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March 2005

Optic Neuritis and Multiple Sclerosis: Long-term Prognostic Considerations

Arch Neurol. 2005;62(3):506. doi:10.1001/archneur.62.3.506

The recent report from the 10-year follow-up from the Optic Neuritis Study Group cohort, pertaining to neurological impairment, provides valuable multiple sclerosis prognostic information and illustrates the value of prolonged follow-up in the evaluation of any therapeutic intervention in a chronic disease such as multiple sclerosis.1 As one of the original participants in the initial study, I still remember our collective enthusiasm when we learned that the 2-year clinically definite multiple sclerosis diagnosis was delayed in those patients who received methylprednisolone as compared with placebo.2 This benefit was not present thereafter. Now, 10 to 12 years later, nearly half of the patients with clinically definite multiple sclerosis have a relapsing-remitting course with no cumulative disability measured with the Expanded Disability Status Scale. The majority of these patients have a low disability Expanded Disability Status Scale score without disease-modifying treatment. It will be important to know what percentage of these patients had actually been initially randomized to methylprednisolone. These statistics provide a good 10- to 12-year outlook for patients with optic neuritis regardless of a diagnosis of clinically definite multiple sclerosis and presence of several brain lesions on magnetic resonance imaging. Although the Expanded Disability Status Scale score is not likely to reflect the effect of supratentorial, periventricular lesions, it is unlikely that these patients have any significant cognitive deficit.