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Roy W Beck - One of the best experts on this subject based on the ideXlab platform.
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corticosteroids for treating Optic Neuritis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Swaroop S Vedula, Roy W BeckAbstract:Background Optic Neuritis is an inflammatory disease of the Optic nerve. It occurs more commonly in women than in men. Usually presenting with an abrupt loss of vision, recovery of vision is almost never complete. Closely linked in pathogenesis to multiple sclerosis, it may be the initial manifestation for this condition. In certain patients, no underlying cause can be found.
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treatment of acute Optic Neuritis a summary of findings from the Optic Neuritis treatment trial
Archives of Ophthalmology, 2008Co-Authors: Roy W BeckAbstract:inconclusive because of small sample size. In the 1980s, the Optic Neuritis Treatment Trial was developed to evaluate corticosteroid treatment for Optic Neuritis. This multicenter randomized clinical trial, supported by the National Eye Institute, was designed to answer the following questions: (1) Does treatment with either oral prednisone or intravenous methylprednisolone followed by oral prednisone improve the visual outcome of acute Optic Neuritis? (2) Does either treatment speed recovery of vision? and (3) Are the complications of treatment insignificant in relation to the magnitude of the treatment effect? Long-term follow-up of the cohort was performed to investigate the relationship between Optic Neuritis and the development of multiple sclerosis (MS).
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visual function more than 10 years after Optic Neuritis experience of the Optic Neuritis treatment trial
American Journal of Ophthalmology, 2004Co-Authors: Roy W Beck, Eric Eggenberger, M T Bhatti, Michael C Brodsky, Edward G Buckley, Georgia A Chrousos, James J Corbett, James Goodwin, Barrett Katz, David I KaufmanAbstract:PURPOSE: To assess visual function more than 10 years after an episode of Optic Neuritis in patients enrolled in the Optic Neuritis Treatment Trial. DESIGN: Longitudinal follow-up of a randomized clinical trial. METHODS: Vision testing included measures of visual acuity, contrast sensitivity, and visual field. Quality of life was assessed with the National Eye Institute Visual Function Questionnaire. RESULTS: Examinations were completed on 319 patients. In most patients, visual function test results in the eyes that experienced Optic Neuritis at study entry ("affected eyes") were normal or only slightly abnormal after 9.9 to 13.7 years. Visual acuity in the affected eyes was >or=20/20 in 74%, 20/25 to 20/40 in 18%, <20/40 to 20/200 in 5%, and <20/200 in 3%. On average, visual function was worse in patients with multiple sclerosis (MS) than in those without MS. Recurrent Optic Neuritis in either eye occurred in 35% of patients. Such attacks were more frequent in patients with MS (P <.001). The National Eye Institute Visual Function Questionnaire scores were lower when visual acuity was abnormal and when MS was present. CONCLUSIONS: Most patients retained good to excellent vision more than 10 years after an attack of Optic Neuritis. Recurrences were more frequent in patients with MS.
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high and low risk profiles for the development of multiple sclerosis within 10 years after Optic Neuritis experience of the Optic Neuritis treatment trial
Archives of Ophthalmology, 2003Co-Authors: Roy W Beck, Michael C Brodsky, Edward G Buckley, Georgia A Chrousos, Tariq M Bhatti, Jonathan D Trobe, Pamela S Moke, Robin L Gal, Dongyuan Xing, James J CorbettAbstract:Objective To identify factors associated with a high and low risk of developing multiple sclerosis after an initial episode of Optic Neuritis. Methods Three hundred eighty-eight patients who experienced acute Optic Neuritis between July 1, 1988, and June 30, 1991, were followed up prospectively for the development of multiple sclerosis. Consenting patients were reassessed after 10 to 13 years. Results The 10-year risk of multiple sclerosis was 38% (95% confidence interval, 33%-43%). Patients (160) who had 1 or more typical lesions on the baseline magnetic resonance imaging (MRI) scan of the brain had a 56% risk; those with no lesions (191) had a 22% risk (P Conclusions The 10-year risk of multiple sclerosis following an initial episode of acute Optic Neuritis is significantly higher if there is a single brain MRI lesion; higher numbers of lesions do not appreciably increase that risk. However, even when brain lesions are seen on MRI, more than 40% of the patients will not develop clinical multiple sclerosis after 10 years. In the absence of MRI lesions, certain demographic and clinical features seem to predict a very low likelihood of developing multiple sclerosis. This natural history information is a critical input for estimating a patient's 10-year multiple sclerosis risk and for weighing the benefit of initiating prophylactic treatment at the time of Optic Neuritis or other initial demyelinating events in the central nervous system.
