Risk of MS after single case of optic neuritis?

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Risk of MS after single case of optic neuritis?

Postby Exedoc » Tue Mar 01, 2011 2:28 pm

I am a medical student and I am finding it hard to figure this out, so I can imagine how stressful it must be for patients!

A friend of mine suffered a severe case of unilateral optic neuritis about 2 years ago. She is black, female ofc, and she was 17/18 at the time.As far as I know she had no other neuro symptoms before or since.

All tests at the time came back normal, she lives in the US so I imagine they did the full shebang of tests too. No lesions on MRI anyway, no family history of MS.

Basically.. what is her risk?! There are so many studies out there all saying different things! A lot of them are of such small patient groups to.. like 100 patients sometimes! And it doesn't often stratify your risk according to your demographic and symptoms, and for example, ON in "children and over 40s" is supposed to be much lower risk than the 2-30 age group but where does 17/18 fit into that?

So I was wondering if someone here knows what sort of risk she has, are we talking "she pretty much has MS, just a matter of time" or are we talking "very unlikely but a slightly higher chance than someone who hadn't had ON"?

1%? 10%? 75%? I have seen them all!
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Postby jimmylegs » Tue Mar 01, 2011 6:35 pm

i can't give you stats but here's something to ponder

http://www.mayoclinic.com/health/optic- ... ION=causes
causes of optic neuritis
■Infections. Bacterial infections, including Lyme disease, cat scratch fever and syphilis, or viruses such as measles, mumps and herpes can cause optic neuritis. In addition, some infections may lead to a type of optic neuritis called neuroretinitis, which isn't believed to be associated with the risk of developing multiple sclerosis.

also, some more food for thought:
http://www.ncbi.nlm.nih.gov/pubmed/11273664
Optic Nerve Changes in Zinc-deficient Rats
Abstract
In this study the optic nerve changes in zinc (Zn)-deficient rats are examined. Zinc is one of the essential trace elements and is known to be related to optic nerve diseases such as ethambutol neuropathy. However, the effect of Zn on the optic nerve has not been studied experimentally in animals. We used 3 week old weanling male Wistar Kyoto rats weighing 40–50 g. Rats were fed a Zn-deficient diet containing 0.007 mg of Zn per 100 g, all other nutrients and distilled and deionized water. The same water supplemented with 3 mg Zn per 100 g was given to the control group. After 4 or 7 weeks on a Zn-deficient diet, the optic nerve was examined with an electron microscope. A recovery group was fed a Zn-containing diet for 5 weeks after 7 weeks on the Zn-deficient diet. The serum Zn levels of the deficient group were significantly decreased at both 4 and 7 weeks. Most of the Zn-deficient rats showed hair loss around the eyes and on the extremities. Ultrastructural findings were as follows. The number of myelinated axons of Zn-deficient rats at 4 and 7 weeks were significantly decreased and the myelin sheaths were significantly thinner in the Zn-deficient groups and in the recovery group. Unmyelinated axons were more numerous than in the control rats. Destruction of myelin and proliferation of glial cells were found in the optic nerves of Zn-deficient rats. This study suggests that the optic nerve needs Zn for the maintenance of its cell structure and even if Zn is supplied to the Zn-deficient rats, destruction of the myelin structure may continue. Zn-deficiency induce a decrease of myelinated nerve fibers, and it is thought that optic neuropathy in patients treated with some drugs such as ethambutol may be a secondary change due to Zn-deficiency following drug administration.
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Postby mrbarlow » Wed Mar 02, 2011 8:26 am

http://www.ncbi.nlm.nih.gov/pmc/article ... =pmcentrez


50% probability at 15 years. Female sex might reduce this by a bit.


If I was in your position I would be advising your friend to take a precautionary approach - follow the anti MS diets, take Vitamin D supplements (especially as due to her skin colour she will not be so good at synthesising it from sunlight), get plenty of sunshine.

Hopefully she will be in the other 50% at the 15 year mark.
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Postby Exedoc » Wed Mar 02, 2011 11:42 am

mrbarlow wrote:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440583/?tool=pmcentrez


50% probability at 15 years. Female sex might reduce this by a bit.


If I was in your position I would be advising your friend to take a precautionary approach - follow the anti MS diets, take Vitamin D supplements (especially as due to her skin colour she will not be so good at synthesising it from sunlight), get plenty of sunshine.

Hopefully she will be in the other 50% at the 15 year mark.


It is that high even with negative MRI?
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Postby jimmylegs » Wed Mar 02, 2011 11:54 am

agree re precautionary!
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Postby mrbarlow » Wed Mar 02, 2011 2:01 pm

Exedoc wrote:
mrbarlow wrote:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440583/?tool=pmcentrez


50% probability at 15 years. Female sex might reduce this by a bit.


If I was in your position I would be advising your friend to take a precautionary approach - follow the anti MS diets, take Vitamin D supplements (especially as due to her skin colour she will not be so good at synthesising it from sunlight), get plenty of sunshine.

Hopefully she will be in the other 50% at the 15 year mark.


It is that high even with negative MRI?



ON and no MRI abnormalities - 50% cumulative at 15 years

ON and MRI abnormalities 76% cumulative risk at 15 years

Coincidentially this is where I am having had ON and lesions on an MRI 3.5 months ago.
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Postby EyeDoc » Thu Mar 03, 2011 7:40 pm

I don't think there is a consensus as to a percentage, but it is high for sure. Clinically, when I see a patient with ON between the ages of 16-30 I consider it a pretty big slam dunk for MS until proven otherwise.
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Postby mrbarlow » Fri Mar 04, 2011 12:27 am

EyeDoc wrote:I don't think there is a consensus as to a percentage, but it is high for sure. Clinically, when I see a patient with ON between the ages of 16-30 I consider it a pretty big slam dunk for MS until proven otherwise.


I wish I had seen you when I first developed ON. The idiots i saw in the NHS tried to diagnose everything but. Im 38 and they were speculating it was Temporal Arteritis, Optic Stroke.

Luckily the following week I flew back to Saudi Arabia and was diagnosed inside 48 hours
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