CEREBROSPINAL-FLUID IN ACUTE OPTIC NEURITIS - EXPERIENCE OF THE OPTICNEURITIS TREATMENT TRIAL

Citation
La. Rolak et al., CEREBROSPINAL-FLUID IN ACUTE OPTIC NEURITIS - EXPERIENCE OF THE OPTICNEURITIS TREATMENT TRIAL, Neurology, 46(2), 1996, pp. 368-372
Citations number
46
Categorie Soggetti
Clinical Neurology
Journal title
ISSN journal
00283878
Volume
46
Issue
2
Year of publication
1996
Pages
368 - 372
Database
ISI
SICI code
0028-3878(1996)46:2<368:CIAON->2.0.ZU;2-H
Abstract
The Optic Neuritis Treatment Trial (ONTT) is a prospective study of co rticosteroid treatment of acute optic neuritis (ON), with subsequent l ongitudinal follow-up to determine development of clinically definite multiple sclerosis (CDMS). We analyzed the CSF of 83 patients with cli nically isolated ON who underwent lumbar puncture within 24 hours of e nrollment into the ONTT to determine the value of CSF changes in ON, e specially regarding diagnostic utility, immunologic changes, MRI corre lations, and progression to CDMS. All patients had baseline MRI scans graded for changes typical of MS. CSF measurements included immunoglob ulin G (IgG) synthesis, IgG ratio, myelin basic protein, IgG kappa lig ht chains, and oligoclonal banding. No patients had their diagnosis or management altered as a result of CSF findings. Except for oligoclona l bands, few patients showed any abnormalities on CSF tests, and no te sts correlated with the 2-year development of CDMS. Oligoclonal bandin g, present at baseline in 11 of 13 patients who developed CDMS, did pr edict progression to CDMS, but this was not independent of MRI abnorma lities. Two patients with oligoclonal bands and a normal MRI did progr ess to CDMS. We conclude that CSF analysis may not be necessary in the routine evaluation of patients presenting with a typical clinical pro file of acute ON, and that most CSF tests add little additional inform ation to MRI results for predicting the 2-year development of CDMS. Ho wever, the precise role of oligoclonal banding in the analysis of such patients awaits longer follow-up of this cohort.