Serial visual evoked potentials in 90 untreated patients with acute optic neuritis

To establish the value of visual evoked potentials (VEPs) for monitoring disease evolution, we undertook a population-based study of 90 untreated patients 12 to 57 years of age (median, 32 years) at the onset of optic neuritis (ON) and after 2, 4, 12, and 52 weeks. Optic neuritis was monosymptomatic (AMON) in 58 patients and part of the clinically definite multiple sclerosis (CDMS) in 32 patients. The VEP was abnormal in eyes with acute ON in 69 (77%) of 90 patients at onset and in 80 (89%) of 90 patients at one or more of the follow-up sessions. In eyes with acute ON, normalization of an initially abnormal VEP was observed during 1-year follow-up in 13 (19%) of 69 patients. At onset of ON, VEP was abnormal in 35% of the clinically unaffected eyes. By parametric analysis of variance, the latencies (P = 0.0058), the amplitudes (P = 0.0298), and the combined VEP scores (P = 0.0345) in the eyes with acute ON were significantly associated with the time after onset. The latencies were influenced by the presence of CDMS (P = 0.0033), whereas the amplitudes were influenced by visual acuity (P = 0.0000). When visual acuity was included in a multifactor model, the time after onset was, however, not significantly associated with the amplitude (P = 0.8826). The mean latency of the VEPs in eyes with acute ON was significantly shorter in AMON than in ON as part of CDMS. This study provides evidence that VEP abnormality is often transitory, and that VEP often normalizes during follow-up. The diagnostic yield is increased by repeating VEP in the spontaneous course of acute ON. Visual evoked potential is a sensitive tool for revealing subclinical lesions.