIS=
clinically isolated syndrome;
CLIMB=
Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women's Hospital;
MS=
multiple sclerosis;
NMO=
neuromyelitis optica;
OR=
odds ratio;
PMS=
pediatric multiple sclerosis

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received November 12, 2013.
  • Accepted in final form March 11, 2014.
  • © 2014 American Academy of Neurology
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