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the effect of corticosteroids for acute Optic Neuritis on the subsequent development of multiple sclerosis
The New England Journal of Medicine, 1993Co-Authors: Roy W Beck, David I Kaufman, Jonathan D Trobe, Mark J Kupersmith, Patricia A Cleary, Donald W Paty, Hendricks C BrownAbstract:Background Optic Neuritis is often the first clinical manifestation of multiple sclerosis, but little is known about the effect of corticosteroid treatment for Optic Neuritis on the subsequent risk of multiple sclerosis. Methods We conducted a multicenter study in which 389 patients with acute Optic Neuritis (and without known multiple sclerosis) were randomly assigned to receive intravenous methylprednisolone (250 mg every six hours) for 3 days followed by oral prednisone (1 mg per kilogram of body weight) for 11 days, oral prednisone (1 mg per kilogram) alone for 14 days, or placebo for 14 days. Neurologic status was assessed over a period of two to four years. The patients in the first group were hospitalized for three days; the others were treated as outpatients. Results Definite multiple sclerosis developed within the first two years in 7.5 percent of the intravenous-methylprednisolone group (134 patients), 14.7 percent of the oral-prednisone group (129 patients), and 16.7 percent of the placebo grou...
John J Chen - One of the best experts on this subject based on the ideXlab platform.
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population based incidence of Optic Neuritis in the era of aquaporin 4 and myelin oligodendrocyte glycoprotein antibodies
American Journal of Ophthalmology, 2020Co-Authors: Mohamed B Hassan, Eoin P. Flanagan, Sean J Pittock, Jiraporn Jitprapaikulsan, Caroline Stern, Amy Kunchok, Robert C Foster, David O Hodge, Tariq M Bhatti, John J ChenAbstract:Purpose To re-evaluate the population-based incidence of Optic Neuritis in the era of aquaporin-4-immunoglobulin G (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG, which are biomarkers of Optic Neuritis that is distinct from multiple sclerosis (MS). Over the past 15 years, 2 new biomarkers have been discovered that allow for further characterization of the cause of atypical Optic Neuritis: AQP4-IgG and MOG-IgG. Design Retrospective, population-based cohort. Setting: population-based. Participants: all residents of Olmsted County, Minnesota, with Optic Neuritis diagnosed between January 1, 2000, and December 31, 2018. Methods The Rochester Epidemiology Project database was used to identify patients. Sera were tested for AQP4-IgG and MOG-IgG by using a live-cell-based flow cytometry assay. Main outcome measurements were the incidence and cause of Optic Neuritis. Results Optic Neuritis was diagnosed in 110 patients, providing an annual incidence of 3.9 per 100,000. The final diagnosis was MS in 57%, idiopathic in 29%, MOG-IgG-associated disorder in 5%, AQP4-IgG-seropositive neuromyelitis Optic spectrum disorder (NMOSD) in 3%, infectious type in 2%, sarcoidosis in 2%, seronegative NMOSD in 1%, and medication-related in 1%. All 3 patients positive for AQP4-IgG had more than 1 Optic Neuritis attack, 2 with residual no light perception vision in at least 1 eye. Among MOG-IgG-positive patients, 4 of 6 patients had recurrent Optic Neuritis, and all 6 had a final visual acuity of 20/30 or better. Conclusions At a population level, AQP4-IgG and MOG-IgG account for 9% of Optic Neuritis and are associated with recurrent attacks, but MOG-IgG Optic Neuritis has a better visual outcome than AQP4-IgG Optic Neuritis.
