Purchase this article with an account.
Renata P. Ramos, Danilo B. Fernandes, Samira Apostolos-Pereira, Dagoberto Callegaro, Mario Luiz R. Monteiro; Clinical Characteristics Of Visual Loss In Patients With Neuromyelitis Optica. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3878.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Review the ophthalmological characteristics and demographic findings in patients with both monophasic and relapsing neuromyelitis optica.
The study was conducted at the University of Sao Paulo. The diagnosis of NMO was based on the Wingerchuck et al’s revised diagnostic criteria in 2006. All patients were prospectively submitted to an complete ophthalmic evaluation, and findings from the neurological examination, imaging studies and laboratory investigation were reviewed. Data from each optic neuritis (ON) event were collected. Standard automated perimetry was also performed. To assess visual loss we used an ordinal scale described by Wingerchuck et al.
We identified 54 patients diagnosed with NMO, 21 through medical records and 33 directly evaluated by our clinic. 89% of the patients were female. 17% were white, 24% were blacks, 2% asiatic and 57% were mixed races. The mean age of onset was 31.96(±10.62) years. The mean age of the first optic neuritis and the first myelitis episode were 32.86(±11.28) and 32.75(±10.56) years, respectively. Of the 54 patients, 25 were tested for the anti-NMO, being 12 (48%) positive. 36 patients had the relapsing clinical course and 18 the monophasic one. The Wingerchuck et al scale score was more severe in the relapsing group (6.53±4.07) than the monophasic group (3.18±2.28). When it is isolated in the relapsing group that individuals with only one ON crisis, they do not differ from the monophasic group, (3,72±2.57) and (3.18±2.28), respectively.
Our results are in accordance with literature about female predominance, age of onset, race prevalence. Other results are different from previous studies, such as the prevalence of affected races and the percentage of anti-NMO patients who tested positive. We think that the distinctive nature of Brazilian population can explain those results. When compared, the visual loss in the relapsing group was more severe than in monophasic group. This fact is probably explained because the relapsing group presented more ON crisis. When we evaluated individuals who had only one episode of ON in the relapsing group, they did not differ from the monophasic group. Because of a different epidemiology, different clinical pattern of optic nerve and spinal cord involvement, distinct histological lesions from that observed is MS, we do believe that NMO is a separate entity and not merely a variant of MS.
This PDF is available to Subscribers Only