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Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients
Published on: April 14, 2014
The Presence of MRZ Reactions Improves the Prediction of Multiple Sclerosis in Children with Optic Neuritis
Franziska Kauth1, Sophie Chen1, Eva-Maria Wendel2
1Department of Pediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, D-45711 Datteln, Germany.
Abstract:
Background/Purpose: Optic neuritis (ON) is a rare disease that may remain a single episode or transform into MS. OCBs and spinal MRI lesions have already been identified as prognostic factors. Aim: Our aim was to evaluate if the presence of more than one elevated antibody index of measles, rubella, and/or varicella-zoster (MRZ) is an indicator of risk of conversion. Methods: In total, 228 patients diagnosed with ON between 1990 and 2013 were included in this retrospective study. All children had a data set consisting of age, sex, ON type, MRI, and detailed CSF studies, including the presence of OCBs and MRZ reactions and a follow-up of at least 1.5 years. Children were then divided into two groups: those who developed MS according to the McDonald criteria 2010 (n = 92) and those who did not (n = 136). Binary logistic regression analysis was used to assess the relationship between the different prognostic factors and conversion to MS. Positive (PPV) and negative predictive values were calculated. Results: Binary logistic regression analysis revealed that an MS-like MRI (p < 0.001), positive OCBs (p = 0.002), and a positive MRZ reaction (p < 0.001) were significant prognostic factors for conversion to MS after ON. Calculated PPVs showed a positive MRZ reaction alone to already be a good predictor (PPV 0.90 (95%CI: 0.82 to 0.95), p < 0.001). The best prediction was possible with a combination of cMRI, the presence of OCBs, and a positive MRZ reaction (PPV 1.00 (0.93 to 1.00), p < 0.001). Conclusions: Our findings show that a positive MRZ reaction alone already has a high predictive value for future conversion to MS and should be included in the workup of a child with an initial demyelinating event.
Insights
A positive measles, rubella, and/or varicella-zoster (MRZ) reaction in cerebrospinal fluid predicts conversion from optic neuritis to multiple sclerosis (MS). This MRZ reaction, along with MRI and OCBs, aids in early MS risk assessment in children.
Area of Science:
- Neurology
- Immunology
- Ophthalmology
Background:
- Optic neuritis (ON) is a rare neurological condition.
- ON can be a single episode or progress to multiple sclerosis (MS).
- Oligoclonal bands (OCBs) and spinal MRI lesions are known prognostic factors for MS conversion.
Purpose of the Study:
- To determine if elevated antibody indices for measles, rubella, and/or varicella-zoster (MRZ) predict conversion from ON to MS.
- To evaluate the predictive value of MRZ reactions, alone and in combination with other factors, for MS development.
Main Methods:
- Retrospective study of 228 children diagnosed with ON between 1990 and 2013.
- Data collected included age, sex, ON type, MRI, cerebrospinal fluid (CSF) studies (OCBs, MRZ reactions), and follow-up of at least 1.5 years.
- Binary logistic regression and predictive values were used to analyze prognostic factors for MS conversion.
Main Results:
- MS-like MRI, positive OCBs, and positive MRZ reactions were significant predictors of MS conversion after ON.
- A positive MRZ reaction alone demonstrated a high predictive value (PPV 0.90) for MS conversion.
- The combination of cMRI, OCBs, and a positive MRZ reaction achieved the highest predictive value (PPV 1.00).
Conclusions:
- A positive MRZ reaction is a strong independent predictor of future MS development following ON.
- The MRZ reaction should be incorporated into the diagnostic workup for children presenting with initial demyelinating events.
- Early identification of MS risk can potentially guide timely therapeutic interventions.