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clinical phenotype radiological features and treatment of myelin oligodendrocyte glycoprotein immunoglobulin g mog igg Optic Neuritis
Current Opinion in Neurology, 2020Co-Authors: John J Chen, Tariq M BhattiAbstract:Purpose of review To review the clinical characteristics, radiological manifestations and treatment of myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) Optic Neuritis. Recent findings Serum antibodies to MOG have recently been found to be a biomarker of MOG-IgG-associated disorder (MOGAD), a demyelinating disease distinct from both multiple sclerosis (MS) and aquaporin-4-IgG neuromyelitis Optica spectrum disorder (AQP4-IgG-positive NMOSD). The phenotype of MOGAD is broad and includes Optic Neuritis, transverse myelitis, and acute demyelinating encephalomyelitis (ADEM). Optic Neuritis is the most common presentation in adults, whereas ADEM is the most common presentation in children. Clinical characteristics suggestive of MOG-IgG Optic Neuritis include recurrent Optic Neuritis, prominent disc edema, and perineural enhancement of the Optic nerve on magnetic resonance imaging. Although the nadir of vision loss is severe with MOG-IgG Optic Neuritis, the recovery is typically better than AQP4-IgG Optic Neuritis and therefore has a favorable overall prognosis. Patients with relapsing disease will often need chronic immunotherapy. Rituximab, azathioprine, mycophenolate mofetil, and monthly intravenous immune globulin are the most commonly utilized treatments. Summary MOGAD is a unique entity that is separate from both MS and AQP4-IgG-positive NMOSD. Recognition of the clinical and radiologic features allow for the correct diagnosis. Future randomized trials will determine the optimal treatment for MOGAD.
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Optical coherence tomography is highly sensitive in detecting prior Optic Neuritis
Neurology, 2019Co-Authors: Sarah Chaoying Xu, Eoin P. Flanagan, Jacqueline A. Leavitt, Sean J Pittock, Randy H. Kardon, John J ChenAbstract:Objective To explore sensitivity of Optical coherence tomography (OCT) in detecting prior unilateral Optic Neuritis. Methods This is a retrospective, observational clinical study of all patients who presented from January 1, 2014, to January 6, 2017, with unilateral Optic Neuritis and OCT available at least 3 months after the attack. We compared OCT retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thicknesses between affected and unaffected contralateral eyes. We excluded patients with concomitant glaucoma or other Optic neuropathies. Based on analysis of normal controls, thinning was considered significant if RNFL was at least 9 µm or GCIPL was at least 6 µm less in the affected eye compared to the unaffected eye. Results Fifty-one patients (18 male and 33 female) were included in the study. RNFL and GCIPL thicknesses were significantly lower in eyes with Optic Neuritis compared to unaffected eyes (p Conclusions OCT, especially with GCIPL analysis, is a highly sensitive modality in detecting prior Optic Neuritis, which is made more robust by using intereye differences to approximate change. Classification of evidence This study provides Class III evidence that OCT accurately identifies patients with prior unilateral Optic Neuritis.
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myelin oligodendrocyte glycoprotein antibody positive Optic Neuritis clinical characteristics radiologic clues and outcome
American Journal of Ophthalmology, 2018Co-Authors: John J Chen, Alfonso Sebastian Lopezchiriboga, James P Fryer, Janmendelt Tillema, Eoin P. Flanagan, Jacqueline A. Leavitt, Andrew Mckeon, Jiraporn Jitprapaikulsan, Brian G Weinshenker, Vanda A LennonAbstract:Purpose To characterize the clinical phenotype of myelin oligodendrocyte glycoprotein antibody (MOG-IgG) Optic Neuritis. Design Observational case series. Methods Setting : Multicenter. Patient/Study Population : Subjects meeting inclusion criteria: (1) history of Optic Neuritis; (2) seropositivity (MOG-IgG binding index > 2.5); 87 MOG-IgG-seropositive patients with Optic Neuritis were included (Mayo Clinic, 76; other medical centers, 11). MOG-IgG was detected using full-length MOG-transfected live HEK293 cells in a clinically validated flow cytometry assay. Main Outcome Measures : Clinical and radiologic characteristics and visual outcomes. Results Fifty-seven percent were female and median age at onset was 31 (range 2–79) years. Median number of Optic Neuritis attacks was 3 (range 1–8), median follow-up 2.9 years (range 0.5–24 years), and annualized relapse rate 0.8. Average visual acuity (VA) at nadir of worst attack was count fingers. Average final VA was 20/30; for 5 patients (6%) it was ≤20/200 in either eye. Optic disc edema and pain each occurred in 86% of patients. Magnetic resonance imaging showed perineural enhancement in 50% and longitudinally extensive involvement in 80%. Twenty-six patients (30%) had recurrent Optic Neuritis without other neurologic symptoms, 10 (12%) had single Optic Neuritis, 14 (16%) had chronic relapsing inflammatory Optic neuropathy, and 36 (41%) had Optic Neuritis with other neurologic symptoms (most neuromyelitis Optica spectrum disorder–like phenotype or acute disseminated encephalomyelitis). Only 1 patient was diagnosed with MS (MOG-IgG-binding index 2.8; normal range ≤ 2.5). Persistent MOG-IgG seropositivity occurred in 61 of 62 (98%). A total of 61% received long-term immunosuppressant therapy. Conclusions Manifestations of MOG-IgG-positive Optic Neuritis are diverse. Despite recurrent attacks with severe vision loss, the majority of patients have significant recovery and retain functional vision long-term.
