Abstract Details

Title Longitudinally Extensive Optic Neuritis Distinguishes Neuromyelitis Optica from Multiple Sclerosis

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) S47 - (-)

Poster/Presentation
Number 004

Objective

Background The anterior visual pathway is morphologically and physiologically part of the central nervous system. Demyelinating and inflammatory processes may affect the AVP and are typically disruptive of the local blood brain barrier, as is frequently noted in optic neuritis. One report showed that enhancement length did not distinguish optic neuritis between neuromyelitis optica (NMO) and multiple sclerosis (MS) when multiple cases were averaged. However, the specificity for longitudinally extensive enhancement of the AVP to differentiate optic neuritis among NMO, MS, and sarcoidosis has not been previously reported.

Design/Methods A University Institutional Review Board approved this retrospective study. Patients presenting with optic neuritis secondary to multiple sclerosis, neuromyelitis optica, or sarcoidosis who had a neuro-ophthalmological exam and MRI within four weeks of onset were selected. Total length of gadolinium enhancement involving the afferent visual system was measured by an investigator blinded to the clinical diagnosis. Presence of pain, papillitis, and visual field metrics were also recorded.

Results Thirty-five patients were selected (25 MS, 5 NMO, 5 sarcoid). P values were <0.05 for bilateral involvement, chiasm involvement, and total AVP enhancement measuring >60mm for NMO when compared to MS. Length of enhancement did not distinguish sarcoid from NMO or MS. Neither pain, disc swelling, nor baseline HVF metrics differentiated NMO, MS, or sarcoid.

Conclusions Besides the presence of bilateral and chiasmal involvement, already described as characteristic of NMO, we here demonstrate that afferent visual system enhancement length greater than 60mm, a term we propose as 'longitudinally extensive optic neuritis', helps distinguish NMO from MS.

Authors/Disclosures
PRESENTER	No disclosure on file
John Pula, MD, FAAN (NorthShore University HealthSystem)	Dr. Pula has nothing to disclose.
Bonnie M. Keung, MD (Swedish Neuroscience Institute/Swedish Medical Center)	No disclosure on file
	No disclosure on file
Jorge C. Kattah, MD, FAAN (University of Illinois College of Medicine at Peoria)	Dr. Kattah has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Bonezzi, Switzer , Poilitto and Hupp Legal Firm.
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit)	Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.

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