Prognostic effect of initial magnetic resonance imaging findings in patients with optic neuritis as the first attack

Öz

Objectives: Multiple sclerosis (MS) is an autoimmune-mediated disorder of central nervous system characterized by inflammatory, demyelinating and axonal dam-age. Optic neuritis (ON) is the most frequently observed symptom of MS, appearing as an initial symptom in 20% of patients. Predicting the progression of optic neuritis is very important for planning the different and early treatments of the disease. In this study, we aimed to research the initial MRI findings in MS patients with initial symptoms of optic neuritis how much effect to get a certain MS diagnosis and elapsed time until second attack. Methods: In this study, 40 patients (30 females, 10 males) admitted to our Multiple Sclerosis Clinic at the Okmeydanı Training and Research Hospital during 2000-2015 period, with the initial attack of optic neuritis were evaluated. We observed the amount of time until the patients’ second attack and whether or not MS developed in those patients with lesion on their MRI, and among those patients with a normal MRI. Results: There was at least one lesion in the first MRI in 75% (n=30) of the patients, the first MRI was normal in 25% (n=10) of the patients. The elapsed time between the two attacks according to first MR finding; the aver-age time was 3.60±3.33 years among patients with a normal MRI. The average time was 1.27±1.16 years in patients whose MRI's exhibited signs of lesion. The average elapsed time between year of first symptom and year of diagnosis during disease was 0.37±0.57 years in cases whose first MRI's exhibited signs of lesion. In the other cases with normal MRI mean time were 3.14±3.54 years. The elapsed time between the first and second attack was statistically longer in the group with normal initial MRI (p=0.032) than patients with lesions in their initial MRI. MS developed in 82.5% (n=33) of 40 patients, on the other hand, 17.5 % (n=7) are followed as clinically isolated syndrome. Initial MRIs were normal in 5 of these 33 patients who took MS diagnosis. There was a statistically significant relationship between MS diagnosis and presence of lesions in the initial MRI (p=0.006). Conclusion: The elapsed time between first and second attacks and progress time of illness in patients whose MRI's exhibited signs of lesion are shorter than patients with normal MRI.

Anahtar Kelimeler

• Multiple sclerosis
• optic neuritis
• magnetic resonance imaging
• second attack

Optik nörit olgularının ilk ataktaki manyetik rezonans görüntüleme bulgularının hastalık prognozuna etkisi

Öz

Amaç: Multipl skleroz (MS), inflamasyon, demiyeli-nizasyon ve akson hasarı ile karakterize otoimmün bir santral sinir sistemi hastalığıdır. Optik nörit (ON), MS'nin en sık göz bulgusudur ve hastaların yaklaşık olarak %20'sinde başlangıç belirtisi olarak görülür. Optik nöritin MS’ye dönüşümünü öngörmek farklı ve erken tedavilerin değerlendirilmesinde rol oynayabilir. Bu çalışmada ilk atağı optik nörit hasta-larının MS’ye dönüşümü ile ilk manyetik rezonans görüntüleme (MRG) bulgularının korelasyonu, ikinci atağa kadar geçen süreye ve kesin MS tanısı almaya olan etkisini araştırmak amaçlanmıştır. Yöntem: Bu çalışmada 2000-2015 yılları arasında Okmeydanı Eğitim ve Araştırma Hastanesi Multipl Skleroz Polikliniği’ne ON başlangıç semptomu ile başvuran düzenli takip edilen 30’u kadın, 10’u erkek toplam 40 hasta değerlendirmeye alınmıştır. İlk atak sırasında çekilen başlangıç MRG’lerinde demiyelini-zan lezyon olan hastalarla ilk atak MRG’leri normal olanlarda MS gelişip gelişmediği, 2. atağa kadar geçen süreleri gözden geçirilmiştir. Bulgular: Hastaların %75’inin (n=30) ilk MRG‘lerinde demiyelinizan lezyon veya lezyonlar mevcut iken %25’inin (n=10) MRG’leri normaldi. İlk MRG bulgularına göre iki atak arası geçen süre ilk MRG’si normal olanlarda ortalama 3.6±3.33 yıl iken ilk MRG’de lezyon olanlarda ortalama 1.27±1.16 yıldı. Hastalık süresince ilk semptom yılı ile tanı yılı arasında ortalama geçen süre ilk atakta MRG bulgusu olanlarda ortalama 0.37±0.57 yıl, ilk MRG normal olan olgularda 3.14±3.54 yıl idi. İlk kraniyal MRG’si normal olan olgularda iki atak arası geçen süre, ilk MRG’sinde lezyon saptananlara göre anlamlı düzey-de uzun bulunmuştur (p=0.032). 40 hastanın %82.5’inde (n=33) MS gelişmişken, %17.5’inde (n=7) MS gelişmediği, klinik izole sendrom olarak takip edildiği tespit edildi. MS tanısı alan 33 hasta-nın 5’inde ilk MRG’sinin normal olduğu saptanmış-tır. İlk MRG’sinde demiyelinizan lezyon saptanması ile MS gelişme durumu açısından istatistiksel olarak anlamlı ilişki bulunmuştur (p=0.006). Sonuç: Bu çalışmada ilk atak sırasında çekilen baş-langıç MRG’sinde demiyelinizan lezyon veya lez-yonlar saptanan hastaların iki atak arası geçen süre ve hastalık gelişim süresi ilk MRG’si normal olan hasta-ların bulguları ile kıyaslandığında bu süreler anlamlı olarak kısa bulunmuştur.

Anahtar Kelimeler

• Multipl skleroz
• optik nörit
• manyetik rezonans görüntüleme
• ikinci atak

Kaynakça

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