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prevalence of myelin oligodendrocyte glycoprotein and aquaporin 4 igg in patients in the Optic Neuritis treatment trial
JAMA Ophthalmology, 2018Co-Authors: John J Chen, James P Fryer, Oliver W Tobin, Masoud Majed, Eoin P. Flanagan, Jacqueline A. Leavitt, Andrew Mckeon, Jiraporn Jitprapaikulsan, Sean J PittockAbstract:Importance Autoantibodies to aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) are recently established biomarkers of autoimmune Optic Neuritis whose frequency and accompanying phenotype, especially for MOG-IgG, are still being characterized. The Optic Neuritis Treatment Trial (ONTT) was a well-known randomized clinical trial in Optic Neuritis; therefore, knowledge of the serostatus and accompanying phenotype of these patients would be useful to determine the frequency of these antibodies in patients presenting with typical monocular Optic Neuritis and their outcomes. Objectives To determine the AQP4-IgG and MOG-IgG serostatus of patients within the ONTT and describe the clinical features of seropositive patients. Design, Setting, and Participants In this follow-up study of the randomized clinical trial, ONTT, conducted between July 1, 1988, and June 30, 1991, analysis of serum for AQP4-IgG and MOG-IgG was performed from January 1 to April 30, 2017. A total of 177 patients from the ONTT with acute Optic Neuritis and serum available for analysis were enrolled from 13 academic referral centers. Interventions Analysis of serum for AQP4-IgG and MOG-IgG was performed at Mayo Clinic Neuroimmunology Laboratory in 2017 with a flow cytometry, live cell, AQP4- and MOG-transfected cell-based assay. Main Outcomes and Measures Aquaporin-4–IgG and MOG-IgG serostatus. Results Of the 177 patients in the study (135 women and 42 men; mean [SD] age, 32.8 [6.9] years), 3 were positive for MOG-IgG (1.7%) and none were positive for AQP4-IgG. All 3 patients positive for MOG-IgG had disc edema at presentation. Two patients later had a single episode of recurrent Optic Neuritis. All 3 patients had complete recovery of visual acuity, and none were corticosteroid dependent, although peripheral visual field loss persisted in 1 patient. None of the 3 patients positive for MOG-IgG had demyelinating lesions on magnetic resonance imaging scans, and none had developed multiple sclerosis at the 15-year follow-up. Conclusions and Relevance Frequency of MOG-IgG was rare in the ONTT, and AQP4-IgG was not found in patients in the ONTT. Characteristics of patients positive for MOG-IgG in the ONTT support the previously described phenotype of MOG-IgG Optic Neuritis. Myelin oligodendrocyte glycoprotein–related disease appears to be a different entity than multiple sclerosis. Overall, AQP4-IgG and MOG-IgG may be less common in isolated Optic Neuritis than previously reported.
Robert H Ritch - One of the best experts on this subject based on the ideXlab platform.
