Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis
To identify clinical and demographic features associated with the severity and recovery from acute optic neuritis (AON) episodes in patients with multiple sclerosis (MS). Adult (n = 253) and pediatric (n = 38) patients whose first symptom was AON were identified from our MS database. Severity measur...
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| Vydáno v: | Neurology Ročník 82; číslo 24; s. 2173 |
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17.06.2014
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| Abstract | To identify clinical and demographic features associated with the severity and recovery from acute optic neuritis (AON) episodes in patients with multiple sclerosis (MS).
Adult (n = 253) and pediatric (n = 38) patients whose first symptom was AON were identified from our MS database. Severity measured by loss of visual acuity (mild attack ≤20/40, moderate attack 20/50-20/190, and severe attack ≥20/200) and recovery in visual acuity at 1 year after the attack (complete recovery ≤20/20, fair recovery 20/40, and poor recovery ≥20/50) were recorded. Demographic and clinical features associated with attack severity and recovery were identified using proportional odds logistic regression. For another group of patients, blood samples were available within 6 months of an AON attack. In this group, the impact of vitamin D level on the severity/recovery was also assessed.
Men (adjusted odds ratio [OR] = 2.28, p = 0.03) and subjects with severe attacks (adjusted OR = 5.24, p < 0.001) had worse recovery. AON severity was similar between the pediatric and adult subjects, but recovery was significantly better in pediatric subjects in the unadjusted analysis (p = 0.041) and the analysis adjusted for sex (p = 0.029). Season-adjusted vitamin D level was significantly associated with attack severity (OR for 10-U increase in vitamin D level = 0.47; 95% confidence interval: 0.32, 0.68; p < 0.001). Vitamin D level was not associated with recovery from the attack (p = 0.98) in univariate analysis or after accounting for attack severity (p = 0.10).
Vitamin D levels affect AON severity, whereas younger age, attack severity, and male sex affect AON recovery. Underlying mechanisms and potential therapeutic targets may identify new measures to mitigate disability accrual in MS. |
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| AbstractList | To identify clinical and demographic features associated with the severity and recovery from acute optic neuritis (AON) episodes in patients with multiple sclerosis (MS).OBJECTIVETo identify clinical and demographic features associated with the severity and recovery from acute optic neuritis (AON) episodes in patients with multiple sclerosis (MS).Adult (n = 253) and pediatric (n = 38) patients whose first symptom was AON were identified from our MS database. Severity measured by loss of visual acuity (mild attack ≤20/40, moderate attack 20/50-20/190, and severe attack ≥20/200) and recovery in visual acuity at 1 year after the attack (complete recovery ≤20/20, fair recovery 20/40, and poor recovery ≥20/50) were recorded. Demographic and clinical features associated with attack severity and recovery were identified using proportional odds logistic regression. For another group of patients, blood samples were available within 6 months of an AON attack. In this group, the impact of vitamin D level on the severity/recovery was also assessed.METHODSAdult (n = 253) and pediatric (n = 38) patients whose first symptom was AON were identified from our MS database. Severity measured by loss of visual acuity (mild attack ≤20/40, moderate attack 20/50-20/190, and severe attack ≥20/200) and recovery in visual acuity at 1 year after the attack (complete recovery ≤20/20, fair recovery 20/40, and poor recovery ≥20/50) were recorded. Demographic and clinical features associated with attack severity and recovery were identified using proportional odds logistic regression. For another group of patients, blood samples were available within 6 months of an AON attack. In this group, the impact of vitamin D level on the severity/recovery was also assessed.Men (adjusted odds ratio [OR] = 2.28, p = 0.03) and subjects with severe attacks (adjusted OR = 5.24, p < 0.001) had worse recovery. AON severity was similar between the pediatric and adult subjects, but recovery was significantly better in pediatric subjects in the unadjusted analysis (p = 0.041) and the analysis adjusted for sex (p = 0.029). Season-adjusted vitamin D level was significantly associated with attack severity (OR for 10-U increase in vitamin D level = 0.47; 95% confidence interval: 0.32, 0.68; p < 0.001). Vitamin D level was not associated with recovery from the