Related Experiment Video
Updated: Jul 3, 2026
Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients
Published on: April 14, 2014
Antinuclear antibody and delayed immunotherapy predict disease evolution in isolated optic neuritis-onset NMOSD: A
Liang Sun1, Can Chen1, Yunqing Wu1
1Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 2, Xihuan South Road, Beijing Economic-Technological Development Area, Beijing, 100176, China.
Background:
The disease course of neuromyelitis optica spectrum disorder (NMOSD) presenting with isolated optic neuritis (ON) is heterogeneous. Predictive factors for progression to other core phenotypes or bilateral ON (BON) remain poorly defined.
Objective:
To delineate disease evolution patterns and identify risk factors for phenotypic conversion and BON in a long-term cohort of ON-onset NMOSD, with a specific focus on the impact of antinuclear antibody (ANA) and the timing of immunosuppressive therapy (IMT).
Methods:
This single-center retrospective cohort study enrolled 231 AQP4-IgG-seropositive NMOSD patients with isolated ON onset (2010-2022). All had ≥3 years of follow-up (median 7 years). Disease evolution was categorized as: sustained isolated ON, conversion to other core phenotypes (e.g., myelitis), or progression from unilateral to BON. Multivariable Cox regression and logistic models were used to assess predictors, including ANA status and IMT initiation timing (Early: ≤3 months; Delayed: >3 months after first attack).
Results:
During follow-up, 35.1% (81/231) experienced phenotypic conversion, and 68.4% (130/190 of unilateral-onset cases) progressed to BON. Multivariable analyses identified ANA seropositivity (HR = 1.65, 95% CI 1.10-2.49, p=0.016) and delayed IMT initiation (HR = 2.76, 95% CI 1.12-6.77, p=0.027) as independent predictors of phenotypic conversion. For BON conversion, delayed IMT was the strongest independent risk factor (HR 3.23, 95% CI 1.49-7.00, p=0.003). Notably, among patients not receiving maintenance IMT (71/231), a subgroup (42/71, 59.2%) maintained minimal disability (EDSS ≤3), often in the setting of comorbidities contraindicating treatment; although this proportion declined substantially with very long-term follow-up.
Conclusion:
In AQP4-IgG-positive NMOSD presenting with isolated ON, ANA seropositivity and delayed IMT are independent predictors of disease evolution toward more severe phenotypes, whereas longer follow-up duration itself confers a modest protective effect. These findings highlight a critical early therapeutic window for IMT and support risk-stratified, individualized management in this clinically diverse population.