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imaging of the Optic disc and retinal nerve fiber layer in acute Optic Neuritis
Journal of the Neurological Sciences, 2006Co-Authors: Michael J Pro, Mauricio E Pons, Jeffrey M Liebmann, Robert H RitchAbstract:Abstract Purpose To demonstrate whether Optical coherence tomography (OCT-3) and scanning laser ophthalmoscopy (HRT-2) can be used to measure changes of the Optic disc and peripapillary retinal nerve fiber layer (RNFL) in eyes with acute retrobulbar Optic Neuritis that have no clinically apparent Optic disc swelling. To correlate these findings with presentation magnetic resonance imaging (MRI) of the affected Optic nerve. Methods Eight consecutive patients with acute retrobulbar Optic Neuritis, who had no prior Optic Neuritis in either eye, were prospectively investigated at presentation and at between 1 and 3 months with clinical examination, OCT-3, HRT-2. At presentation, MRI of the Optic nerves were performed in 7/8 patients. Results Compared to unaffected eyes, affected eyes without clinically seen Optic disc swelling at baseline, there was a non-significant trend to increased thickness in the total RNFL, superior and nasal measurements. Baseline HRT in affected eyes showed smaller mean cup to disc ratio ( p = 0.003) and a smaller cup area ( p = 0.002) compared with the unaffected eye. The MRI-demonstrated Optic nerve lesion did not correlate with OCT RNFL thickening or HRT decrease of the physiological cup. Follow-up imaging of the affected eyes showed normalization of HRT cup size parameters and OCT RNFL thickness ( p p = 0.021) compared with fellow unaffected eyes (57.8 μm), which did not change. Conclusion OCT-3 and HRT demonstrate mild RNFL thickening or Optic disc swelling in acute Optic Neuritis, even when swelling is not seen clinically. OCT-3 appears to reveal measurable RNFL thinning in the temporal quadrant after retrobulbar Optic Neuritis, even though vision improves. RNFL imaging may be useful in future studies of residual injury after Optic Neuritis.
Sean J Pittock - One of the best experts on this subject based on the ideXlab platform.
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population based incidence of Optic Neuritis in the era of aquaporin 4 and myelin oligodendrocyte glycoprotein antibodies
American Journal of Ophthalmology, 2020Co-Authors: Mohamed B Hassan, Eoin P. Flanagan, Sean J Pittock, Jiraporn Jitprapaikulsan, Caroline Stern, Amy Kunchok, Robert C Foster, David O Hodge, Tariq M Bhatti, John J ChenAbstract:Purpose To re-evaluate the population-based incidence of Optic Neuritis in the era of aquaporin-4-immunoglobulin G (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG, which are biomarkers of Optic Neuritis that is distinct from multiple sclerosis (MS). Over the past 15 years, 2 new biomarkers have been discovered that allow for further characterization of the cause of atypical Optic Neuritis: AQP4-IgG and MOG-IgG. Design Retrospective, population-based cohort. Setting: population-based. Participants: all residents of Olmsted County, Minnesota, with Optic Neuritis diagnosed between January 1, 2000, and December 31, 2018. Methods The Rochester Epidemiology Project database was used to identify patients. Sera were tested for AQP4-IgG and MOG-IgG by using a live-cell-based flow cytometry assay. Main outcome measurements were the incidence and cause of Optic Neuritis. Results Optic Neuritis was diagnosed in 110 patients, providing an annual incidence of 3.9 per 100,000. The final diagnosis was MS in 57%, idiopathic in 29%, MOG-IgG-associated disorder in 5%, AQP4-IgG-seropositive neuromyelitis Optic spectrum disorder (NMOSD) in 3%, infectious type in 2%, sarcoidosis in 2%, seronegative NMOSD in 1%, and medication-related in 1%. All 3 patients positive for AQP4-IgG had more than 1 Optic Neuritis attack, 2 with residual no light perception vision in at least 1 eye. Among MOG-IgG-positive patients, 4 of 6 patients had recurrent Optic Neuritis, and all 6 had a final visual acuity of 20/30 or better. Conclusions At a population level, AQP4-IgG and MOG-IgG account for 9% of Optic Neuritis and are associated with recurrent attacks, but MOG-IgG Optic Neuritis has a better visual outcome than AQP4-IgG Optic Neuritis.
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Optical coherence tomography is highly sensitive in detecting prior Optic Neuritis
Neurology, 2019Co-Authors: Sarah Chaoying Xu, Eoin P. Flanagan, Jacqueline A. Leavitt, Sean J Pittock, Randy H. Kardon, John J ChenAbstract:Objective To explore sensitivity of Optical coherence tomography (OCT) in detecting prior unilateral Optic Neuritis. Methods This is a retrospective, observational clinical study of all patients who presented from January 1, 2014, to January 6, 2017, with unilateral Optic Neuritis and OCT available at least 3 months after the attack. We compared OCT retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thicknesses between affected and unaffected contralateral eyes. We excluded patients with concomitant glaucoma or other Optic neuropathies. Based on analysis of normal controls, thinning was considered significant if RNFL was at least 9 µm or GCIPL was at least 6 µm less in the affected eye compared to the unaffected eye. Results Fifty-one patients (18 male and 33 female) were included in the study. RNFL and GCIPL thicknesses were significantly lower in eyes with Optic Neuritis compared to unaffected eyes (p Conclusions OCT, especially with GCIPL analysis, is a highly sensitive modality in detecting prior Optic Neuritis, which is made more robust by using intereye differences to approximate change. Classification of evidence This study provides Class III evidence that OCT accurately identifies patients with prior unilateral Optic Neuritis.
