Multipe Sclerosis - Diagnosis
Optic Neuritis -
updated: 10 November 2009
Diagnosing and managing multiple sclerosis
Practitioner. 2009 Sep;253(1721):25-30, 2-3.
Jenkins TM, Thompson AJ.
The most common form of MS is relapsing remitting MS (RRMS). This is now a treatable condition and early diagnosis is becoming increasingly important in order to guide management decisions. After several years, RRMS may evolve into a slowly progressive deterioration in neurological function, known as secondary progressive MS. In 10-15% of people with MS, the condition follows this pattern of slow deterioration from onset, without relapses or remissions. This is primary progressive MS. It is difficult to predict prognosis in an individual patient. Factors associated with a favourable prognosis include female sex, onset with optic neuritis or sensory symptoms (rather than weakness or ataxia) and a long interval between initial relapses. RRMS is most commonly diagnosed in white women in their 20s. The first attack is known as a 'clinically isolated syndrome' reflecting inflammation in a single location. Common sites and symptoms are: optic nerve; spinal cord; sensory symptoms; Lhermitte's symptom and brainstem. The time course of symptoms is often helpful, as it is characteristic of inflammation. Patients tend to deteriorate over days, remain at a nadir for a week or two, and then recover over weeks. Recovery may be incomplete. Question patients directly to find out if there is a past history of any of the other common symptoms and perform a full neurological examination. Primary progressive MS should be suspected in patients presenting with a progressive spastic paraparesis or cerebellar syndrome. The diagnosis of MS should be made by a specialist and patients with a syndrome suggestive of MS should be referred to a neurologist. The mainstays of pharmacological treatment in RRMS are still the beta interferons and glatiramer acetate. These drugs reduce the rate of relapse by about a third and are therefore indicated for mobile patients with at least two relapses in the past two years.
Publication Types:
Online - Abstract
Optic neuritis: a review
Int MS J. 2009 Sep;16(3):82-9.
Shams PN, Plant GT.
Acute demyelinating optic neuritis (ON) is the initial presentation in approximately 20% of cases of multiple sclerosis (MS) and is characterized by unilateral, subacute, painful visual loss without systemic or neurological symptoms. The Optic Neuritis Treatment Trial (ONTT) has provided valuable insights into both the natural history and clinical course of demyelinating ON with respect to treatment. Visual function improves spontaneously over weeks and within 12 months 93% have recovered to a visual acuity of at least 20/40. Treatment with high-dose corticosteroids may accelerate visual recovery, but has little impact on long-term visual outcome. In the ONTT the 10-year risk of recurrence of demyelinating ON was 35%. The presence of white matter lesions on the initial magnetic resonance image of the brain has been identified as the strongest predictor for the development of MS. The 15-year risk of developing MS in the ONTT was 25% with no lesions, but 75% with one or more lesions. Since there is evidence of early axonal damage in acute demyelinating ON, disease-modifying drugs should be considered in patients at high risk of developing MS in the future as prophylaxis against permanent neurological impairment.
Publication Types:
Online - Article
Optic neuritis in multiple sclerosis: diagnosis and prognosis data
Rev Neurol (Paris). 2009 Mar;165 Suppl 4:S145-7.
Beddiaf A, de Sèze J.
The most frequent ophthalmologic sign in multiple sclerosis (MS) is optic neuritis (ON), but internuclear ophthalmoplegia, nystagmus, and ocular motor nerve palsies are also observed. This paper describes the most important signs suggesting an inflammatory origin of ON, most particularly MS. We detail new laboratory exams such as optic coherence tomography (OCT), which could be of potential interest for MS patients. Finally, we summarize the prognosis factors for disability in MS after a first episode of ON.
Publication Types:
Online - Abstract
Optic neuritis and risk of MS: differential diagnosis and management
Cleve Clin J Med. 2009 Mar;76(3):181-90
Osborne BJ, Volpe NJ.
Optic neuritis, a cause of sudden vision loss, often heralds the onset of multiple sclerosis (MS) within the next few years. It is important to distinguish optic neuritis from other types of optic neuropathy so that treatment can be started promptly, possibly delaying the onset of MS.
Publication Types:
Online - Article
Optic neuropathy in multiple sclerosis
Oftalmologia. 2008;52(4):3-14.
scu S, Pascu R, Panea C, Voinea L, Badarau A, Nanea M, Romanitan O, Ciuluvica R.
The inflammation of the optic nerve called optic neuropathy could be an onset marker of multiple sclerosis. The authors review the place of optic neuropathy (neuritis) in the inflammatory demyelinating disease continuum, especially as the onset symptom of multiple sclerosis. We present the clinical symptoms, the aetiology of optic neuritis and the adjacent methods used to investigate optic neuritis. In the article are presented the actual criteria used to establish the multiple sclerosis diagnosis and the revised criteria for optic neuromyelitis, with emphasis on the differential diagnosis between these diseases.
Publication Types:
Online - Abstract
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