Optic neuritis as an initial symptom in multiple sclerosis

Abstract

A multicenter documentation system which includes standardized information was used on 1271 patients with multiple sclerosis (MS). In 441 (34.7%) cases the optic nerve was involved at the 1st appearance of the disease, and in 212 (16.6%) subjects optic neuritis (ON) was the sole initial sign. For all MS patients with ON at onset of the disease the female to male ratio was 1.3, whereas it was 1.5 for the whole series. The mean age at onset was 2 yr lower for patients with initial ON as compared with the whole series (29.0 and 31.1 yr, respectively). Correlation of the disability of the patients to the duration of the disease revealed the best prognosis for patients with ON as the sole initial sign of MS. The frequency of brainstem/cerebellar and pyramidal signs was lowest among these patients at the time of the present examination. The difference was more pronounced during the first years of the disease and disappeared after longer duration. The correlation curves of disability to the present age of the patients confirmed this pattern. The idea of initial ON as being a favorable sign of the later course is not supported. As an initial bout of MS, it may reflect more precisely the mean age of onset of the disease than other signs.