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prevalence of myelin oligodendrocyte glycoprotein and aquaporin 4 igg in patients in the Optic Neuritis treatment trial
JAMA Ophthalmology, 2018Co-Authors: John J Chen, James P Fryer, Oliver W Tobin, Masoud Majed, Eoin P. Flanagan, Jacqueline A. Leavitt, Andrew Mckeon, Jiraporn Jitprapaikulsan, Sean J PittockAbstract:Importance Autoantibodies to aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) are recently established biomarkers of autoimmune Optic Neuritis whose frequency and accompanying phenotype, especially for MOG-IgG, are still being characterized. The Optic Neuritis Treatment Trial (ONTT) was a well-known randomized clinical trial in Optic Neuritis; therefore, knowledge of the serostatus and accompanying phenotype of these patients would be useful to determine the frequency of these antibodies in patients presenting with typical monocular Optic Neuritis and their outcomes. Objectives To determine the AQP4-IgG and MOG-IgG serostatus of patients within the ONTT and describe the clinical features of seropositive patients. Design, Setting, and Participants In this follow-up study of the randomized clinical trial, ONTT, conducted between July 1, 1988, and June 30, 1991, analysis of serum for AQP4-IgG and MOG-IgG was performed from January 1 to April 30, 2017. A total of 177 patients from the ONTT with acute Optic Neuritis and serum available for analysis were enrolled from 13 academic referral centers. Interventions Analysis of serum for AQP4-IgG and MOG-IgG was performed at Mayo Clinic Neuroimmunology Laboratory in 2017 with a flow cytometry, live cell, AQP4- and MOG-transfected cell-based assay. Main Outcomes and Measures Aquaporin-4–IgG and MOG-IgG serostatus. Results Of the 177 patients in the study (135 women and 42 men; mean [SD] age, 32.8 [6.9] years), 3 were positive for MOG-IgG (1.7%) and none were positive for AQP4-IgG. All 3 patients positive for MOG-IgG had disc edema at presentation. Two patients later had a single episode of recurrent Optic Neuritis. All 3 patients had complete recovery of visual acuity, and none were corticosteroid dependent, although peripheral visual field loss persisted in 1 patient. None of the 3 patients positive for MOG-IgG had demyelinating lesions on magnetic resonance imaging scans, and none had developed multiple sclerosis at the 15-year follow-up. Conclusions and Relevance Frequency of MOG-IgG was rare in the ONTT, and AQP4-IgG was not found in patients in the ONTT. Characteristics of patients positive for MOG-IgG in the ONTT support the previously described phenotype of MOG-IgG Optic Neuritis. Myelin oligodendrocyte glycoprotein–related disease appears to be a different entity than multiple sclerosis. Overall, AQP4-IgG and MOG-IgG may be less common in isolated Optic Neuritis than previously reported.
Tariq M Bhatti - One of the best experts on this subject based on the ideXlab platform.
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population based incidence of Optic Neuritis in the era of aquaporin 4 and myelin oligodendrocyte glycoprotein antibodies
American Journal of Ophthalmology, 2020Co-Authors: Mohamed B Hassan, Eoin P. Flanagan, Sean J Pittock, Jiraporn Jitprapaikulsan, Caroline Stern, Amy Kunchok, Robert C Foster, David O Hodge, Tariq M Bhatti, John J ChenAbstract:Purpose To re-evaluate the population-based incidence of Optic Neuritis in the era of aquaporin-4-immunoglobulin G (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG, which are biomarkers of Optic Neuritis that is distinct from multiple sclerosis (MS). Over the past 15 years, 2 new biomarkers have been discovered that allow for further characterization of the cause of atypical Optic Neuritis: AQP4-IgG and MOG-IgG. Design Retrospective, population-based cohort. Setting: population-based. Participants: all residents of Olmsted County, Minnesota, with Optic Neuritis diagnosed between January 1, 2000, and December 31, 2018. Methods The Rochester Epidemiology Project database was used to identify patients. Sera were tested for AQP4-IgG and MOG-IgG by using a live-cell-based flow cytometry assay. Main outcome measurements were the incidence and cause of Optic Neuritis. Results Optic Neuritis was diagnosed in 110 patients, providing an annual incidence of 3.9 per 100,000. The final diagnosis was MS in 57%, idiopathic in 29%, MOG-IgG-associated disorder in 5%, AQP4-IgG-seropositive neuromyelitis Optic spectrum disorder (NMOSD) in 3%, infectious type in 2%, sarcoidosis in 2%, seronegative NMOSD in 1%, and medication-related in 1%. All 3 patients positive for AQP4-IgG had more than 1 Optic Neuritis attack, 2 with residual no light perception vision in at least 1 eye. Among MOG-IgG-positive patients, 4 of 6 patients had recurrent Optic Neuritis, and all 6 had a final visual acuity of 20/30 or better. Conclusions At a population level, AQP4-IgG and MOG-IgG account for 9% of Optic Neuritis and are associated with recurrent attacks, but MOG-IgG Optic Neuritis has a better visual outcome than AQP4-IgG Optic Neuritis.
