Objectives: To describe the time and space patterns of patients with monosy
mptomatic optic neuritis (MON) in Stockholm County, Sweden, and to explore
the role of environmental factors in the etiology of MON and multiple scler
osis.
Design: Population-based and prospective incidence survey.
Setting: Census based on referrals from 1.68 million inhabitants of Stockho
lm County.
Patients: One hundred forty-seven new patients with MON were consecutively
referred by ophthalmologists and neurologists from January 1, 1990, through
December 31, 1995. A standardized questionnaire was used for data collecti
on.
Main Outcome Measures: Evaluations consisted of annual incidence, statistic
al significance of temporal aggregation, Knox test, likelihood score test a
pplied to the ratio of the highest to lowest seasonal proportion of registe
red events, and standardized morbidity ratio for municipalities.
Results: We observed a seasonal pattern of MON incidence, with the highest
incidence (31%) in the spring and the lowest (17%) in the winter (ratio of
highest to lowest seasonal proportion, 1.84; 95% confidence interval, 1.13-
3.01; P = .007). The seasonal monthly incidences were correlated with the a
verage number of sunny hours and the temperature. The presence of positive
immune activity markers (ie, mononuclear pleocytosis and oligoclonal IgG ba
nds in the cerebrospinal fluid) seemed to be linked to the onset of MON in
winter. No aggregation by time, space, or month of birth was detected.
Conclusions: Monosymptomatic optic neuritis in Stockholm County occurred at
an uneven frequency across the seasons, with the highest incidence in spri
ng and the lowest in winter. This seasonal pattern is compatible with that
described in most previous reports. Environmental and probable infectious f
actors unevenly distributed by season may play a role in the etiology and e
arly clinical course of MON.