Elsevier

Ophthalmology

Volume 114, Issue 4, April 2007, Pages 810-815.e2
Ophthalmology

Original Article
Natural History of the Visual Impairment of Relapsing Neuromyelitis Optica

https://doi.org/10.1016/j.ophtha.2006.06.060Get rights and content

Purpose

To describe the clinical features and natural history of the visual impairment of relapsing neuromyelitis optica.

Design

Prospective observational case series.

Participants

Thirty patients of Afro-Caribbean origin with neuromyelitis optica and 47 patients with multiple sclerosis.

Methods

A complete ophthalmologic examination was performed with each ocular attack and during a remission period at least 6 months after the last attack.

Main Outcome Measures

Incidence of unilateral and bilateral optic neuritis and incidence of unilateral and bilateral severe visual loss, defined as visual acuity (VA) ≤ 20/200.

Results

Twenty-eight patients (93%) with neuromyelitis optica were female and 2 (7%) were male. The mean age of onset was 30±10.5 years. Mean disease duration was 9.5±5.4 years. Neuromyelitis optica first manifested by an episode of optic neuritis in 23 cases (76.6%), bilateral in 4. The average number of ocular attacks per patient was 2.7±1.6. Twenty-one patients (70%) showed impairment in both eyes. Median times from onset to unilateral optic neuritis, bilateral optic neuritis, mono-ocular severe visual loss, and binocular severe visual loss were 0±0.08, 1±1.6, 2±0.8, and 13±3 years, respectively. Fifteen patients (50%) experienced severe visual loss in both eyes and 6 (20%) in one eye. Severe visual loss occurred in as few as 2 attacks.

Conclusion

This study is the largest series of relapsing neuromyelitis optica in a population of African descent. Neuromyelitis optica’s visual impairment is very severe; it contrasts drastically with that typically observed in multiple sclerosis. We confirmed that the prognosis for optic neuritis in patients with neuromyelitis optica is worse than the prognosis in patients with multiple sclerosis.

Section snippets

Materials and Methods

Our study was conducted at the University Hospital Center of Fort de France, Martinique, a French West Indies island. The Martinican population (381 500 inhabitants) primarily descends from a mixed heritage of Amerindian, black, white, and East Indian populations that have inhabited the island throughout the centuries. The percentage of whites in Martinique is between 8% and 10%.10 All of the patients in this study are of Afro-Caribbean origin through both parents. None had a history of optic

Neuromyelitis Optica Patients (Tables 2, 3 [Available at http://aaojournal.org])

Twenty-eight patients (93%) were female and 2 were male (7%). The mean age was 39.6±12 years. The mean age of onset was 30±10.5. The optico-medullary time elapsed was 2.3±3.4 years. Mean disease duration was 9.5±5.4 years (range, 2–27). Ten patients (33%) died after 3 to 19 years (mean, 8.7): 8 from respiratory distress, 1 from septicemia from a urinary tract infection, and 1 from severe epilepsy. The EDSS score was 7.3±2.4. The number of patients in whom the handicap was severe enough to alter

Discussion

The first reported cases of neuromyelitis optica were monophasic in nature. According to Devic, the attacks occurred in a very short time, from a few hours to a few weeks, but never more than 6 months.1 However, this finding is not typical, as shown in Wingerchuk et al’s series of 71 cases, 23 of them monophasic and 48 relapsing.8 Furthermore, among the 24 cases of neuromyelitis optica reported by Papais-Alvarenga et al in Brazil, 22 were relapsing and only 2 were monophasic.14 Six of 9 cases

References (27)

  • J. De Seze et al.

    Devic’s neuromyelitis optica: clinical, laboratory, MRI and outcome profile

    J Neurol Sci

    (2002)
  • V.A. Lennon et al.

    A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis

    Lancet

    (2004)
  • E. Devic

    Myélite subaiguë compliquée de névrite optique

    Bull Med

    (1894)
  • B.G.W. Arnason et al.

    China: demyelinating diseases

    Lancet

    (1982)
  • P. Cabre et al.

    Role of return migration in the emergence of multiple sclerosis in French West Indies

    Brain

    (2005)
  • P. Cabre et al.

    MS and neuromyelitis optica in Martinique (French West Indies)

    Neurology

    (2001)
  • J.E. Cosnett

    Multiple sclerosis and neuromyelitis optica: case report and speculation

    S Afr Med J

    (1981)
  • Y. Kuroiwa et al.

    Nationwide survey of multiple sclerosis in Japan: clinical analysis of 1,084 cases

    Neurology

    (1975)
  • J. de Seze et al.

    Is Devic’s neuromyelitis optica a separate disease?A comparative study with multiple sclerosis

    Mult Scler

    (2003)
  • D.M. Wingerchuk et al.

    The clinical course of neuromyelitis optica (Devic’s syndrome)

    Neurology

    (1999)
  • D.W. Paty et al.

    MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT

    Neurology

    (1988)
  • N. Monplaisir et al.

    Study of HLA antigens of the Martinican population

    Tissue Antigens

    (1985)
  • W.I. McDonald et al.

    Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the Diagnoses of Multiples Sclerosis

    Ann Neurol

    (2001)
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