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clinical phenotype radiological features and treatment of myelin oligodendrocyte glycoprotein immunoglobulin g mog igg Optic Neuritis
Current Opinion in Neurology, 2020Co-Authors: John J Chen, Tariq M BhattiAbstract:Purpose of review To review the clinical characteristics, radiological manifestations and treatment of myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) Optic Neuritis. Recent findings Serum antibodies to MOG have recently been found to be a biomarker of MOG-IgG-associated disorder (MOGAD), a demyelinating disease distinct from both multiple sclerosis (MS) and aquaporin-4-IgG neuromyelitis Optica spectrum disorder (AQP4-IgG-positive NMOSD). The phenotype of MOGAD is broad and includes Optic Neuritis, transverse myelitis, and acute demyelinating encephalomyelitis (ADEM). Optic Neuritis is the most common presentation in adults, whereas ADEM is the most common presentation in children. Clinical characteristics suggestive of MOG-IgG Optic Neuritis include recurrent Optic Neuritis, prominent disc edema, and perineural enhancement of the Optic nerve on magnetic resonance imaging. Although the nadir of vision loss is severe with MOG-IgG Optic Neuritis, the recovery is typically better than AQP4-IgG Optic Neuritis and therefore has a favorable overall prognosis. Patients with relapsing disease will often need chronic immunotherapy. Rituximab, azathioprine, mycophenolate mofetil, and monthly intravenous immune globulin are the most commonly utilized treatments. Summary MOGAD is a unique entity that is separate from both MS and AQP4-IgG-positive NMOSD. Recognition of the clinical and radiologic features allow for the correct diagnosis. Future randomized trials will determine the optimal treatment for MOGAD.
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high and low risk profiles for the development of multiple sclerosis within 10 years after Optic Neuritis experience of the Optic Neuritis treatment trial
Archives of Ophthalmology, 2003Co-Authors: Roy W Beck, Michael C Brodsky, Edward G Buckley, Georgia A Chrousos, Tariq M Bhatti, Jonathan D Trobe, Pamela S Moke, Robin L Gal, Dongyuan Xing, James J CorbettAbstract:Objective To identify factors associated with a high and low risk of developing multiple sclerosis after an initial episode of Optic Neuritis. Methods Three hundred eighty-eight patients who experienced acute Optic Neuritis between July 1, 1988, and June 30, 1991, were followed up prospectively for the development of multiple sclerosis. Consenting patients were reassessed after 10 to 13 years. Results The 10-year risk of multiple sclerosis was 38% (95% confidence interval, 33%-43%). Patients (160) who had 1 or more typical lesions on the baseline magnetic resonance imaging (MRI) scan of the brain had a 56% risk; those with no lesions (191) had a 22% risk (P Conclusions The 10-year risk of multiple sclerosis following an initial episode of acute Optic Neuritis is significantly higher if there is a single brain MRI lesion; higher numbers of lesions do not appreciably increase that risk. However, even when brain lesions are seen on MRI, more than 40% of the patients will not develop clinical multiple sclerosis after 10 years. In the absence of MRI lesions, certain demographic and clinical features seem to predict a very low likelihood of developing multiple sclerosis. This natural history information is a critical input for estimating a patient's 10-year multiple sclerosis risk and for weighing the benefit of initiating prophylactic treatment at the time of Optic Neuritis or other initial demyelinating events in the central nervous system.