Clinical course of optic neuritis in patients with relapsing neuromyelitis optica

CLINICAL SCIENCES

Clinical Course of Optic Neuritis in Patients
With Relapsing Neuromyelitis Optica
Regina Maria Papais-Alvarenga, MD, MSc, PhD; Sandro Carvalho Carellos, MD, MSc; Marcos Papais Alvarenga, MD;
Clarice Holander, MD; Roberly Pinto Bichara, MD, MSc; Luiz Claudio Santos Thuler, MD, MSc, PhD

Objective: To describe the clinical characteristics, course, and prognosis of optic neuritis in recurrent neuromyelitis optica.
Methods: We analyzed 60 patients diagnosed using 1999
Mayo Clinic criteria who were seen between 1985 and
2004 at Hospital da Lagoa (Rio de Janeiro, Brazil).
Results: Optic neuritis was the initial feature in 53.3% of patients, most with unilateral disease. Recurrent optic neuritis before myelitis occurred in 18.3%. The visual impairment was severe at nadir of the visual index event in 78.3%, with a high remission rate. In the median disease duration of 8 years (range, 0.5-30 years), 380 relapses (118 optic neuritis, 223 myelitis, 39 optic neu-

ritis and myelitis) occurred. At the last follow-up, 53.3% of patients had bilateral visual impairment and 63.3% were blind in at least 1 eye. A high mortality rate (23.3%) was due to cervical myelitis. Mortality rates were significantly higher among Afro Brazilian patients (58.3%).
Conclusions: Optic neuritis in patients with recurrent neuromyelitis optica has a severe and acute onset, with predominantly unilateral lesions followed by improvement of clinical symptoms. In the long-term, the disease leads to severe bilateral visual impairment. Mortality rates are higher among patients of Afro Brazilian descent. Arch Ophthalmol. 2008;126(1):12-16

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HE FIRST DESCRIPTION OF BIlateral amaurosis associated with subacute myelitis and a fatal course was provided by Eugène Devic at the end of the 19th century in Lyon, France.1
For more than a century, these clinical parameters were the basis for the diagnosis of a rare neurological disease restricted to the optic nerve