attack (p = 0.98) in univariate analysis or after accounting for attack severity (p = 0.10).RESULTSMen (adjusted odds ratio [OR] = 2.28, p = 0.03) and subjects with severe attacks (adjusted OR = 5.24, p < 0.001) had worse recovery. AON severity was similar between the pediatric and adult subjects, but recovery was significantly better in pediatric subjects in the unadjusted analysis (p = 0.041) and the analysis adjusted for sex (p = 0.029). Season-adjusted vitamin D level was significantly associated with attack severity (OR for 10-U increase in vitamin D level = 0.47; 95% confidence interval: 0.32, 0.68; p < 0.001). Vitamin D level was not associated with recovery from the attack (p = 0.98) in univariate analysis or after accounting for attack severity (p = 0.10).Vitamin D levels affect AON severity, whereas younger age, attack severity, and male sex affect AON recovery. Underlying mechanisms and potential therapeutic targets may identify new measures to mitigate disability accrual in MS.CONCLUSIONVitamin D levels affect AON severity, whereas younger age, attack severity, and male sex affect AON recovery. Underlying mechanisms and potential therapeutic targets may identify new measures to mitigate disability accrual in MS. To identify clinical and demographic features associated with the severity and recovery from acute optic neuritis (AON) episodes in patients with multiple sclerosis (MS). Adult (n = 253) and pediatric (n = 38) patients whose first symptom was AON were identified from our MS database. Severity measured by loss of visual acuity (mild attack ≤20/40, moderate attack 20/50-20/190, and severe attack ≥20/200) and recovery in visual acuity at 1 year after the attack (complete recovery ≤20/20, fair recovery 20/40, and poor recovery ≥20/50) were recorded. Demographic and clinical features associated with attack severity and recovery were identified using proportional odds logistic regression. For another group of patients, blood samples were available within 6 months of an AON attack. In this group, the impact of vitamin D level on the severity/recovery was also assessed. Men (adjusted odds ratio [OR] = 2.28, p = 0.03) and subjects with severe attacks (adjusted OR = 5.24, p < 0.001) had worse recovery. AON severity was similar between the pediatric and adult subjects, but recovery was significantly better in pediatric subjects in the unadjusted analysis (p = 0.041) and the analysis adjusted for sex (p = 0.029). Season-adjusted vitamin D level was significantly associated with attack severity (OR for 10-U increase in vitamin D level = 0.47; 95% confidence interval: 0.32, 0.68; p < 0.001). Vitamin D level was not associated with recovery from the attack (p = 0.98) in univariate analysis or after accounting for attack severity (p = 0.10). Vitamin D levels affect AON severity, whereas younger age, attack severity, and male sex affect AON recovery. Underlying mechanisms and potential therapeutic targets may identify new measures to mitigate disability accrual in MS. |
| Author | Healy, Brian C Kivisakk, Pia Chitnis, Tanuja Benson, Leslie A Malik, Muhammad Taimur Musallam, Alexander Weiner, Howard L |
| Author_xml | – sequence: 1 givenname: Muhammad Taimur surname: Malik fullname: Malik, Muhammad Taimur organization: From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston – sequence: 2 givenname: Brian C surname: Healy fullname: Healy, Brian C organization: From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston – sequence: 3 givenname: Leslie A surname: Benson fullname: Benson, Leslie A organization: From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston – sequence: 4 givenname: Pia surname: Kivisakk fullname: Kivisakk, Pia organization: From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston – sequence: 5 givenname: Alexander surname: Musallam fullname: Musallam, Alexander organization: From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston – sequence: 6 givenname: Howard L surname: Weiner fullname: Weiner, Howard L organization: From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston – sequence: 7 givenname: Tanuja surname: Chitnis fullname: Chitnis, Tanuja email: tchitnis@partners.org organization: From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston. tchitnis@partners.org |
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| SubjectTerms | Adolescent Adult Age Factors Child Female Humans Longitudinal Studies Male Multiple Sclerosis - blood Multiple Sclerosis - complications Optic Neuritis - blood Optic Neuritis - etiology Recovery of Function - physiology Severity of Illness Index Visual Acuity - physiology Vitamin D - blood Young Adult |
| Title | Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis |
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